A new survey of people who inject illicit drugs in the state of Washington yields positive and important findings for policy makers as the world struggles to deal with the COVID-19 pandemic, said authors of the survey by the 91̽�� and Public Health-Seattle & King County.

Most people – 82% ­– who inject heroin and roughly half of methamphetamine users are interested in reducing or stopping their use and are open to a broad array of services to help them manage their substance use, according to the led by ����’s and Public Health-Seattle & King County.

The latest results of the survey, which has been conducted every two years since 2015, also show that possession of naloxone — a drug that rapidly reverses opioid overdose — has increased substantially. Researchers found that nearly 80% of respondents in King County and outside the county who use opioids possessed a naloxone kit in 2019, compared to when only 47% in King County and 24% outside the county possessed naloxone.

“These surveys provide important insights into the complex lives of people who use drugs in our state and can be used to inform our health care, public health, social service, public policy and criminal legal system responses, particularly during and after the COVID-19 pandemic,” said study co-author , principal research scientist at the institute.

During the COVID-19 crisis, syringe exchanges continue to operate across Washington state, although programs have had to substantially modify how they deliver services, including distributing prepackaged supplies, moving outdoors and providing mobile and delivery services.

Public Health-Seattle & King County is also offering screening and COVID-19 testing at the , Downtown Public Health, Monday through Friday from 1 to 4 p.m. (one of the sites participating in the survey). At other syringe-services program , providers are asking COVID-19 screening questions and providing information about testing locations and other resources, public health officials said.

“People who inject drugs, and also smoke them, are at high risk for contracting and having serious consequences of COVID-19 and already use emergency health care resources at high rates,” said Banta-Green.

Consequently, access to syringe services – which distribute clean syringes and help to reduce the risk of contracting or transmitting infectious diseases – during this crisis can help alleviate pressure for emergency medical care while also helping this at-risk population get treatment to reduce or stop their drug use.

“This report confirms that the majority of persons who inject drugs are interested in reducing or stopping their drug use and improving their health,” said Dr. Jeff Duchin, Health Officer at Public Health-Seattle & King County. “The syringe exchange provides an important entry point and ongoing resources to help connect people to treatment when they are ready.”

For instance, programs such as Public Health-Seattle & King County’s����provides access to treatment co-located with needle exchange. The program lowers barriers to treatment safely and successfully.

Another important finding in the survey, Banta-Green pointed out, is that 68% of participants who have been diagnosed with hepatitis C remain untreated and were interested in treatment for that disease, which is good news since hepatitis C with a three-month course of medication.

“We are honored to work with our syringe-services partners across Washington state to better understand how we can best serve people who use drugs,” said Banta-Green. “It’s so important to understand that people are very interested in getting help, and that syringe exchanges provide an incredible array of life-saving services. They also provide ongoing personal relationships with members of our communities who are often in personal crisis and poor health.”

The new Syringe Exchange Health Survey, on the Alcohol & Drug Abuse Institute’s website, consists of responses from 1,269 participants from most of the more than 30 fixed and mobile syringe services programs in 23 Washington counties.

Co-authors include Alison Newman, continuing education specialist, and Susan Kingston, project coordinator, 91̽��Alcohol & Drug Abuse Institute; Sara Glick, research assistant professor, 91̽��School of Medicine, Division of Allergy & Infectious Diseases; and Joe Tinsley, needle exchange coordinator, Public Health-Seattle & King County. This research was funded by the Washington State Health Care Authority, Division of Behavioral Health and Recovery.

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For more information, contact Banta-Green at calebbg@uw.edu.

Learn more about the ����’s Population Health Initiative: a 25-year, interdisciplinary effort to bring understanding and solutions to the biggest challenges facing communities.

A new article published by researchers from University of Puget Sound and 91̽�� reports that, based on analysis of public wastewater samples in at least one Western Washington population center, cannabis use both increased and substantially shifted from the illicit market since retail sales began in 2014.

Led by chemist Dan Burgard, the research team analyzed wastewater samples collected from 2013-2016 from two treatment plants that service a community of two hundred thousand��in Western Washington.

“We set out to perform a wastewater-based analysis that explored the impact of newly legalized retail cannabis sales on its use, and to determine if this approach could estimate the size of the legal market place,” says Burgard, who chairs the chemistry department at Puget Sound.

The researchers estimate that THC-COOH (the metabolite of psychoactive THC in cannabis created within the human body) found in wastewater has increased by 9% per quarter, on average, from December 2013 to December 2016. During this time, cannabis sales increased at nearly 70% per quarter, on average, for stores operating from August 2014 to December 2016.

“Given that wastewater represents a total population measure, these findings suggest that many established users switched very quickly from the illegal to the legal market,” says Burgard. “This is the strongest statement possible regarding displacement of the illegal market.”

Caleb Banta-Green, interim director and principal research scientist at 91̽��’s Alcohol and Drug Abuse Institute, is a co-author of the article and was a key researcher on the project.

“This project was designed to aid the understanding of how the sales of adult recreational cannabis impact its total consumption within a population,” says Banta-Green. “We believe this will be a valuable tool for local, state, national and international policy makers as they assess and consider Washington’s recreational cannabis law.”

In the past six years nine U.S. states (Colorado, Washington, Alaska, Oregon, Nevada, California, Maine, Massachusetts, Vermont, Michigan, and the District of Columbia), as well as the countries of Uruguay and recently Canada, have legalized the adult use of recreational cannabis.

“Existing measures, particularly surveys are subject to important biases and limitations, including potential changes in self-report as social norms change as well as very limited information on the amount of THC actually consumed,” Banta-Green notes. “Wastewater based estimates help address these limitations.”

The researchers note that their findings suggest that legalization is, in part, achieving one of its primary objectives which was to eliminate black market sales.

Funded in part by a grant from the National Institute on Drug Abuse, the research process included testing samples from 387 days spread over three years. The team utilized a new method that enables a complementary and potentially more timely and objective assessment of illicit drug consumption compared to existing measures.

Raw wastewater samples representing a full day are collected at a treatment plant and analyzed for drugs and their metabolites at extremely low concentrations (part per billion or part per trillion levels).�� These data can be used to track drug consumption trends, both legal and illegal, but not individual users. In some instances, the concentration of the metabolites can be used to “back calculate” to the actual number of doses of drug used in a particular area.

When this research project was announced in 2015 and throughout its duration it has earned national and international press from media like , , , and .

The report, titled “Using Wastewater-Based Analysis to Monitor the Effects of Legalized Retail Sales on Cannabis Consumption in Washington State, USA,” was published in , a journal published by the Society for the Study of Addiction.

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For more information, contact Banta-Green at calebbg@uw.edu.

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