ArticleThe International journal on drug policy2025
Prevalence and correlates of multiple injections per injection episode among people who inject drugs in rural U.S. communities.
Article in The International journal on drug policy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Article
- Injection Drug Use and Sexual Behaviors Associated With Infection Transmission and Access to Harm Reduction for People Who Use Drugs and Sell Sex in the Rural US.Substance use : research and treatmentArticle
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25 authors.
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Abstract
backgroundMultiple injections per injection episode (MIPIE) is increasingly common among people who inject drugs (PWID). While MIPIE may lower overdose risk, it could elevate infectious disease risk. This study examined the prevalence of MIPIE among rural PWID in the United States and its associations with injection behaviors associated with disease transmission (e.g., syringe mediated drug sharing, receptive supply sharing) and health outcomes (e.g., hepatitis C virus (HCV) status, naloxone possession, and overdose).
methodsThe Rural Opioid Initiative includes eight research cohorts of rural people who use drugs from across the U.S., recruited from 01/2018 to 03/2020. MIPIE was dichotomized as any vs. none using the question: "How many times in the past 30 days did you inject more than one time in one sitting?" We employed a fixed effects meta-analytic approach to examine cross-sectional associations through adjusted regression analyses.
resultsAmong 2441 PWID, most reported MIPIE (71% [n=1729]). In adjusted analyses, MIPIE was associated with a higher prevalence of past 30-day receptive syringe sharing (Prevalence Ratio (PR)=2.02; 95% confidence interval (CI)=1.74-2.34), syringe-mediated drug sharing (PR=1.92; 95%CI=1.69-2.18), receptive supply sharing (PR=1.99; 95%CI=1.75-2.26), distributive supply sharing (PR=2.30; 95%CI=1.99-2.65), HCV (PR=1.26; 95%CI=1.11-1.44), naloxone possession (PR=1.32; 95%CI=1.17-1.50), overdose ever (PR=1.42; 95%CI=1.25-1.57), and overdose in the prior 90 days (PR=2.09; 95%CI=1.52-2.87).
conclusionsMIPIE is a common practice among rural PWID and is associated with injection behaviors associated with disease transmission, HCV, and overdose. Intervention studies should develop harm reduction strategies that address both overdose prevention and infectious disease mitigation related to MIPIE.
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