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Case study: Improving safety for people who inject drugs

Researchers at the NIHR Collaboration for Leadership in Applied Health Research and Care West (CLAHRC West), in collaboration with the NIHR Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol Drugs Project and Bristol City Council, worked with people who inject drugs, and volunteers and professionals who work with them, to understand their views on detachable low dead space injecting equipment and whether they would be willing to switch to this safer equipment.

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The challenge

An estimated 1 in 6 people who inject drugs share needles and syringes with other people, increasing their risk of infection with HIV, hepatitis B virus and hepatitis C virus. These infections are usually spread when blood from one person collects in the space between the needle and the plunger - the ‘dead space’ - and the injecting equipment is shared with someone else without having been cleaned.

Low dead space injecting equipment, which can come with fixed needles or needles that can be removed, has less space between the needle and the plunger when it’s fully pushed in. Research suggests that low dead space equipment could reduce the chance of spreading infections if it’s re-used or shared.

Needle and syringe programmes supply sterile equipment to people who inject drugs. Introducing low dead space injecting equipment with detachable needles to these programmes could reduce risk of infection among people who share equipment. But this move would only be effective if people who inject drugs, needle and syringe programmes, and commissioners are willing to switch to this safer equipment.

Our research

Researchers at the NIHR Collaboration for Leadership in Applied Health Research and Care West (CLAHRC West), in collaboration with the NIHR Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol Drugs Project and Bristol City Council, worked with people who inject drugs, and volunteers and professionals who work with them, to understand their views on detachable low dead space injecting equipment and whether they would be willing to switch to this safer equipment.

The researchers found that most people who inject drugs found it difficult to change injecting equipment. If there weren’t any problems, people saw no need to change and preferred using their usual equipment.

However, they also found that people who inject drugs supported the new equipment once they understood the benefits. They valued the fact that less drug is wasted with low dead space injecting equipment and that the equipment was associated with a lower risk of transferring infections.

It’s a really helpful intervention (…) I don’t have to [just] talk about diseases and viruses and stuff, but these syringes here, you get absolutely all your drug
A needle exchange staff member

Making a difference

The research findings were used by the Bristol Drugs Project to support the introduction of detachable low dead space injecting equipment. Now all high dead space equipment with a low dead space equivalent has been replaced.

The team then received funding from the Economic and Social Research Council (ESRC) to support Deborah Hussey, an Assertive Engagement Worker from Bristol Drugs Project, to visit needle and syringe programmes to understand barriers to the uptake of detachable low dead space injecting equipment. They subsequently worked with people who inject drugs to co-design posters, a booklet and an animation to increase the adoption of this new, safer equipment in needle and syringe programmes across the UK.

The materials have been shared widely with people who inject drugs, needle and syringe programmes, commissioners and public health stakeholders and are available to all needle and syringe programmes in the country from Exchange Supplies’ website.

This project is an important step towards encouraging needle and syringe programmes and commissioners to introduce this equipment and helping service users accept it. It has great potential to reduce the harms of injecting drugs
Jo Kesten, Principal Investigator

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