Harms associated with injecting in public spaces: a global systematic review and meta-analysis

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy Pub Date : 2025-04-27 DOI:10.1016/j.drugpo.2025.104819

Mehrdad Khezri , Sarah Kimball , Courtney McKnight , Saba Rouhani , Amanda M. Bunting , Mohammad Karamouzian , Danielle C. Ompad , Don Des Jarlais

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引用次数: 0

Abstract

Background

Despite increasing backlash against harm reduction efforts and the need to understand the risk environments encountered by people who inject drugs (PWID), a quantitative systematic review on public injecting and associated health and drug-related outcomes is lacking. We aimed to summarize the global evidence on the prevalence and harms associated with injecting in public spaces.

Methods

We searched MEDLINE, Embase, PsycINFO, CINAHL, Scopus, Global Health, and Web of Science from inception to March 21, 2024. We pooled data from included studies using random-effects meta-analyses to quantify the associations between recent (i.e., current or within the last year) public injecting and associated outcomes. Public injecting was defined as injecting in public or semi-public spaces, including streets, parks, and abandoned buildings. Risk of bias was assessed using the Joanna Briggs Institute’s critical appraisal tool.

Results

Of the 6144 initial records, 84 studies were eligible for inclusion. The pooled prevalence of recent public injecting was 48.85 % (95 % confidence intervals [CI] 43.87, 53.85). Public injecting was associated with increased odds of recent non-fatal overdose (odds ratio [OR] 2.51, 95 % CI 2.01, 3.13), HCV infection (OR 1.55, 95 % CI 1.18, 2.02), recent needle/syringe sharing (OR 2.41, 95 % CI 1.97, 2.94), recent sex work (OR 1.75, 95 % CI 1.03, 2.97), recent incarceration (OR 2.10, 95 % CI 1.78, 2.47), and recent unstable housing/homelessness (OR 4.23, 95 % CI 3.17, 5.65). Public injecting showed a statistically non-significant association with HIV infection (OR 1.41, 95 % CI 0.80, 2.46). Public injecting was also associated with a higher willingness to use supervised injection facilities (OR 2.66, 95 % CI 1.86, 3.80).

Conclusion

Public injecting is prevalent among PWID and associated with various adverse drug- and health-related outcomes, highlighting the need for increased access to safe injection spaces. Findings support developing interventions to reduce harms from public injecting, such as addressing structural risks from law enforcement, expanding naloxone programs, and establishing overdose prevention centers. Housing interventions, in particular, could serve as an effective upstream strategy to reduce public injecting and related harms.

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与公共场所注射相关的危害：全球系统回顾和荟萃分析

背景：尽管对减少危害工作的反对日益强烈，并且需要了解注射吸毒者所面临的风险环境，但缺乏对公共注射以及相关健康和毒品相关结果的定量系统审查。我们的目的是总结关于公共场所注射的流行和危害的全球证据。方法检索MEDLINE， Embase, PsycINFO， CINAHL, Scopus, Global Health， Web of Science自成立至2024年3月21日。我们汇集了纳入研究的数据，使用随机效应荟萃分析来量化最近（即，当前或去年）公共注射与相关结果之间的关联。公共注射被定义为在公共或半公共空间注射，包括街道、公园和废弃的建筑物。使用乔安娜布里格斯研究所的关键评估工具评估偏见风险。结果6144项初始记录中，84项研究符合纳入条件。近期公共注射的总流行率为48.85%（95%可信区间[CI] 43.87, 53.85）。公共场所注射与近期非致命性用药过量（比值比[OR] 2.51, 95% CI 2.01, 3.13）、丙型肝炎病毒感染（比值比[OR] 1.55, 95% CI 1.18, 2.02）、近期共用针头/注射器（比值比[OR] 2.41, 95% CI 1.97, 2.94）、近期性工作（比值比[OR] 1.75, 95% CI 1.03, 2.97）、近期监禁（比值比[OR] 2.10, 95% CI 1.78, 2.47）以及近期住房不稳定/无家可归（比值比[OR] 4.23, 95% CI 3.17, 5.65）相关。公共场所注射与HIV感染的相关性无统计学意义（OR 1.41, 95% CI 0.80, 2.46）。公共注射也与使用监督注射设施的较高意愿相关（OR 2.66, 95% CI 1.86, 3.80）。结论公共注射在PWID中普遍存在，并与各种不良药物和健康相关结局相关，突出了增加安全注射空间的必要性。研究结果支持开发干预措施以减少公共注射的危害，例如解决执法部门的结构性风险，扩大纳洛酮项目，建立过量预防中心。住房干预措施尤其可以作为减少公共注射和相关危害的有效上游战略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Drug Policy SUBSTANCE ABUSE-

CiteScore

7.80

自引率

11.40%

发文量

307

审稿时长

62 days

期刊介绍： The International Journal of Drug Policy provides a forum for the dissemination of current research, reviews, debate, and critical analysis on drug use and drug policy in a global context. It seeks to publish material on the social, political, legal, and health contexts of psychoactive substance use, both licit and illicit. The journal is particularly concerned to explore the effects of drug policy and practice on drug-using behaviour and its health and social consequences. It is the policy of the journal to represent a wide range of material on drug-related matters from around the world.