In these unprecedented times, it is important that awareness is raised around the risks associated with sharing drug paraphernalia in relation to Blood Borne Viruses (BBV’s) and bacterial infections, including hepatitis C. Hepatitis C is a robust virus and can live outside of the body for several days, and up to three weeks in drug paraphernalia such as spoons, filters and needles. The reusing of drug paraphernalia is not recommended for this reason and the risk of infection to service users during the pandemic has been extremely high.
Due to the large queues at pharmacies service users have been reluctant to go for their needle exchange which increases the likelihood of reusing and sharing of drug paraphernalia. This presents a higher risk of service users contracting bacterial infections and BBV’s, including hepatitis C. The Public Health England report: Shooting Up: Infections among people who inject drugs in the UK, 2018, states that over half of people who inject drugs report having had a recent symptom of a bacterial infection.
“Over half of people who inject drugs report having had a recent symptom of a bacterial infection”.
Throughout the pandemic, all NHS SMPA services have endeavoured to offer needle exchange harm reduction services. In most instances, a telephone service has been set up for service users to call through with their requirements, bags are then exchanged outside the premises, whilst adhering to social distancing measures.
One of our best practice examples is being done by SMPA members Inclusion on the Isle of Wight. As part of this initiative staff are utilising a mobile outreach van to deliver needle exchange to service users. Inclusion received the van in February, just before the pandemic. The van had just started to be used before lockdown, following on from previous successes utilising a van for needle exchanges in Hampshire. Gary Hutchings is the BBV Service Manager for the Isle of Wight and explains that:
“We are now taking bespoke needle exchange orders over the phone, the packs are put together at the hub and then we deliver them out at a set time and place, wearing PPE and following social distancing measures. Also we are delivering out bigger bags so that people can outwardly distribute those to others. Previously people had been asked to stand and wait in a queue at the pharmacy for up to an hour, and a lot of people didn’t want to do that. We therefore brought a new initiative to the island and we now have a clinic van which we take out to various places twice a week to reach service users where they are. We have also been providing interventions and harm reduction information wearing PPE and following strict social distancing measures”.
“We now have a clinic van which we take out to various places twice a week to reach service users where they are and from a distance. We have also been providing interventions and harm reduction information”
As measures begin to ease and restrictions relax, Gary explains that the plan is to extend the use of the van for face-to face clinics too:
“Before lockdown, we used the van to pull up onto one service user’s driveway, we brought the service to them. Prior to lockdown we had been using the van for other things, such as if someone is suffering from domestic violence. They can come over to the van and let us know what’s going on. They can let us know that they’re not safe. So there are quite a lot of facets to it. We also started mental wellbeing clinics on the Isle of Wight. Our nurses can look at elements of physical and mental health and plug people into the relevant services with a nurse's signature on those referrals. That way we can capture people as they come into the service. We’re looking at doing that with the van going forward. Hep C testing has had to pause during lockdown, however testing has just started up again across services and it will be happening imminently here on the island.”
“We also started mental wellbeing clinics on the Isle of Wight. Our nurses can look at elements of physical and mental health and plug people into the relevant services with a nurse's signature on those referrals”
As lockdown restrictions ease, it is more important than ever that service users are aware of the risks associated with reusing drug paraphernalia and the associated risk with BBV’s as well as Covid-19 infection risks. Recently in one area in the UK one infection has been traced to 17 new people, where most denied, or weren't even aware, that they had it. At least one of those people was treated and subsequently went on to get reinfected. The spreading of the infection remains a very serious problem and examples of harm reduction initiatives such as those taking place on the Isle of White serve as a good example of how to combat the spread of infection.