A syndemic examination of injecting drug use, incarceration and multiple drug-related harms in French opioid users

• DOI: https://doi.org/10.1108/IJPH-06-2021-0056
• Published date: 22 December 2021
• Date: 22 December 2021
• Pages: 417-428
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice
• Author: Salim Mezaache,Laélia Briand-Madrid,Virginie Laporte,Daniela Rojas Castro,Patrizia Carrieri,Perrine Roux

A syndemic examination of injecting drug

use, incarceration and multiple drug-

related harms in French opioid users

Salim Mezaache, Laélia Briand-Madrid, Virginie Laporte, Daniela Rojas Castro,

Patrizia Carrieri and Perrine Roux

Abstract

Purpose –People who inject drugs(PWID) face multiple health problems, includinginfectious diseases

and drug overdoses. Applyingsyndemic and risk environment frameworks,this paper aims to examine

the co-occurrence and clustering of drug-related harms and their association with incarceration

experiencewith or without in-prison drug injection.

Design/methodology/approach –The authors used data from a cross-sectional survey conducted in

2015 among 557 activeopioid injectors. Self-reported datawere collected through face-to-face oronline

questionnaires. They distinguished three harm categories, namely, viral infections, bacterial infections

and overdoses, and built an index variable by summing the number of harm categories experienced,

yielding a score from 0 to 3. Associationbetween incarceration experience and co-occurrenceof harms

was modelledusing a multinomial logistic regression.

Findings –Of the 557 participants,30% reported lifetime experience of drug-relatedviral infection, 46%

bacterial infection and22% drug overdose. Multinomial logistic models showedthat those who injected

drugs during incarceration were more likely to report two (aOR = 2.35, 95% CI: 1.03–5.36) and three

(aOR = 9.72, 95% CI: 3.23–29.22) harm categories than those who had never beenincarcerated. They

were also more likelyto report three harm categories than formerlyincarcerated respondents who did not

inject drugsin prison (aOR = 5.14, 95% CI: 1.71–15.48).

Originality/value –This study provides insights of the syndemic nature of drug-related harms and

highlights that drug injectionduring incarceration is associated with co-occurring harms. Public health

interventionsand policy changes are needed to limitthe deleterious impact of prison on PWID.

Keywords HIV, Prison, Injection drug use, HCV, Bacterial infections, Syndemic, Overdoses

Paper type Research paper

Introduction

Drug-related harms account for a significant proportion of the disease burden in people

who inject drugs (PWID) and represent a global health and societal concern (Degenhardt

et al., 2017). Despite large prevention, screening and treatment efforts, blood-borne viral

infections –including HIV and hepatitis C virus (HCV) –still reach epidemic levels among

PWID. Globally, it is estimated that one in six PWID lives with HIV and one in two has been

exposed to HCV (Degenhardt et al., 2017). PWID also frequently experience bacterial

infections, the most common being abscesses and other skin and soft tissue infections

occurring at injection sites (lifetime prevalence up to 69%) (Larney et al.,2017). These

represent the primary cause of hospital admissions in this population and can lead to more

serious infections such as endocarditisor osteomyelitis through the haematogenous spread

of pathogens (Gordon and Lowy, 2005;Lewer et al.,2017). Furthermore, recent reports

show that the incidence of these life-threatening infections is increasing in areas with high

(Informationabout the

authorscan be found at the

end of this article.)

Received 22 June 2021

Revised 7 November 2021

15 November 2021

Accepted 16 November 2021

The authors thank all members

of the PrebupIV Study Group

and all the stakeholders

involved, especially participating

centers, their staff and, in

particular, the study participants.

They also thank Jude Sweeney

forthe English revisionand

editing of the manuscript. This

study received external funding

from the Inter-ministerial Mission

for Combating Drugs and

Addictive Behaviors (MILDECA).

Thefunderhadnoroleinstudy

design, analysis, preparation of

manuscript and decision to

publish.

DOI 10.1108/IJPH-06-2021-0056 VOL. 18 NO. 4 2022, pp. 417-428, ©Emerald Publishing Limited, ISSN 1744-9200 jINTERNATIONAL JOURNAL OF PRISONER HEALTH jPAGE 417