Recommendations

Community-based Needle Exchange Programs or Syringe Service Programs: Nearly 80% of new users of injectable opioids had previously used prescription oral opioid pain medication.[118,119] Illicit use of injectable opioids is accompanied by an increased rate of human immunodeficiency virus (HIV) and hepatitis infection. Community-based needle exchange programs have been shown to be an effective risk mitigation strategy for reducing high-risk behaviors (e.g., sharing needles) and infectious disease transmission among injection drug users.[120] For those patients who develop OUD and progress to intravenous drug use, the first recommendation should be for medication assisted treatment (MAT) for OUD (see Recommendation 17). For patients who decline MAT for OUD,  clinicians should consider educating the patient regarding sterile injection techniques and community based needle exchange programs, if programs are available. The 2015 outbreak of HIV/hepatitis in rural  Indiana and subsequent successful implementation of a needle exchange program is an example of the threat to rural communities from non-prescription opioid use and the potential benefits of needle exchange programs for use as a risk mitigation strategy.[121,122]

Question: What is the ratio of new users of injectable opioids who had previously used prescription oral opioid pain medication?
Answer: 80%

Question: What is accompanied by an increased rate of the human immunodeficiency virus (HIV) and hepatitis infection?
Answer: Illicit use of injectable opioids

Question: What accompanies the illicit use of injectable opioids?
Answer: an increased rate of human immunodeficiency virus (HIV) and hepatitis infection

Question: What has been an effective risk mitigation strategy for reducing high-risk behaviors and infectious disease transmission among injection drug users?
Answer: Community-based needle exchange programs

Question: What is an example of high-risk behaviors?
Answer: sharing needles

Question: Community-based needle exchange programs have been shown to do what?
Answer: be an effective risk mitigation strategy for reducing high-risk behaviors (e.g., sharing needles) and infectious disease transmission among injection drug users

Question: For which patients the first recommendation should be for medication assisted treatment (MAT) for OUD?
Answer: patients who develop OUD and progress to intravenous drug use

Question: What is the first recommendation for patients who develop OUD and progress to intravenous drug use?
Answer: medication assisted treatment (MAT) for OUD

Question: For whom should clinicians consider educating the patient regarding sterile injection techniques and community-based needle exchange programs, if programs are available?
Answer: patients who decline MAT for OUD

Question: What should the clinicians do for patients who decline MAT for OUD?
Answer: educating the patient regarding sterile injection techniques and community based needle exchange programs, if programs are available

Question: What is an example of the threat to rural communities from non-prescription opioid use and the potential benefits of needle exchange programs for use as a risk mitigation strategy?
Answer: The 2015 outbreak of HIV/hepatitis in rural  Indiana and subsequent successful implementation of a needle exchange program

Question: The 2015 outbreak of HIV/hepatitis in rural Indiana and subsequent successful implementation of a needle exchange program is an example of what?
Answer: the threat to rural communities from non-prescription opioid use and the potential benefits of needle exchange programs for use as a risk mitigation strategy