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. 2019 Apr 2;16(1):23.
doi: 10.1186/s12954-019-0295-5.

Barriers to using new needles encountered by rural Appalachian people who inject drugs: implications for needle exchange

Stephen M Davis  1   2 , Alfgeir L Kristjansson  3 , Danielle Davidov  4   3 , Keith Zullig  3 , Adam Baus  3 , Melanie Fisher  5
Affiliations

Barriers to using new needles encountered by rural Appalachian people who inject drugs: implications for needle exchange

Stephen M Davis et al. Harm Reduct J. .

Abstract

Background: Using a new needle for every injection can reduce the spread of infectious disease among people who inject drugs (PWID). No previous study has examined new needle use barriers among PWIDs residing in the rural Appalachian part of the United States, an area currently in the midst of a heroin epidemic.

Objective: Therefore, our primary aim was to explore self-reported barriers to using a new needle by PWID attending a needle exchange program (NEP).

Methods: We conducted a cross-sectional survey of PWID attending two NEPs in rural West Virginia located in the heart of Central Appalachia. A convenience sample of PWID (n = 100) completed the Barriers to Using New Needles Questionnaire.

Results: The median number of barriers reported was 5 (range 0-19). Fear of arrest by police (72% of PWID "agreed" or "strongly agreed") and difficulty with purchasing needles from a pharmacy (64% "agreed" or "strongly agreed") were the most frequently cited barriers.

Conclusions/importance: Congruent with previous findings from urban locations, in rural West Virginia, the ability of PWID to use a new needle obtained from a needle exchange for every injection may be compromised by fear of arrest. In addition, pharmacy sales of new needles to PWID may be blunted by an absence of explicit laws mandating nonprescription sales. Future studies should explore interventions that align the public health goals of NEPs with the occupational safety of law enforcement and health outreach goals of pharmacists.

Keywords: Barriers to using new needles; Hepatitis C virus; Needle exchange programs; Paraphernalia laws; People who inject drugs; Policing behaviors.

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Conflict of interest statement

Ethics approval and consent to participate

The West Virginia University Institutional Review Board approved the protocol (IRB#1707657397) and waived the requirement for written documentation of consent.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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