Data from Canadian studies has shown that the percentages of people who inject drugs with a used needle have varied from just under 9%, up to 27%. Unfortunately, needles are far from the only item being reused or shared.
Cookers, filters, sterile water, ascorbic acid and tourniquets are among some of the other popular items that are being used on more than one occasion and/or shared amongst the sexual partners, family and friends of intravenous drug users.
While advocates of harm reduction initiatives have long cited the critical need for the distribution of clean, sterile supplies to intravenous drug users; educating and informing users regarding the dangerous practice of supply sharing, as well as its risks is crucial in order to prevent the further spread of communicable diseases and infection.
There are various different reasons as to why an intravenous drug user would choose to engage in the reuse of, or sharing of equipment. Often times it all comes down to the perceived risk, context, and the type of injection partner.
"Most inject with their regular sex partners, close friends, or family. They inject mostly in their own homes, or at friends' or relatives' places. Injection drug users know not to share needles but may interpret this to mean only not with people close to them"
Unfortunately, this is an all too common interpretation of 'the rules' regarding needle sharing.
On several different occasions when I was actively using, I found myself in the situation where someone wanted to share a needle or cooker, or otherwise engage in behaviour that could result in the contamination of supplies and the spread of disease and infection. Sharing with others was a risk I was personally never willing to take. My refusal often ended up offending whomever wanted to share, but thankfully both my Husband and myself were lucky enough to make it out of addiction hell without contracting any diseases.
Many intravenous drug users are not so lucky.
"[...] under laboratory conditions HIV can survive in blood in needles for up to 30 days or longer. [...] studies show that recovery of viable HIV is affected by factors including: volume of blood, storage temperature, and duration of storage (Abdala et al., 1999; 2000; Heimer & Abdala, 2000). At temperatures between 4 C and 22 C, HIV was recovered following storage for up to 42 days."
Even when people are using their own sterile needles, they may be sharing cookers (the small round container user to mix and cook drugs), as well as other supplies used in the process of cooking and injecting drugs intravenously.
"A cross-sectional study of 145 people who inject drugs in London, Ontario found that more participants gave cookers (45%) to someone else than used needles (36%) or other types of equipment (water 36%, filters 29%, and swabs 8%; Strike et al., 2010). Thirty-seven percent also reported that they had re-used someone's cooker. More recent data from Ontario, col- lected between 2010 and 2012 as part of the I-track Study, found that 25.6% of the 953 people who inject drugs sampled had borrowed cookers (average of data from Toronto, Kingston, Sudbury, Thunder Bay, and London, Ontario; unpublished data)."
The sharing of cookers can be just as risky when it comes to contracting diseases or infections.
"There may be greater opportunity for contaminating cookers with HIV and HcV compared to other injection-related equipment given the above evidence that people who inject drugs tend to retain and reuse cookers longer than filters or rinse water, share cookers more frequently than other equipment, and share cookers even when a sterile needle is used for injection."
The practice of retaining used cookers for future use is much more common practice amongst intravenous drug users than you might imagine.
If I'm being completely honest, retaining my own used cookers for the residue left inside was an admittedly regular practice for me when I was using intravenously. During the times that I had a plentiful supply of drugs, I would consciously try to only use a cooker once; meaning I would only mix, cook, and draw up one syringe full. Then, I would store those cookers aside, hidden away for times of need. It was a sort of 'fail safe' or 'backup plan' for those times when my supply ran out. Simply reintroduce water to the mixture, give it another go and hope for the best.
I was of course well aware that even the reuse of my own cookers came with risks, but the tremendous physical and psychological power of withdrawals was more than enough to overcome any hesitations I had. On many occasions, I have witnessed people giving away their used cookers to a dope sick friend, in an effort to help them minimize withdrawals. Intravenous drug users see value left in the used cookers residue, which could be one of the factors contributing to such high incidence of cooker reuse and sharing.
It's not just cookers. The sharing of other common intravenous drug use supplies can spread disease and infection as well. Whether it be filters, ascorbic acid, sterile water, alcohol swabs, or even tourniquets; there is a real risk of contracting diseases no matter what item you are sharing.
"Participant observation studies of people who inject drugs in Australia (crofts et al., 1999) and Scotland (taylor et al., 2004) have shown that tourniquets may be a potential source of exposure to blood-borne pathogens. For example, a person who injects drugs may use the tourniquet to stem the flow of blood after an injection. This person may then apply the tourniquet to an injecting partner's arm, depositing a smear of blood on the skin which is subsequently punctured by a needle. Passing the tourniquet over the injection site creates the opportunity for the blood of someone living with HcV or HIV to make contact with the blood of another person. Any activity that introduces new pathogens to a person's skin, especially where there is an injection site, may plausibly elevate risk of infection."
Supply sharing is not a problem unique to Canada. It occurs in the United States, United Kingdom, Austrailia, Europe, and not surprisingly; wherever intravenous drug use rears its ugly head.
"In a study involving five US cities, data from 1,438 people who inject drugs and do not practice receptive syringe sharing indicated that 54% reported non-syringe equipment sharing, a composite variable that combined responses about sharing cookers, filtration cottons, and water. Thirty-nine percent of participants who reported equipment sharing shared primarily with a sexual partner, 46% shared with an injection partner or friend, and less than 2% reported sharing with dealers or strangers."
The above statistics are rightfully sobering. The high incidence of supply sharing, and the risks associated with it can follow the user for life.
So what steps need to be taken in order to prevent the further spread of disease, and curb the risky behaviour of supply sharing?
"International evidence demonstrates that effective communicable disease prevention programming for people who use drugs can reduce transmission of HIV, HcV, HBV, and other harms related to drug use. Injection drug use is associated with many negative health and social outcomes. Harm reduction programs, like needle and syringe programs (nSPs), lead to reduced HIV incidence and prevalence, reduced needle and equipment reuse, and are cost-effective".
It is imperative to provide intravenous drug users with proper education regarding safe injection practices, and to dismiss any incorrect notions or myths surrounding the sharing of needles and supplies. Regardless of what you are sharing or whom you are sharing it with, be it with a sexual partner, family, friends, or strangers; the risk of contracting diseases or infections remains the same.
While users may often be aware of the risks associated with needle sharing, they may be unaware that the sharing of cookers or other injection related supplies is just as risky. By implementing and educating intravenous drug users on the associated risks, harm reduction programs can continue to provide a safe, judgement-free zone that allows for the access to sterile supplies, educational materials, free disease testing, treatment options, and strive to help reduce the incidence of the dangerous practice of supply sharing.
Support you local needle exchanges and harm reduction initiatives! It is through their wonderful work that drug users are able to safely use and effectively curb the risk of disease and damage to themselves, as well as their community.
Source: Best Practice Recommendations For Canadian Harm Reduction Programs: Part 1 [PDF]. (2013). Retrieved from http://www.catie.ca/sites/default/…
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