One thing that has remained unchanged for our clients in the UK is that, when using brown heroin and crack cocaine, they need an acid and water source to prepare the drug for injection. Fortunately, one thing that has changed in the last 20 years is that they now have access to sterile acidifier powders and other paraphernalia as part of the harm reduction response. But new research published in 2019 (and showcased at the NNEF Forum in December 2019) highlights why these basic elements of needle exchange cannot be overlooked.
Research and experience had showed that people who inject drugs were using a wide range of unsanitary, high-risk acidifiers before the law changes in 2003 to allow citric acid sachets (and 2005 for ascorbic acid – VitC – sachets). Things such as fizzy drinks, vinegar, lemon juice and kitchen cleaning products were being used, with predictable impacts on health!
The Harm Reduction Journal article – Injecting-related health harms and overuse of acidifiers among people who inject heroin and crack cocaine in London: a mixed-methods study – found that citric and Vit C powder sachets were the primary acid used by most people. However, the authors (Magdalena Harris, Jenny Scott, Talen Wright, Rachel Brathwaite, Daniel Ciccarone and Vivian Hope) reported that people are frequently using too much acid which can lead to venous burns and harm. A minority of respondents did still report using lemon juice and kettle descaler.
Presenting at the NNEF Forum, Dr. Harris also highlighted their research (due for publication in 2020) into water sources – especially against a backdrop where some services have stopped providing sterile water ampoules due to costs and supply-side issues. People reported using puddle water, toilet water and other dangerous sources.
Together, this highlights that needle exchanges up and down the country need to ‘go back to basics’ and ensure that they are providing the right materials and advice to people who inject drugs.