Public injecting and its association with mental health and other drug-related outcomes among people who inject drugs in Iran

Mehrdad Khezri; Fatemeh Tavakoli; Mohammad Karamouzian; Hamid Sharifi; Nima Ghalehkhani; Ghazal Mousavian; Soheil Mehmandoost; Matin Bazargani; Ali Mohammad Hosseinpour; Marzieh Mahboubi; Stefan Baral; Mostafa Shokoohi

doi:10.1016/j.jsat.2022.108868

Public injecting and its association with mental health and other drug-related outcomes among people who inject drugs in Iran

J Subst Abuse Treat. 2022 Dec:143:108868. doi: 10.1016/j.jsat.2022.108868. Epub 2022 Aug 19.

Affiliations

¹ HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
² HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran; Department of Epidemiology, School of Public Health, Brown University, Providence, RI, United States; Centre on Drug Policy Evaluation, Saint Michael's Hospital, Toronto, ON, Canada.
³ Center for HIV/STI Control and Prevention, Tehran University of Medical Sciences, Tehran, Iran.
⁴ Center for HIV/STI Control and Prevention, Mashhad University of Medical Sciences, Mashhad, Iran.
⁵ Center for Communicable Disease Control, Ministry of Health and Medical Education, Tehran, Iran.
⁶ Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States.
⁷ HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. Electronic address: shokoohi.mostafa2@gmail.com.

PMID: 36137306
DOI: 10.1016/j.jsat.2022.108868

Abstract

Background: Injecting in public places may increase the risk of drug and health-related harms among people who inject drugs (PWID). We examined the prevalence of public injecting and associations with non-fatal overdose, needle/syringe sharing, sexual health, and mental health among PWID in Iran.

Methods: Using respondent-driven sampling, we recruited 2684 PWID from 11 major cities between July 2019 and March 2020. We defined public injecting as injecting primarily in public places, such as streets, parks, or abandoned buildings. Multivariable logistic regression models assessed public injecting and its associated factors, as well as the association of public injecting with certain health outcomes.

Results: Of 2388 respondents, 69.6 % reported public injecting in the previous year. Self-identifying as men (adjusted odds ratio [aOR] = 4.21; 95 % confidence intervals [95 % CI]: 2.31, 7.65), homelessness (aOR = 6.81; 95 % CI: 5.10, 9.10), high injection frequency (aOR = 1.58; 95 % CI: 1.03, 2.44), and free needle/syringe uptake (aOR = 1.47; 95 % CI: 1.04, 2.07) were significantly associated with public injecting. Compared to PWID who primarily inject in non-public places, PWID who mostly used public places had significantly greater odds of reporting non-fatal overdose (aOR = 2.02; 95 % CI: 1.01, 4.02), needle/syringe sharing (aOR = 1.77; 95 % CI: 1.08, 2.90), unsafe sexual practices with casual sexual partners (aOR = 2.16; 95 % CI: 1.03, 4.55), suicidal ideation (aOR = 1.50; 95 % CI: 1.02, 2.21), and self-harm (aOR = 1.78; 95 % CI: 1.24, 2.54) in the last three months.

Conclusion: These results suggest the potential utility of a safer injecting environment to mitigate the multiple harms associated with public injecting in Iran. Optimizing health and well-being of PWID necessitates integrating supervised injection facilities into the current harm reduction programs and services in Iran. Future studies should also consider the experiences of additional mental health harms associated with public injecting when exploring adverse health outcomes among PWID.

Keywords: HIV risk; Iran; Mental health; Overdose; People who inject drugs; Public injecting.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
Drug Overdose* / epidemiology
Drug Users* / psychology
HIV Infections* / epidemiology
Humans
Iran / epidemiology
Male
Mental Health
Needle Sharing
Prevalence
Risk-Taking
Substance Abuse, Intravenous* / complications