Injecting drug use and needle exchange

While injecting equipment had been available from a variety of chemists across the UK prior to the introduction of Needle Exchange programmes (now called Needle Syringe Programmes or NSPs) for many years, the chances of securing regular clean needles depended on your proximity to a suitably inclined pharmacist.

Since the 1980s, exchange/syringe programmes have been set up across the country, and are now available to thousands of users, although unfortunately with widely varying access options and opening hours.

Today, NSPs are monitored by local authorities and the NHS to ensure they comply with NICE (National Institute for Health and Care Excellence) Guidelines on safe access to the resources. These state:

  • All programmes should, as a minimum:
  • encourage people who inject drugs to use the services on offer.
  • provide as many needles and syringes and other injecting equipment as someone need.
  • provide sharps bins and advice on how to dispose of equipment safely.
  • provide advice on safer injecting and ways to get help to stop using drugs or switch to non-injecting methods.

More specialist programme services should include:

  • advice and services to help them stop injecting or reduce the frequency of injecting.
  • treatment of infections and other health problems, vaccinations and housing and benefits advice (or help to access to such services).

Safer injecting
 

People inject for a variety of complex reasons, but mainly for the speed and intensity of the effect. A wide range of drugs are injected, not just the opioids and amphetamine/cocaine and a culture around injecting ketamine in particular, has developed over the last few years. The guidance is exactly the same. It is wise to remember with disassociatives that increasing your dose makes you less aware of issues such as personal safety and tolerance. It also reduces co-ordination, which can result in painful damage,often masked by the drugs immediate effects.

  • Non pharmaceuical preperations, if injected should be put in the vein (or with the needle removed ‘up the bum’). Other injecting methods such as Intra-Muscular or Sub-cutaneous (I/M or S/C) are only really appropriate for pharmaceutical preparations. Steroids should be injected intramuscularly, and the plunger depressed slowly. 
  • Needles provided to clients tend to be smaller 1mL and 2mL, with fixed needles in some cases for the former. Larger barrels are available, but services are reluctant to give them out.
  • The main injecting areas are the arm (mainline), around the crook of the elbow, and at the back of the arm following the same vein.
  • Consider the pro’s and con’s of other routes of administration. Do not be pressured into injecting.
  • Always prepare in a sterile environment.
  • Always use a new needle and syringe, clean (BP amps) water. Wipe the injection area with a swab.
  • Inject into veins, try to avid small capillaries. The pointed part of the needle tip should pierce the skin first.
  • If you need a tourniquet, loosen it before depressing the plunger. Tourniquets are placed above the injecting site.
  • Do not draw back too much blood, you risk clotting.
  • Do not flush more than once; as the drug effects hit you, that is the effect of the original plunger depression, it just happens to synchronise with flushing. It is an illusion and you are damaging your veins by putting them under repeat duress. Depress half the liquid through the needle, wait to be sure that the dose is manageable.
  • If the blood that comes out is pink-red as opposed to black-red, you are in an artery: pull out and press a clean tissue on the site until it stops bleeding. If you hit a nerve, you will know it. Again, withdraw the needle and wait before trying again. Replace with a new needle.
  • Do not let anyone else prepare for you, particularly out of your view. Make sure you see all equipment come out of sterile packaging. Do not use a common cup as a water source.
  • Be aware of your tolerance, check to see if the drug looks any different from the type you know; if you are uncertain, be cautious.