title: Syringe disposal among people who inject drugs in Los Angeles: the role of sterile syringe source.
abstract: BACKGROUND
  Few recent studies have investigated the prevalence of improperly discarded syringes in community settings by people who inject drugs (PWID). We examined whether syringe source was associated with the act of improper syringe disposal and amount of syringes improperly disposed of among PWID in Los Angeles, California.
  
  
  METHODS
  A cross-sectional sample of PWID (N=412) was recruited and administered a structured questionnaire between July 2011 and April 2013. Descriptive analyses investigated syringe access and disposal practices among participants. Multivariate logistic regression analysis identified adjusted associations between syringe source (syringe exchange program [SEP] or pharmacy) and improper syringe disposal.
  
  
  RESULTS
  Most participants were male (69%), homeless (62%) and low-income earners (64%). The majority (87%) of the sample received syringes from a SEP in the past six months, with 26% having received syringes from pharmacies and 36% from unauthorised sources (e.g., friend, drug dealer). Of more than 30,000 used syringes reportedly disposed of by participants during the past 30 days, 17% were disposed of improperly. Two percent of participants disposed of any used syringes at pharmacies, compared to 68% who used SEPs for syringe disposal. Having received sterile syringes from a SEP was independently associated with lower odds of improper syringe disposal; however, purchasing sterile syringes from pharmacies was associated with significantly higher odds of improper syringe disposal.
  
  
  CONCLUSIONS
  In a city with both SEPs and pharmacies as syringe source and disposal options for PWID, these findings suggest that while pharmacies are selling syringes, they are not as readily involved in safe syringe disposal. Given limits on SEP availability and the large geographic size of Los Angeles County, augmenting current SEP services and providing other community disposal sites, including pharmacy disposal, processes could reduce improper syringe disposal among PWID in Los Angeles.
authors.affiliation: Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia. Electronic address: brendanq@burnet.edu.au.
authors.forename: Brendan
authors.initials: B
authors.lastname: Quinn
authors.affiliation: Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California, 2001 North Soto Street, MC 9239, Los Angeles, CA 90033, United States.
authors.forename: Daniel
authors.initials: D
authors.lastname: Chu
authors.affiliation: Urban Health Program, RTI International, 351 California Street (Suite 500), San Francisco, CA 94104, United States.
authors.forename: Lynn
authors.initials: L
authors.lastname: Wenger
authors.affiliation: Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California, 2001 North Soto Street, MC 9239, Los Angeles, CA 90033, United States.
authors.forename: Ricky N
authors.initials: RN
authors.lastname: Bluthenthal
authors.affiliation: Urban Health Program, RTI International, 351 California Street (Suite 500), San Francisco, CA 94104, United States.
authors.forename: Alex H
authors.initials: AH
authors.lastname: Kral
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002140:California; D003430:Cross-Sectional Studies; D005260:Female; D006703:Ill-Housed Persons; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D018671:Needle-Exchange Programs / Q000706:statistics & numerical data*; D010593:Pharmaceutical Services / Q000706:statistics & numerical data; D012037:Refuse Disposal / Q000706:statistics & numerical data*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D013594:Syringes / Q000706:statistics & numerical data* / Q000600:supply & distribution; D055815:Young Adult
keywords: Pharmacy; Syringe access; Syringe exchange programs