Khezri Mehrdad, Kimball Sarah, McKnight Courtney, Rouhani Saba, Bunting Amanda M, Karamouzian Mohammad, Ompad Danielle C, Des Jarlais Don
Department of Epidemiology, New York University School of Global Public Health, New York, NY, United States; 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, New York University School of Global Public Health, New York, NY, United States.
Int J Drug Policy. 2025 Jun;140:104819. doi: 10.1016/j.drugpo.2025.104819. Epub 2025 Apr 27.
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.
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.
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).
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.
尽管对减少伤害措施的反对声浪日益高涨，且有必要了解注射毒品者（PWID）所面临的风险环境，但目前缺乏关于公共注射及其相关健康和毒品相关后果的定量系统评价。我们旨在总结全球范围内关于在公共场所注射的患病率及其相关危害的证据。
我们检索了MEDLINE、Embase、PsycINFO、CINAHL、Scopus、Global Health和Web of Science数据库，检索时间从各数据库建库至2024年3月21日。我们使用随机效应荟萃分析对纳入研究的数据进行汇总，以量化近期（即当前或过去一年内）公共注射与相关后果之间的关联。公共注射被定义为在公共或半公共空间进行注射，包括街道、公园和废弃建筑。使用乔安娜·布里格斯研究所的批判性评价工具评估偏倚风险。
在6144条初始记录中，有84项研究符合纳入标准。近期公共注射的合并患病率为48.85%（95%置信区间[CI] 43.87，53.85）。公共注射与近期非致命过量用药几率增加相关（优势比[OR] 2.51，95% CI 2.01，3.13）、丙型肝炎病毒（HCV）感染（OR 1.55，95% CI 1.18，2.02）、近期针头/注射器共用（OR 2.41，95% CI 1.97，2.94）、近期性工作（OR 1.75，95% CI 1.03，2.97）、近期监禁（OR 2.10，95% CI 1.78，2.47）以及近期住房不稳定/无家可归（OR 4.23，95% CI 3.17，5.65）。公共注射与艾滋病毒感染之间的关联在统计学上无显著意义（OR 1.41，95% CI 0.80，2.46）。公共注射还与使用监督注射设施的意愿较高相关（OR 2.66，95% CI 1.86，3.80）。
公共注射在注射毒品者中很普遍，并与各种不良毒品和健康相关后果相关，这凸显了增加安全注射空间可及性的必要性。研究结果支持制定干预措施以减少公共注射带来的危害，例如应对执法方面的结构性风险、扩大纳洛酮项目以及建立过量用药预防中心。特别是住房干预措施，可以作为减少公共注射及其相关危害的有效上游策略。
