Needle acquisition source and receptive needle sharing among U.S. adults with a history of injection drug use

Background Receptive needle sharing increases the risk of bloodborne infections among people who inject drugs. Contemporary national evidence on its relationship with needle acquisition source remains limited.Methods We analyzed pooled 2021–2024 National Survey on Drug Use and Health (NSDUH) data from 3,749 U.S. adults with a history of injection drug use. Needle acquisition source was categorized as pharmacy, needle exchange, street/shooting gallery, interpersonal/dealer, or other. Survey-weighted logistic regression estimated adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for receptive needle sharing.Results Overall, 678 participants reported receptive needle sharing, with a weighted prevalence of 20.3% (95% CI, 18.0%–22.7%). Compared with pharmacy acquisition, adjusted odds were higher for street/shooting-gallery (AOR, 4.87; 95% CI, 2.71–8.75), interpersonal/dealer (AOR, 4.98; 95% CI, 3.48–7.13), and other sources (AOR, 2.66; 95% CI, 1.28–5.55). Needle-exchange acquisition was not significantly associated with receptive sharing (AOR, 1.54; 95% CI, 0.75–3.15).Conclusions Informal needle acquisition was strongly associated with receptive sharing, supporting efforts to improve reliable, low-barrier access to sterile injection equipment.