Injection Drug Users’ Utilization of Health Care in

New York City

Melicia Laroco-Molter

Harm Reduction Coalition

Harm Reduction CoalitionMission Statement

The Harm Reduction Coalition is a national advocacy and capacity-building organization that promotes the health and dignity of individuals and communities impacted by drug use. HRC advances policies and programs that help people address the adverse effects of drug use including overdose, HIV, hepatitis C, addiction, and incarceration. We recognize that the structures of social inequality impact the lives and options of affected communities differently, and work to uphold every individual's right to health and well-being, as well as in their competence to protect themselves, their loved ones, and their communities.

Principles ofHarm Reduction

Harm reduction is a set of practical strategies that reduce negative consequences of drug

use, incorporating a spectrum of strategies from safer use, to managed use to abstinence.

Harm reduction strategies meet drug users "where they're at," addressing conditions of use

along with the use itself.

1. Clean Bottle 2. Bleach3. Bandages4. Sterile Water5. Tourniquet

6. Bottle Cap/Cooker7. Cotton Balls8. Syringes9. Injection Instructions (Spanish & English)10. Alcohol Swabs

AbstractThrough the principles of harm reduction, the Harm Reduction Coalition addresses the adverse affects of drug use. To better advocate for the health care needs of injection drug users, the student intern conducted a pilot study at syringe exchange programs. The pilot study included topical literature research, the formation of a community advisory board, a focus group, the administration of two surveys, and interviews with current and former injection drug users on their health care experiences. In addition, the student intern also videoed select interviewee’s anecdotes regarding health care for advocacy purposes. The student intern completed the design of the focus group moderator guide and interview protocol, design of the surveys, facilitation of the board, conduction of the focus group and interviews, video editing, and quantitative and qualitative research using the gathered data. The results will be compiled in a report to be used by the organization for advocacy purposes.

IntroductionLearning Objective 1

Identify health care utilization and barriers among IDUs at SEPs in New York City

Activity 1a: Develop survey(s) with advisory committee that will be administered to the community.Activity 1b: Administer surveys to the community.Activity 1c: Interview stakeholders in the community regarding health care utilization and barriers.Activity 1d: Conduct focus group(s) within the community.Activity 1e: Pull main themes from conducted interviews and focus groups.

Learning Objective 2Employ quantitative techniques to analyze surveys mentioned in LO1.

Activity 1a: Perform descriptive analysis on data collected in LO1-1b.Activity 2b: Perform multivariate analysis to examine relationship between health care barriers and health care utilization among IDUs in New York City.

Health Problem and Justification• Injection drug use is

associated with 36% of HIV/AIDS cases in the US

• Among IDUs with HIV/AIDS, 50-90% are also infected with HCV

• In NYS, there are a quarter million IDUs, 35-50% with HIV/AIDS

• The NHBS conducted in 2009 noted that 16% of NYC’s IDUs are infected with HIV/AIDS

• They also noted that 51% of NYC IDUs used speedballs and 70% of NYC heroin IDUs injected daily

Injection drug use also increases the chances of overdose, collapsed veins, soft skin and bacterial infections,

endocarditis (heart infection), and septicaema (blood infection).

Intern’s RolesThe intern’s project was a

preliminary, mixed methods research project that focused

on the health care utilization of injection drug users (IDUs) that

patronize New York City’s syringe exchange programs

(SEPs).

The intern’s roles included:• A topical literature research• The formation and

facilitation of a community advisory board

• Moderating a focus group• Administration of two

surveys• Conducting interviews with

current and former IDUs on health care experiences

• Coordination with NYC SEPs

Research Methods

• Topical literature search

• Site visits at participating SEPs– Stationery programs–Mobile Units

• Formation of advisory board

• Focus group

• Survey development• SEP administration

of surveys• Conduct interviews• Video selected

interviewees’ retelling of health care experiences

Surveys

Results

• N=187• 24.1% female (N=45) 56.1% male

(N=105) 2.7% transgendered (N=5)• 80.2% (N=150) in English

19.8% Spanish (N=37) • Age range of 25 and 64 (76% or N=

142) • 75% indicated a diagnosis of

HIV/AIDS or HCV• Spanish respondents 1.6 times

more like to de diagnosed with HCV or diabetes

• Twice as like to seek care at the ER

• 18.7% experienced barriers to health care over a 12 month period

• 15% of Spanish survey respondents saw a health care professional compared to 50% of English survey respondents

• Spanish respondents fours times more likely to be unaware of places to go for services

• Overall, respondents cited lack of transportation (1.8 times) & lack of insurance (1.556 times) as a barrier health care

Physical Health Survey

Results

• N=24• 29.2% female (N=7)

54.2% male (N=13)• 95.8% (N=23) in English 4.2%

(N=1) in Spanish • Age range of 25 and 64 (87.5%

or N= 21)• 20.8% (N=5) received mental

health care in the past 12 months

• 41.7% (N=10) received care either while incarcerated or at a medical van

• 20.8% (N=5) experienced barriers to receiving mental health care

• Respondents cited provider not speaking the person’s primary language (41.7%; N=10), past poor treatment (16.7%; N=4), and the lack of transportation (16.7%; N=4) as barriers to receiving mental health care

Mental Health Survey

Results

Health & Health Care• “Emergency rooms and being treated

horribly and all kinds of stuff comes to mind. But also just keeping yourself well, having a regular doctor. I think of the positive aspects of health care in my life and what I think what is supposed to happen is usually that you have a primary care doctor and he can lead you around the rest of the phalanx to you know get the resources you need…”(Mary, Caucasian, 30s)

• “Money…to get good health care you gotta have a lot of money. You need an operation…you need a liver transplant or something like that, you know you gotta have Apple [a computer company] kind of money…I’m so low on the scale. I have no income. I’m basically homeless so that I can go into a hospital ad get relatively good health care [via Medicaid]…”(Bob, African American, 40s)

Stigma & Treatment• “…I went to a hospital here…I always had

abdominal pain…they’d give me Maalox, send me home…this time my abdominal pain was so bad I got off the table and I saw these scissors and I was trying to kill myself cause I couldn’t take the pain. So when they [the clinic personnel] saw that, they decided to take me seriously and send me to [a hospital. When I walked in there, I had a gall bladder that was getting ready to erupt along with seven gall stones – they told me the size of golf balls. Now, I’ve been going to the doctor all these years…nobody tried to figure out why is she having all this abdominal pain. Because I was using drugs. And that [the lack of appropriate health care] almost killed me… [She saw] maybe four or five [doctors]…” (Peggy, African American, 40s).

Interviews

Results

Incarceration• “some people think that

because you went to jail or because you use drugs in the past or whatever, that they are so-called ‘better than you’ but it’s not that way…” (Bill, Latino, 60s)Bill discovered that he has diabetes during a dental visit while in jail; the dentist found that he had loose teeth, a sign of gum damage due to diabetes. Since then, he lost many of his teeth and sees a doctor monthly to control his diabetes.

Disclosure• Many stated the importance of disclosing

either their current or past injection drug use. They cited the complications of drug interactions, the need for appropriate pain medication, and the possibility of their drug use as the cause of a health problem as reasons.

• Those that did not disclose their drug use cited the fear of poor treatment or the lack of necessity as reasons– Bob disclosed his drug use to his

dentist in order to receive appropriate pain medication, but did not disclose to his eye doctor.

– Hamilton, a Caucasian man in his 30s, did not disclose his drug use to his allergist because he has “known him since [he] was 12 years old and he was [his] doctor when [he] was growing up.”

Interviews

Limitations• Pre-Survey Focus Group

– Though useful, more time may have yielded richer data.• Communication

– Though the intern attempted to reduce miscommunication among participating SEPs, additional project support & time could mitigate complications.

• Language Barriers– There is a particular need for those with Spanish, Russian,

Yiddish, and Chinese (Mandarin or Cantonese) language skills.

• Cultural Barriers– This is particularly true in order to better serve the Chinese

and Hasidic Jewish communities

Recommendations forFuture Research

• The transgendered portion of the IDU community– Though the intern was unable to conduct

interviews with self-identified transgendered persons, the intern noted the presence of the community at SEPs.

– Injection drug use within the transgendered community is a growing concern, especially since the injected drugs may also be non-prescribed hormones and other items which SEPs may not have prior experience.