The two studies published in Journal of Acquired Immune Deficiency Syndrome (JAIDS) were initiated in 2016 to address a public health emergency in London, Ontario when HIV rates amongst injection drug users more than doubled.
"This outbreak occurred despite London having Canada's largest per capita sterile needle and syringe distribution program, a strong opiate substitution therapy program and a multidisciplinary HIV clinic," says Dr. Michael Silverman, Lawson Associate Scientist and Chair/Chief of Infectious Diseases at the Schulich School of Medicine & Dentistry, Western University, London Health Sciences Centre and St. Joseph's Health Care London. "We knew there must be a novel method of HIV transmission at play."
August - June - Research - Team - Injection
From August 2016 to June 2017, the research team interviewed 119 injection drug users to understand their injection behaviours and risk for HIV. They discovered that those who shared equipment used to prepare drugs for injection were 22 times more likely to contract HIV than those who did not, despite not sharing needles or syringes.
The equipment includes a metal 'cooker' used to dissolve drugs in water and a filter used to draw the mixture, known as 'the wash,' into the syringe. Injection drug users reported reusing the equipment when consuming controlled-release hydromorphone, one of the most commonly injected opioids.
Controlled-release - Hydromorphone - Wash - Amounts - Drug
"Controlled-release hydromorphone is expensive and difficult to dissolve. After the first wash, large amounts of the drug remain in the equipment which is then saved, shared or sold for future use," explains Dr. Sharon Koivu, Associate Scientist at Lawson and Associate Professor at Schulich Medicine & Dentistry. "While people know not to share needles, some use their own needle multiple times allowing for contamination of the equipment."
The team took their findings back to the research laboratory. They confirmed that, on average, 45 per cent of the drug remains in the equipment after the first wash. They not...
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