Glasgow Involvement Group Views from injecting drugs users in Glasgow Pathways to Treatment and Care Conference Stirling Royal Infirmary 30 th September 2004

Study Background  Catchment Group  Existing Users of Needle Exchanges  Previous Users of Needle Exchanges  IDUs who have never used Needles Exchanges  Methods  Structured Outreach Interviews  Self Completion Survey  Focus Groups

Sample Profile  Sample size was N= 76  76% were male  Average age was 33  Majority (52%) didn’t have own accommodation  The main sources of income in the preceding six months were  Unemployed with regular income from Government (81%)  Illegal Activities (47%)

Current Drug Use  All using heroin  The next most commonly illicitly obtained drugs are  Valium (68%)  Cocaine (39%)  Cannabis (37%)  Crack (14%)  DFs (12%) Illicit Drug Use

Current Drug Use  47 (62%) were being prescribed substitute drugs  All prescribed methadone with 25% prescribed more than one drug.  Majority prescribed methadone was between 60 and 120 mls – range from mls Prescribed

Risk Behaviour  Only one person was not currently injecting heroin  49 [65%] of those injecting heroin originally smoked it  22 [45%] of those who initially smoked, moved to injecting within 6 months  48% were injecting at least twice a day  27 out of 30 [90%] using cocaine were injecting it  Most common reason for injecting was peer pressure (33%)  Three quarters stated that it was a “spur of the moment” when first injected  Only four (5%) said that they had ever been shown how to safely inject but 64% would access safer injecting training if available Injecting

Risk Behaviour  Needles/Syringes  70% [n=52] had shared needles/syringes  34% of these had shared in the previous 3 months  Injecting Paraphernalia  87% [n=65] had shared paraphernalia  68% of these had shared in previous 3 months Sharing

Blood Borne Viruses  Information  Types of information - leaflets, advice from a worker and a booklet  47% had been given information  Information Rating 25% good to very good 56% OK 56% OK 19% poor to very poor 19% poor to very poor  Tests:  HIV – 58%(0) tested positive  Hep B– 54%(2) tested positive  Hep C – 67%(26) tested positive

Blood Borne Viruses  Knowledge Transmission Routes  Needle risk – 97% easy to catch HIV/Hep C from “dirty needles”  Injecting Paraphernalia risk — HIV - 40% [no risk, not easy, don’t know] — Hep C - 15% [no risk, not easy, don’t know]

Needle Exchange Accessibility  50% were using pharmacy needle exchanges but the most common needle exchange used was GDCC (37%)  82% stated that opening hours were suitable and only 2 people saw opening hours as barrier to accessing NXs  56% of those who expressed a view believed there were sufficient places to get clean equipment.

Needle Exchange Quality of Service  Information Provision  “Very Poor” was the most common response to rating the information provided by NX  Staff Attitudes  Positive response with 46% rating the staff’s attitude as good or very good  10% of responses poor or very poor.  Privacy/Confidentiality/Safety  Majority (65%) stated that there was sufficient privacy at NX  76% believe that the information provided is treated in confidence  20% had concerns about their safety when attending NX

Needle Exchange  Return Policy  76% say that they always return used needed/syringes  Over half the sample [51%] stated the return policy is a good policy  Barriers to Needle Exchanges  29% stated that there were no barriers  The four most common barriers were:  Privacy (30%)  Police (20%)  Stigma (17%)  Fear of losing script (16%)

Needle Exchange  Service Improvement 5 most frequently identified items that the respondents would like to be provided with are:  Sterile Injecting Equipment (59%)  Acidifiers (41%)  Access to Community Rehabilitation (37%)  Spoons (34%)  Injectable Drugs (34%)

Training  63% would like safer injection training  50% would like first aid training  79% would like overdose training

Pharmacy NX / Addiction Service NX  Rating of service  Staff attitudes  Privacy  Safety  Rating information provision  Injecting Techniques  Physical Health needs  Sexual Health Needs  Abscesses/Wound advice  General Drug Information Addiction Service NX rated more positively on all topics bar safety

Pharmacy NX / Addiction Service NX  BBV Information  Pharmacy - 82% positively rated  Addiction Service - 78% positively rated

Prescribed V Non Prescribed  Prescribed  76% sharing needles  91% sharing paraphernalia  54% shared needles in last month  Non prescribed  59% sharing needles  79% sharing paraphernalia  29% shared needles in last month Impact on risk behaviour& injecting practises

Conclusions  Information Provision needs to be improved  Issues still around lack of knowledge re BBVs and high risk injecting practises  NXs need to play a more prominent role in reducing harm associated with drug injecting  More training needed on safer injecting /fatal overdose provision  Better screening and case management is required for those on substitute prescribing programmes  For this group of drug users, the Substitute Prescribing Programmes may not be achieving its key treatment objectives

 Full report due December