Tools for Harm Reduction:
Advantages and Barriers when
Distributing Drug Paraphernalia
Jamie Bridge
October 2009
INTRODUCTION
• Injecting drugs since pre-1900s
• NX since 70s / 80s (USA / Edinburgh / Amsterdam)
• NX currently (formally) exists in 77 countries
• UK = First pilot projects in 1987; 120 outlets by 1990
• By 1997 = ‘Over 2,000’ (27 million needles)
• Various models (fixed-site, mobile vans, outreach,
machines, pharmacies) and systems
• Do not condone / promote injecting
THIS PRESENTATION
• Overview of available paraphernalia in UK
– Needles and Syringes
– Acidifiers, Cookers, Swabs & Filters
– Sterile Water
– Tourniquets
– ‘Route Transition Interventions’ (pipes / foil)
• Discussion about benefits and barriers
• Focus on legal situation
THE LAW
Drug Trafficking Offences Act 1986 (c.32)
Inserted ‘Section 9A’ into Misuse of Drugs Act 1971
“A person who supplies or offers to supply any article
which may be used or adapted to be used (whether
by itself or in combination with another article or
other articles) in the administration by any person of
a controlled drug to himself or another, believing that
the article (or the article as adapted) is to be so used
in circumstances where the administration is
unlawful, is guilty of an offence”
NEEDLES / SYRINGES (1)
• Sterile / Single Use
• Prevent BBV Transmission
• Prevent Bacterial Infection
• Prevent Wounds
• Various Sizes / Colours
• ‘Never Share’ Range
NEEDLES / SYRINGES (2)
Key Considerations:
• Variety and Choice
– Different Drugs
– Different Clients
• Safe Disposal
– Personal Sharps Bins
– Insurance / Clinical Waste
NEEDLES / SYRINGES (3)
The Law
‘Section 9A’ contains the following exemption:
“It is not an offence under subsection (1) above to
supply or offer to supply a hypodermic syringe, or
any part of one.”
• So no legal barriers to supply
• Sharps bins ≠ ‘administration’
• Other Barriers? =
cost, insurance, disposal,
“NIMBY”
ACIDIFIERS
• Needed for ‘base’ drug to dissolve
– Brown Heroin
– Crack Cocaine
• Sterile alternative to lemon juice,
vinegar (or worse)
• Prevents Fungal Infections:
– Candidal Endophthalmitis
– Candidiasis (Thrush)
COOKERS / SPOONS
• Single-use and disposable
• Prevent burns / cuts
• Prevent sharing
– Possible HIV and HCV transmission?
SWABS & FILTERS
SWABS
• Clean injection site
– Reduce local / systemic infections
FILTERS
• Prevents small particles being injected
– Reduced vein damage and infection
– Granuloma / Blockages
ACIDIFIERS, COOKERS...
The Law
• Before 2003 – supply was technically prohibited
• Statutory Instrument 2003 No. 1653
• Allows for the supply of swabs, “utensils for the
preparation of a controlled drug”, citric acid & filters
• Statutory Instrument
2005 No. 2864
• Allows ascorbic acid
(‘VitC’) too
WATER
• Essential to the injection
process
• Sterile alternative to other
water sources
– Especially for homeless?
• Prevents Sharing
– Viral transmission?
• Prevents Infections
WATER
The Law
• Statutory Instrument 2003 No. 1653
“ampoules of water for injection, only when supplied or
offered for supply in accordance with the Medicines
Act 1968”
• But water for injections = prescription only medicine
• Statutory Instrument 2005 No. 1507
• Allows for supply of water to IDUs – up to 2mls
• Only licensed 2ml ampoule is glass
TOURNIQUETS
• Helps locate and hit a vein
• Quick release products available (self-release?)
• Sterile alternative to shoelaces, rope, belts,
bandanas, wire...
– Prevents trauma to
the skin and veins
– Quick release can
prevent vein rupture
TOURNIQUETS
The Law
• 2003 Statutory Instrument did not include tourniquets
“There was little evidence that tourniquets had any
harm reducing benefits. It was concluded that the
risks attached to their use outweighed their benefits
and that making lawful their
supply could encourage
injecting behaviour”
• Therefore, still technically
prohibited by ‘Section 9A’
PIPES AND CRACK KITS
• ‘Route Transition Intervention’
• Kits can contain glass stems, gauze,
mouthpieces...
• Promotes smoking as
alternative to injecting
• Prevents Sharing Pipes
• Prevents Cuts / Burns
• Engages New Clients
FOIL
• ‘Route Transition Intervention’
• Promotes ‘Chasing’ as alternative to injecting
• LESS risk of HIV, HCV, Overdose, Dependency
• NO risk of abscesses, vein problems, gangrene
• NO discarded needles / litter
• Engages new / more clients
(especially non-injectors)
• Can help clients manage
(or stop) their drug use
ROUTE TRANSITION
INTERVENTIONS
The Law
• Not included in any ‘Statutory Instrument’
• Smoking paraphernalia technically prohibited by
‘Section 9A’
• Campaign to ‘legalise’ foil
(NNEF, Release, IHRA...)
• ACMD ‘considering evidence’
• Decision = November?
...for now!
CONCLUSIONS
• Needle Exchange = More Than Just Needles
• Range of tools needed for drug use
• = Range of harm reduction opportunities
• = Range of paraphernalia available and distributed
• The law reflects this to an extent...
• ... but still technically prohibits valuable interventions
• Service coverage = poor (or unclear)
• Listen to clients, provide the service they need