Opioid withdrawal and its effects on HIV risk behavior: A community based study of people who inject drugs

Background:  Among people who inject opioids, the experience of physical withdrawal sometimes causes people to be less careful about needle-borne risk. In this paper we conduct an epidemiological analysis of the magnitude of withdrawal symptoms and HIV risk among people who inject drugs (PWID). 

Methods:  We conducted a community based, study of non-medical use of prescription drugs by PWID in San Francisco (2011-2014). Participants were recruited using targeted sampling and interviewed using a modified version of the Subjective Opiate Withdrawal Scale (SOWS),as well as questions regarding drug use, syringe sharing (receptive and distributive), and syringe reuse. The modified SOWS is a 17-item scale used to assess intensity of withdrawal with a score ranging from 0 – 17.  We limited this analysis to participants who injected heroin or other opiates in the past 6 months (N=539). Bivariate and multivariate statistics were used to assess the odds of needle-borne risk by the number of SOWS items endorsed.

Results:   One third of the sample reported no withdrawal symptoms, one sixth reported 1-12 symptoms, and half reported 13-17 symptoms.  We found the number of reported withdrawal symptoms was associated with significantly higher odds of syringe re-use (OR=1.033; 95% CI = 1.008-1.058; p<.008).  The number of reported withdrawal symptoms was not associated with receptive needle sharing (OR = 1.032; 95% CI = .996-1.069;p<.08) or distributive needle sharing (OR=1.039; 95% CI=.999-1.080; p<.06).

Conclusions: Interventions to promote safer injection practices among PWID should address opioid withdrawal and its effect on risk-taking.