Citizens who inject drugs: the ‘Fitpack’ study

Abstract

Most injecting drug users have never been in drug treatment yet much research is done on samples with high treatment rates drawn from agency and peer recruited populations. This study accessed drug injectors with little or no prior drug treatment, described their characteristics, BBVI risk behaviours and feedback on services. Its results challenge some stereotypes about citizens who inject drugs. A sample of 511 'hidden' drug injectors, of whom only 28.7% had any specialist drug treatment agency contact, completed a questionnaire which was distributed with 'Fitpack' needle packs sold through community pharmacies in WA. The mean age of respondents was 26.2 years, 43.4% were women, 44.3% were living with their sexual partner, 41.7% were parents, and 46.4% were employed, mostly in full time work. In the previous month 61.2% had injected less frequently than daily. The study accessed a diverse group of drug injectors not typically seen in agency and peer recruited research. They provided useful feedback about how harm reduction strategies among injectors can be improved. However, they also reported higher rates of injecting and sharing than previously found in traditionally recruited samples of injectors which suggests there is no room for complacency regarding the potential for BBVI transmission in this group.

Comparison of needle and syringe programme attendees and non-attendees from a high drug-using area in Sydney, New South Wales

“…In this situation, the potential risk of being infected with hepatitis C and/or hepatitis B is high among this group. Lenton and colleagues [22] also reported that pharmacy attendees in West Australia were more likely to re-use needles after someone else than IDU recruited from NSP. Strategies to improve clean injecting equipment access among non-NSP attendees are encouraged.…”

Needle and syringe provision and disposal in an Australian regional centre

“…The major limitation of this study is that data regarding the number of needles and syringes dispensed from, and returned to, pharmacies were not obtainable. This is notable when considering the findings of Lenton et al [15] that IDUs who purchase needles from pharmacies constitute a different group of IDUs. However, NSP data and interview responses suggest that pharmacies constitute a minor source of needles within the Geelong region.…”

A framework for prevention

“…One, and by no means the only, example of this in WA was research conducted in 1995 with 511 drug injectors who purchased their needles in pharmacy. This showed that many had shared other injecting equipment such as spoons and filters and that the cost of needles and the numbers sold per pack lead to needle sharing and reuse by some injectors [11]. These findings were conveyed to both needle kit manufacturers (organizational level) and health bureaucrats (State level) responsible for prevention of blood-borne viral infections among injecting drug users.…”

“…Largely due to the early adoption of HIV prevention strategies among injecting drug users, WA is thought to have one of the lowest rates of HIV infection among drug injectors in the developed world, with only approximately 1 -2% of injectors infected [11,12]. This example ideally shows how the prevention framework presented here can help identify what prevention activities could be undertaken to identify various mechanisms of action at various community levels to help prevent blood-borne viruses among people who inject drugs.…”