Harm Reduction Less Available in Areas With Rising IDUs and HIV

Access to harm reduction programs such as syringe exchange is lowest in rural and suburban areas, where rates of addiction to heroin and other opioids are on the rise, according to a ystud led by researchers at the Icahn School of Medicine at Mount Sinai and published online in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

"Syringe service programs have been very effective in reducing HIV transmission in the U.S. and throughout the world," said Don Des Jarlais, PhD, Professor of Psychiatry and Preventive Medicine, Icahn School of Medicine at Mount Sinai and lead author of the study. "Our data show that rural and suburban SSPs face some special challenges in recruiting clients, funding, and staffing, but that these programs can provide the needed services when they are implemented. �The biggest problem is simply that we do not have enough of them in rural and suburban areas. State and local governments can save lives by extending these programs."

Over the last decade, there has been an increase in drug injection in the United States, primarily the injection of prescription opioids and heroin among persons who started opioid use with oral analgesics before transitioning to injecting. Syringe service programs (SSPs) allow people who inject drugs to exchange used needles and syringes for new, sterile needles and syringes. These programs reduce the chances that people who inject drugs will share injection equipment and thereby contract infections like HIV and hepatitis C. Many SSPs also distribute a medication called naloxone, which is proven to reverse opiate overdoses.

Researchers assessed the landscape and availability of syringe service programs across the United States, finding that 69 percent of SSPs surveyed were located in urban areas, leaving only 20 percent in rural areas and 9 percent in suburban locations. The findings indicate that harm reduction services are lacking for people in communities where they are often needed most. A recent study published in the Journal of Urban Health reports that half of all IV drug users live outside of major urban areas. The range of services offered at SSPs also varied by region. For example, only 37 percent of programs surveyed in rural areas offered naloxone, compared to 61 percent of urban programs that provided this service.

One of the most highly reported recent epidemics of new HIV infections resulting from injection drug use was in southeastern Indiana. Until Indiana Governor Mike Pence declared the HIV outbreak a public health emergency in the spring of 2015, syringe exchange programs were illegal in the state.

"Over the last 20 years, syringe service programs have proven to be very potent weapons in the fight against HIV/AIDS," said Ann Nugent, Senior Research Associate, Baron Edmond de Rothschild Chemical Dependency Institute at Mount Sinai Beth Israel and co-author of the study. "The challenge today is to extend the life-saving benefits of syringe exchange programs to all persons who need them -- regardless of where they live."

The study was sponsored by the American Foundation for AIDS Research. Additional collaborators include researchers from the North American Syringe Exchange Network and the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, a division of the CDC.

The Mount Sinai Health System is an integrated health system committed to providing distinguished care, conducting transformative research, and advancing biomedical education. Structured around seven hospital campuses and a single medical school, the Health System has an extensive ambulatory network and a range of inpatient and outpatient services -- from community-based facilities to tertiary and quaternary care.

The System includes approximately 6,100 primary and specialty care physicians; 12 joint-venture ambulatory surgery centers; more than 140 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. Physicians are affiliated with the renowned Icahn School of Medicine at Mount Sinai, which is ranked among the highest in the nation in National Institutes of Health funding per investigator.

The Mount Sinai Hospital is ranked as one of the nation's top 10 hospitals in Geriatrics, Cardiology/Heart Surgery, and Gastroenterology, and is in the top 25 in five other specialties in the 2015-2016 "Best Hospitals" issue of U.S. News & World Report. Mount Sinai's Kravis Children's Hospital also is ranked in seven out of ten pediatric specialties by U.S. News & World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 11th nationally for Ophthalmology, while Mount Sinai Beth Israel is ranked regionally.