Substance Use
Prevalence and harms associated with injecting in public spaces: a systematic review and meta-analysis Mehrdad Khezri* Mehrdad Khezri Sarah Kimball Courtney McKnight Saba Rouhani Danielle Ompad Don Des Jarlais
Background: Although it is essential to understand the current risk environments encountered by people who inject drugs to develop harm reduction services, a review that quantitatively synthesizes evidence on public injecting is lacking. We aimed to summarize evidence on the prevalence and harms associated with public injecting globally.
Methods: We searched Medline, Embase, PsycINFO, CINAHL, Scopus, Global Health, and Web of Science until March 11, 2023. We pooled data from included studies using random-effects meta-analyses. The timeframe for recent was defined as current or within the last year. The risk of bias was assessed using the Joanna Briggs Institute’s critical appraisal tool.
Results: Of 3114 records, 58 studies were included. The pooled prevalence of recent public injecting was 50.05% (95%CI 45.19-54.90, I2=99.1%, number of studies [n]=44). Public injecting was associated with recent non-fatal overdose (OR 2.22, 95%CI 1.81-2.72, I2=30.6%, n=13), needle/syringe sharing (OR 2.70, 95%CI 2.08-3.51, I2=66.4%, n=15), arrest/incarceration (OR 2.14, 95%CI 1.83-2.50, I2=47.2%, n=9), sex work (OR 2.26, 95%CI 0.97-5.28, I2=85.3%, n=5), unstable housing/homelessness (OR 4.45, 95%CI 3.32-5.96, I2=88.3%, n=15), and higher willingness to use supervised injection facilities (OR 2.66, 95%CI 1.86-3.80, I2=87.4%, n=8). We also found the association between public injecting and HIV (n=3), HCV (n=2), skin and soft tissue infections (n=4), and mental health outcomes (n=3).
Conclusions: Public injecting is prevalent and associated with experiencing a multitude of adverse outcomes, underscoring the need to increase access to safe injection spaces. Findings support developing interventions to minimize harms of public injecting, including addressing structural risks tied to encounters with law enforcement and expanding naloxone programs and overdose prevention centers. Housing interventions could serve as an effective upstream strategy to reduce public injecting and its harms.