Methamphetamine Injection-Related Risks
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I am writing in follow-up to my previous letter regarding the increasing use of methamphetamine and the dangers it poses, including increasing the risk of HIV, sexually transmitted diseases (STDs) and hepatitis. My December 2004 letter included: (a) suggested action steps that your agency/organization can take, (b) an overview of health consequences of methamphetamine use, and (c) a listing of available resources. For enhanced access, this letter is available on the New York State Department of Health (NYSDOH) web site.
The Resource Sheet that accompanied the letter offers live links to information from numerous local, state and federal sources. By visiting the Department of Health's web site, you, your staff and your clients can access a wealth of information.
Intervening against methamphetamine use is critical, as is making referrals to substance abuse treatment and counseling programs. In addition to its toll-free helpline at 1-877-8HOPENY (1-877-846-7369), the NYS Office of Alcoholism and Substance Abuse Services offers on-line access to statewide directories of treatment and prevention providers.
For methamphetamine users who cannot enter drug treatment, it is important to stress harm reduction principles to prevent HIV infection and other medical problems.
Need for a Focus on Injection-Related Risks While methamphetamine can be injested by swallowing, snorting or smoking, some users prefer injection. Unless safe injection techniques are used, practices used to inject methamphetamine carry with them increased risk for transmitting and acquiring HIV and hepatitis C.
Many methamphetamine injectors may not know how to reduce the risks associated with injection. Provision of information and referrals for services that can help methamphetamine injectors reduce risks associated with injection practices are vitally important if we are to prevent HIV and viral hepatitis infections. Ideally, individuals served by your agency/organization who may be injecting or even considering injecting methamphetamine should have access to information about safe injection techniques. We need your help to make sure that this happens.
Access to Sterile Syringes and Information about Safer Injection Techniques There are 15 New York State Department of Health-approved harm reduction/syringe exchange programs (SEPs), most of which are in New York City (see Resource Sheet: Methamphetamine Injection). Syringe exchange services are provided as part of a comprehensive harm reduction model, through which clients who will not or cannot abstain from drug use or will not or cannot enter into treatment, can learn methods to reduce the risk of HIV infection and other harm to themselves and their partners. In addition to the provision of clean injection equipment, harm reduction services include:
- distribution and demonstration of bleach kits and safer injection techniques;
- distribution and demonstration of condoms and dental dams;
- provision of information on risk reduction practices related to sexual and drug-using behaviors;
- distribution of other harm reduction supplies and literature; and
- direct provision of or referrals to HIV counseling and testing, partner notification assistance, drug treatment, health care, legal, housing and social services.
As noted above, in addition to making sterile syringes available, SEPs provide other harm reduction supplies. This is important because sharing of injection equipment other than syringes - - water, bottle caps (used to mix drugs), cotton (used to filter the mixture) - - carries with it risk of infection. SEP staff can also help advise methamphetamine injectors how to reduce risks associated with preparation of drugs for injection and sharing of drugs. The SEPs have been trained to serve as a resource for crystal methamphetamine issues.
SEPs have been found to be effective in reducing syringe sharing and other injection-related risk behaviors. Many SEPs have already taken steps to help meet the needs of methamphetamine injectors. Specific initiatives include new informational materials about health risks associated with methamphetamine use, health education/support groups specifically for methamphetamine injectors, and outreach to venues frequented by methamphetamine injectors.
In addition, up to ten sterile syringes may be purchased at any one time by persons age 18 and over without a prescription in most community pharmacies statewide. The Department's web site offers a directory of pharmacies that are registered with the Expanded Syringe Access Demonstration Program (ESAP) to sell syringes without a prescription.
There are over 2,800 ESAP providers across NYS.
Availability of Training Surrounding Drugs and the Principles of Harm Reduction AIDS Institute-funded regional training centers offer a number of trainings on substance use and harm reduction. In addition, the Harm Reduction Coalition is funded as a training "center of expertise" in harm reduction. For information about upcoming trainings visit the Department's web site.
I urge you to encourage your staff to become familiar with information about methamphetamine use and about programs and services to which individuals may be referred.
Guthrie S. Birkhead, M.D., M.P.H.
Director, AIDS Institute