The uptake of foil from needle and syringe provision services and its role in smoking or snorting heroin among people who inject drugs in Scotland

Karen Dunleavy; Sharon J. Hutchinson; Norah E. Palmateer; David J. Goldberg; Avril Taylor; Alison Munro; Samantha J. Shepherd; Rory N.  Gunson; Sophie Given; John Campbell; Andrew  McAuley

doi:10.1016/j.drugpo.2021.103369

The uptake of foil from needle and syringe provision services and its role in smoking or snorting heroin among people who inject drugs in Scotland

Karen Dunleavy, Sharon J. Hutchinson, Norah E. Palmateer, David J. Goldberg, Avril Taylor, Alison Munro, Samantha J. Shepherd, Rory N. Gunson, Sophie Given, John Campbell, Andrew McAuley

Health Sciences

Research output: Contribution to journal › Article › peer-review

5 Citations (Scopus)

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Abstract

Background: In the UK, legislation was implemented in 2014 allowing needle and syringe provision (NSP) services to offer foil to people who inject drugs (PWID) to encourage smoking rather than injecting. This paper aims to examine the association between foil uptake and smoking or snorting heroin among PWID. This is the first large scale national study to examine foil uptake and smoking or snorting heroin among PWID post legislative change.

Method: Data from 1453 PWID interviewed via Scotland's Needle Exchange Surveillance Initiative in 2017–2018 were analysed using multivariate logistic regression.

Results: Overall, 36% of PWID had obtained foil from NSP services in the past six months. The odds of smoking or snorting heroin were higher among those who had obtained foil (Adjusted Odds Ratio (AOR) 3.79 (95% CI 2.98–4.82) p<0.001) compared to those who had not. Smoking or snorting heroin was associated with lower odds of injecting four or more times daily (AOR 0.60 (95% CI 0.40–0.90) p = 0.012) and injecting into the groin or neck (AOR 0.57 (95% CI 0.46–0.71) p<0.001) but increased odds of having had a skin and soft tissue infection (SSTI) (AOR 1.49 (95% CI 1.17–1.89) p = 0.001) and having experienced an overdose (AOR 1.58 (95% CI 1.18–2.10) p = 0.002) both in the past year.

Conclusion: The promotion of smoking drugs via foil provision from NSP services may contribute to the package of harm reduction measures for PWID alongside the provision of injecting equipment. We found that those in receipt of foil were more likely to smoke or snort heroin, and that smoking or snorting heroin was associated with a lower likelihood of some risky injecting behaviours, namely frequent injecting and injecting into the groin or neck. But it remains uncertain if the provision of foil can lead to a reduction in health harms, such as SSTI and overdose. Future research is needed to understand PWID motivations for smoking drugs, obtaining foil from NSP services, and its uses particularly among polydrug users.

Original language	English
Article number	103369
Number of pages	7
Journal	International Journal of Drug Policy
Volume	98
Early online date	30 Jul 2021
DOIs	https://doi.org/10.1016/j.drugpo.2021.103369
Publication status	Published - Dec 2021

Keywords

Foil provision
Harm reduction
Health harms
People who inject drugs
People who smoke heroin
Polydrug use

ASJC Scopus subject areas

Medicine (miscellaneous)
Health Policy

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Author Accepted ManuscriptAccepted author manuscript, 1.1 MBLicence: CC BY-NC-ND

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Dunleavy, K., Hutchinson, S. J., Palmateer, N. E., Goldberg, D. J., Taylor, A., Munro, A., Shepherd, S. J., Gunson, R. N., Given, S., Campbell, J., & McAuley, A. (2021). The uptake of foil from needle and syringe provision services and its role in smoking or snorting heroin among people who inject drugs in Scotland. International Journal of Drug Policy, 98, Article 103369. https://doi.org/10.1016/j.drugpo.2021.103369

@article{db6df02040f04a018de77c42762bb8a3,

title = "The uptake of foil from needle and syringe provision services and its role in smoking or snorting heroin among people who inject drugs in Scotland",

abstract = "Background: In the UK, legislation was implemented in 2014 allowing needle and syringe provision (NSP) services to offer foil to people who inject drugs (PWID) to encourage smoking rather than injecting. This paper aims to examine the association between foil uptake and smoking or snorting heroin among PWID. This is the first large scale national study to examine foil uptake and smoking or snorting heroin among PWID post legislative change.Method: Data from 1453 PWID interviewed via Scotland's Needle Exchange Surveillance Initiative in 2017–2018 were analysed using multivariate logistic regression.Results: Overall, 36% of PWID had obtained foil from NSP services in the past six months. The odds of smoking or snorting heroin were higher among those who had obtained foil (Adjusted Odds Ratio (AOR) 3.79 (95% CI 2.98–4.82) p<0.001) compared to those who had not. Smoking or snorting heroin was associated with lower odds of injecting four or more times daily (AOR 0.60 (95% CI 0.40–0.90) p = 0.012) and injecting into the groin or neck (AOR 0.57 (95% CI 0.46–0.71) p<0.001) but increased odds of having had a skin and soft tissue infection (SSTI) (AOR 1.49 (95% CI 1.17–1.89) p = 0.001) and having experienced an overdose (AOR 1.58 (95% CI 1.18–2.10) p = 0.002) both in the past year.Conclusion: The promotion of smoking drugs via foil provision from NSP services may contribute to the package of harm reduction measures for PWID alongside the provision of injecting equipment. We found that those in receipt of foil were more likely to smoke or snort heroin, and that smoking or snorting heroin was associated with a lower likelihood of some risky injecting behaviours, namely frequent injecting and injecting into the groin or neck. But it remains uncertain if the provision of foil can lead to a reduction in health harms, such as SSTI and overdose. Future research is needed to understand PWID motivations for smoking drugs, obtaining foil from NSP services, and its uses particularly among polydrug users.",

keywords = "Foil provision, Harm reduction, Health harms, People who inject drugs, People who smoke heroin, Polydrug use",

author = "Karen Dunleavy and Hutchinson, {Sharon J.} and Palmateer, {Norah E.} and Goldberg, {David J.} and Avril Taylor and Alison Munro and Shepherd, {Samantha J.} and Gunson, {Rory N.} and Sophie Given and John Campbell and Andrew McAuley",

note = "Funding Information: The NESI survey was funded by Health Protection Scotland. The work for this paper did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Publisher Copyright: {\textcopyright} 2021",

year = "2021",

month = dec,

doi = "10.1016/j.drugpo.2021.103369",

language = "English",

volume = "98",

journal = "International Journal of Drug Policy",

issn = "0955-3959",

publisher = "Elsevier",

}

Dunleavy, K, Hutchinson, SJ, Palmateer, NE, Goldberg, DJ, Taylor, A, Munro, A, Shepherd, SJ, Gunson, RN, Given, S, Campbell, J & McAuley, A 2021, 'The uptake of foil from needle and syringe provision services and its role in smoking or snorting heroin among people who inject drugs in Scotland', International Journal of Drug Policy, vol. 98, 103369. https://doi.org/10.1016/j.drugpo.2021.103369

TY - JOUR

T1 - The uptake of foil from needle and syringe provision services and its role in smoking or snorting heroin among people who inject drugs in Scotland

AU - Dunleavy, Karen

AU - Hutchinson, Sharon J.

AU - Palmateer, Norah E.

AU - Goldberg, David J.

AU - Taylor, Avril

AU - Munro, Alison

AU - Shepherd, Samantha J.

AU - Gunson, Rory N.

AU - Given, Sophie

AU - Campbell, John

AU - McAuley, Andrew

N1 - Funding Information: The NESI survey was funded by Health Protection Scotland. The work for this paper did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Publisher Copyright: © 2021

PY - 2021/12

Y1 - 2021/12

N2 - Background: In the UK, legislation was implemented in 2014 allowing needle and syringe provision (NSP) services to offer foil to people who inject drugs (PWID) to encourage smoking rather than injecting. This paper aims to examine the association between foil uptake and smoking or snorting heroin among PWID. This is the first large scale national study to examine foil uptake and smoking or snorting heroin among PWID post legislative change.Method: Data from 1453 PWID interviewed via Scotland's Needle Exchange Surveillance Initiative in 2017–2018 were analysed using multivariate logistic regression.Results: Overall, 36% of PWID had obtained foil from NSP services in the past six months. The odds of smoking or snorting heroin were higher among those who had obtained foil (Adjusted Odds Ratio (AOR) 3.79 (95% CI 2.98–4.82) p<0.001) compared to those who had not. Smoking or snorting heroin was associated with lower odds of injecting four or more times daily (AOR 0.60 (95% CI 0.40–0.90) p = 0.012) and injecting into the groin or neck (AOR 0.57 (95% CI 0.46–0.71) p<0.001) but increased odds of having had a skin and soft tissue infection (SSTI) (AOR 1.49 (95% CI 1.17–1.89) p = 0.001) and having experienced an overdose (AOR 1.58 (95% CI 1.18–2.10) p = 0.002) both in the past year.Conclusion: The promotion of smoking drugs via foil provision from NSP services may contribute to the package of harm reduction measures for PWID alongside the provision of injecting equipment. We found that those in receipt of foil were more likely to smoke or snort heroin, and that smoking or snorting heroin was associated with a lower likelihood of some risky injecting behaviours, namely frequent injecting and injecting into the groin or neck. But it remains uncertain if the provision of foil can lead to a reduction in health harms, such as SSTI and overdose. Future research is needed to understand PWID motivations for smoking drugs, obtaining foil from NSP services, and its uses particularly among polydrug users.

AB - Background: In the UK, legislation was implemented in 2014 allowing needle and syringe provision (NSP) services to offer foil to people who inject drugs (PWID) to encourage smoking rather than injecting. This paper aims to examine the association between foil uptake and smoking or snorting heroin among PWID. This is the first large scale national study to examine foil uptake and smoking or snorting heroin among PWID post legislative change.Method: Data from 1453 PWID interviewed via Scotland's Needle Exchange Surveillance Initiative in 2017–2018 were analysed using multivariate logistic regression.Results: Overall, 36% of PWID had obtained foil from NSP services in the past six months. The odds of smoking or snorting heroin were higher among those who had obtained foil (Adjusted Odds Ratio (AOR) 3.79 (95% CI 2.98–4.82) p<0.001) compared to those who had not. Smoking or snorting heroin was associated with lower odds of injecting four or more times daily (AOR 0.60 (95% CI 0.40–0.90) p = 0.012) and injecting into the groin or neck (AOR 0.57 (95% CI 0.46–0.71) p<0.001) but increased odds of having had a skin and soft tissue infection (SSTI) (AOR 1.49 (95% CI 1.17–1.89) p = 0.001) and having experienced an overdose (AOR 1.58 (95% CI 1.18–2.10) p = 0.002) both in the past year.Conclusion: The promotion of smoking drugs via foil provision from NSP services may contribute to the package of harm reduction measures for PWID alongside the provision of injecting equipment. We found that those in receipt of foil were more likely to smoke or snort heroin, and that smoking or snorting heroin was associated with a lower likelihood of some risky injecting behaviours, namely frequent injecting and injecting into the groin or neck. But it remains uncertain if the provision of foil can lead to a reduction in health harms, such as SSTI and overdose. Future research is needed to understand PWID motivations for smoking drugs, obtaining foil from NSP services, and its uses particularly among polydrug users.

KW - Foil provision

KW - Harm reduction

KW - Health harms

KW - People who inject drugs

KW - People who smoke heroin

KW - Polydrug use

UR - http://www.scopus.com/inward/record.url?scp=85111548088&partnerID=8YFLogxK

U2 - 10.1016/j.drugpo.2021.103369

DO - 10.1016/j.drugpo.2021.103369

M3 - Article

C2 - 34340168

SN - 0955-3959

VL - 98

JO - International Journal of Drug Policy

JF - International Journal of Drug Policy

M1 - 103369

ER -

The uptake of foil from needle and syringe provision services and its role in smoking or snorting heroin among people who inject drugs in Scotland

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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