People who inject drugs support the use of new, safer ‘low dead space’ syringes, NIHR-funded researchers from the University of Bristol have found. Research suggests that these low dead space syringes could reduce the chance of spreading infections among people who inject drugs, if syringes are re-used or shared, so are a safer alternative to traditional equipment. However, it was not known whether people who inject drugs would be willing to switch to this new equipment, so a team of researchers set out to find this out.
This project was a collaboration between the NIHR Collaboration for Leadership in Applied Health Research and Care West (CLAHRC West) and the NIHR Health Protection Research Unit in Evaluation of Interventions. The research team included Professor Matthew Hickman, Director of the Drug and Alcohol Health Integration Team.
Needle and syringe programmes supply sterile equipment to people who inject drugs, to reduce the likelihood of equipment being shared with others. However, sometimes needles and syringes still get re-used or shared. This increases the chance of spreading infections such as HIV and hepatitis C. The likelihood of spreading these infections is influenced by the type of equipment used to inject drugs.
A low dead space syringe limits the ‘dead’ space that exists between the syringe hub and needle which can harbour bacteria or viruses. So changing to this type of syringe and supplying them through needle and syringe programmes can help protect people who inject drugs from harm of infection.
The team reviewed what is already known about these syringes and whether people who inject drugs minded using them. They also interviewed 23 people who inject drugs, and 13 volunteers and professionals who work with them from Bristol and Bath, to explore their views on low dead space syringes, to decide whether any additional support is needed to encourage their use.
They worked with service users from Bristol Drugs Project (BDP). It can be a challenge for researchers to engage with people who inject drugs because of their addictions and often difficult circumstances. The success of this involvement hinged on the support of the Bristol Drugs Project collaborators who identified service users and helped them attend meetings. Involving service users was valuable in this project, as it offered useful insights into the findings and plans for wider introduction of the new syringes. From the service user perspective, taking part in the oversight of this project was an enjoyable and empowering experience. The research team learnt how important it is to enable service user engagement through practical support and by making an effort to explain the research terms used during the meetings.
Though initial frustration among people who inject drugs was expected about having to change familiar equipment, most people were expected to be willing to try the new syringes and to continue using them, if they worked as well as the original equipment. They found support among people who inject drugs who valued the benefits of less wasted drug and the lower risk of transferring infections.
This has implications for needle and syringe programmes, and the researchers have developed recommendations for the introduction of detachable low dead space syringes, including training staff, educating people who inject drugs and giving a few new syringes to try alongside old equipment, before eventually removing the old equipment.
The team have developed materials to support introducing detachable low dead space syringes, including a flyer for needle and syringe programmes to inform people who inject drugs about the new equipment. They are also developing a step-by-step guide for needle and syringe programmes to introduce the new syringes. Alongside the introduction of low dead space syringes, encouraging appropriate syringe rinsing methods targeting those known to re-use or share equipment may also be necessary.
These findings will be shared with the National Institute of Clinical Excellence and Care (NICE) who produce guidance for needle and syringe programmes.
Jo Kesten, Senior Research Associate at CLAHRC West and the HPRU in Evaluation of Interventions, said:
“It’s vital that changes to services involve the people those changes affect. This is especially true in the public health arena where we’re trying to prevent problems before they happen. If people who inject drugs didn’t like the new equipment but it was introduced anyway, this could lead to all sorts of issues with people avoiding getting new equipment, sharing or re-using the old and injecting in a more risky or harmful way. So we felt it was vital to make sure that the end users would be happy with these changes before they were introduced.”
Rachel Ayres, Volunteer Manager, and Jane Neale, Needle Exchange Manager for Bristol Drugs Project, said:
“People in all walks of life can be unnerved by changes which they aren’t choosing to make and for people who inject drugs a change in the type of syringe supplied could be very unwelcome. The work BDP has done with the research team has helped us to anticipate and respond to people’s worries about low dead space syringes and some people using our needle and syringe programme are now beginning to accept them. The materials developed by the research team will help us to continue to increase the number of people who switch to low dead space syringes and we believe they will also be useful to support other needle and syringe programmes to introduce low dead space syringes effectively too.”
‘Acceptability of low dead space syringes and implications for their introduction: A qualitative study in the West of England’
Joanna Kesten, Rachel Ayres, Jane Neale, Jody Clark, Peter Vickerman, Matthew Hickman and Sabi Redwood. Published in the International Journal of Drug Policy