Department of Pharmacy and Pharmacology

Evidence-based harm reduction equipment for users of illicit drugs

Research led by Dr Jenny Scott has helped improve the health of drug users via the development of safer injecting apparatus and the provision of improved advice from healthcare professionals.

Challenge

It is estimated that over 300,000 people in England alone are dependent on opiates and/or crack cocaine. Many of these are injecting drug users (IDUs), who are exposed to multiple risks, including contraction of HIV and hepatitis C. Abstinence is hard to achieve and often requires many attempts at sustaining a drug-free lifestyle. Harm reduction is an accepted approach that aims to cut the damage caused by illicit drug-taking and current legislation permits the supply of injecting paraphernalia, including acids to increase drug solubility, and filters to remove particles from injections. However, there is no requirement in law for this equipment to be tested for safety or effectiveness prior to marketing, resulting in consumer protection and moral issues around the supply of untested equipment.

Solution

Dr Jenny Scott and colleagues tackled this problem using a blend of pharmacy practice research and laboratory-based pharmaceutical science by interviewing and observing IDUs to develop reproducible methods for preparing drug injections and improving the safety of equipment. Their work has included examining the effects of different acids in the injection-preparation process, determining the concentration of drug in the final injection and studying microbes on the hands of injecting drug users and on the household products used to prepare injections. The team has also tested the performance of different filters and examined the leakage of aluminium from preparation vessels such as spoons.

Benefits and Outcome

Companies that manufacture and distribute injecting paraphernalia, including Exchange Supplies, Association Apothicom and Frontier Medical Group have benefited from the provision of scientific data that has guided product development, contributing to the uptake of new products by health professionals and injecting drug users. As a result, IDUs have access to a range of sterile, fit-for-purpose equipment that has been tested for theoretical safety despite no legal requirement to do so. As well as improving individual health, the supply of equipment has attracted IDUs into needle exchange services, which, by proxy, is thought to have contributed to the control of viruses such as HIV and hepatitis C. This research has also helped policymakers and harm-reduction agencies in a number of countries to develop their thinking and practical approaches.