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 -
