Jenny Scott, University of Bath
ISBN 978 0 7559 7085 3 (Web only publication)
ISSN 0950 2254
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CONTENTS
ACKNOWLEDGEMENTS
EXECUTIVE SUMMARY
CHAPTER ONE: INTRODUCTION
Purpose
Structure
Introduction to the study
Injecting paraphernalia used by IDUs
Health concerns relating to paraphernalia use
Hepatitis C Virus
Bacterial infections
Fungal infections
Vascular damage
The supply of paraphernalia to IDUs through needle exchange schemes
Support for the provision of paraphernalia to IDUs
The UK legal situation
Availability of paraphernalia to IDUs following the law change
The need for research to underpin the supply of paraphernalia to IDUs
Aims of this study
CHAPTER TWO: OVERVIEW OF THE LABORATORY STUDIES
Development of the standardised injection preparation process
Background and summary of method
The findings and how they informed the laboratory work
Drugs used by injection
Drug quantities
Preparation of injections
Development of the standardised injection preparation method
The Hand Washing Study
Method
Collection of the data
Analysis of data
Ethical approval
Results
What is the extent of bacterial contamination on IDUs hands?
Homeless vs. housed
What is the impact of hand cleansing before preparing injections?
Comparison between alcohol hand rub and soap and water: which is better for IDUs?
How can hand cleansing be promoted to IDUs?
Conclusion from hand cleansing study
Aluminium cooker tests
Method
The injections that were prepared and tested
The analysis technique
Results
What do the results show?
Why does this happen?
Are Stericups and other aluminium cookers safe for IDUs?
Conclusions from the aluminium cooker tests
The acid tests
Method
Osmolality measurements
pH measurement
Results
Conclusions from the acid tests
The filter tests
Method
Particle content analysis method
Analysis of used filters for retained drug
The filters that were used in the experiments
Microbiology of used filters
Results and their significance
Particle content analysis & SEM
Comparison with British Pharmacopoeial limits
Drug retained in filters
Microbiology of used filters
Conclusions from the filter tests
CHAPTER THREE: THE FIELD-BASED STUDY METHODS
Objectives
Design
The intervention being studied
Original planned intervention
Changes to the original planned intervention
The factors under investigation
Participant access to needle exchange supplies in both locations
Control of paraphernalia used
The researchers and base locations
Procedures
Ethical approval
Recruitment
Inclusion criteria
Exclusion criteria
Publicity, approach and information for potential participants
Data collection
Study method and Follow-up revisions
Original plan and post pilot modifications
Post pilot questionnaire and recruitment revisions
Confidentiality and anonymity of data collected
Data analysis
Quantitative data
Qualitative data
Researcher competence assurance
Summary of study method (diagram)
CHAPTER FOUR: THE FIELD BASED STUDY FINDINGS
The participants
Demographics and injecting history
Patterns of drug use
Injection sites and administration methods
Breaks in injecting
Who prepares the participant's injections?
Participant summary
Injection preparation equipment used
Needles and syringes
Paraphernalia
Injecting equipment summary
Injecting site complications currently experienced
Data gathered using the NESQ from all participants
Non infected complications
Skin and soft tissue infections
Swelling at injecting sites and puffy limbs
Data on injecting site complications established at the health check
Injecting site complications summary
General health measures established at the baseline health check
General health measures summary
Self reported injecting equipment sharing practices
Sharing practices that have ever been undertaken
Sharing practices that have been undertaken in the past month
Injecting equipment sharing practices summary
Self reported skin cleansing practices
Skin cleansing practices summary
Follow up health check data collected at 6 months
Findings from the qualitative data
Injection preparation and administration practices
The preparation steps used
How did people learn to prepare and inject?
Control over the injection preparation process
Administering injections
Injection preparation and administration summary
Access to injecting preparation equipment in Dundee
Views of Dundee participants on the supplied paraphernalia
Mixed views on the filters supplied in Dundee
Why did the Dundee participants still use makeshift paraphernalia?
Access to makeshift paraphernalia in Aberdeen
General comments on paraphernalia access in Aberdeen
Difficulties reported in obtaining citric acid in Aberdeen
Access to clean makeshift filters in Aberdeen
What do injectors do if they do not have access to the paraphernalia they need?
Unlikely to run out
Improvise
Borrow from and share with others
Use alternative administration routes
Access to injecting preparation equipment summary
Sharing and risk taking behaviours
Why do injectors share needles and syringes despite accessing needle exchange services?
Why do injectors reuse their own needles and syringes despite accessing needle exchange services?
Why do injectors share and reuse paraphernalia?
Perceptions on blood borne virus risks from sharing paraphernalia
Thoughts on passing on used injecting equipment
Thoughts on allowing someone else to inject you
Sharing and risk taking summary
Ideas on promoting use of appropriate paraphernalia and ways to discourage sharing
Thoughts on ways to prevent sharing of injecting equipment
Ways to promote appropriate paraphernalia use and discourage sharing summary
CHAPTER FIVE: DISCUSSION, CONCLUSIONS & RECOMMENDATIONS
Introduction to this chapter
The laboratory based work
Objectives 1 and 2
Objectives 3, 4 and 5
The hand cleansing study
The aluminium cooker tests
The acid tests
The filter tests
Objective 6
The field based study
Objective 1
Objective 2
Objective 3
Objective 4
Implications for practice and recommendations
REFERENCES
APPENDIX: Power calculation to inform field based study (extracted from protocol)
It should be noted that since this research was commissioned a new Scottish government
has been formed, which means that the report reflects commitments and strategic
objectives conceived under the previous administration. The policies, strategies,
objectives and commitments referred to in this report should not therefore be treated as
current Government policy.
The views expressed in this report are those of the researcher and
do not necessarily represent those of the Department or Scottish Ministers.