Injection initiation at 30 years of age or older among a sample of syringe services program participants in Seattle, WA

ABSTRACTBackground Injection drug use is associated with risk for HIV, hepatitis C, and overdose. Despite older age and recent initiation being associated with increased risk, most research of injection initiation has focused on youth.Methods Survey data collected in 2019 at a syringe services program (SSP) in Seattle, WA, were used to estimate the proportion and identify correlates of injection initiation ≥30 years old (“later initiates”). We collected data on sociodemographics, past-week drugs used and routes, and concern about depression and anxiety. The analytical sample included participants who were ≥30 years old and reported lifetime injection. We performed multivariable logistic regression with variables selected a priori (age, gender, race) and those significant in bivariate analyses.Results Of 390 participants, 156 (40%) were later initiates. A higher proportion of later initiates reported past-week heroin use (73% vs 59%, p = .003) and concern about depression (75% vs 65%, p = .03). In multivariable analyses, heroin use (AOR: 2.62, 95% CI: 1.57–4.36) and concern about depression (AOR: 1.63, 95% CI: 1.00–2.64) were associated with increased odds of later initiation.Conclusions Over one-third of participants were later initiates. Providing alternative methods for heroin use (e.g., pipes) and integrating mental health care at SSPs may reduce injection initiation among older people who use drugs.KEYWORDS: Injection initiationpeople who inject drugssyringe services programheroinsubstance use AcknowledgmentsWe are grateful to the study participants for their time and sharing their experiences with us. We appreciate the contributions of the Urban Survivors Union and People’s Harm Reduction Alliance to the development and implementation of the heroin pipe program and study. We are thankful for the support of the Drug Policy Alliance to provide incentives for survey completion.Disclosure statementNo potential conflict of interest was reported by the author(s).Additional informationFundingIncentives for study participation were supported by the Drug Policy Alliance, which did not have a role in the study design, implementation, or analyses.