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 Palmateer, David Goldberg, Avril Taylor, Alison Munro, Samantha J. Shepherd, Rory N. Gunson, Sophie Given, John Campbell, Andrew McAuley

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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 SSTI (AOR 1.49 (95% CI 1.17-1.89) p=0.001) and having experienced an overdose both in the past year (AOR 1.58 (95% CI 1.18-2.10) p=0.002).
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 languageEnglish
Article number103369
Number of pages7
JournalInternational Journal of Drug Policy
Volume98
Early online date30 Jul 2021
DOIs
Publication statusE-pub ahead of print - 30 Jul 2021

Keywords

  • people who inject drugs
  • people who smoke heroin
  • foil provision
  • harm reduction
  • health harms
  • polydrug use

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