21CHAPTER 4 CONCLUSION & RECOMMENDATIONS<strong>The</strong> main aim of this study was to assess the acceptance, effectiveness and efficiency ofthe provision of single use citric acid sachets to IDUs in Greater Glasgow and Lanarkshireand overall, the findings have been extremely positive.Firstly, the va st majo rity of pa rticipants in this study repo rte d no t only using the singleuse citric acid sachets, but also preferring them to all other available acidifiers. Moreover,a number of newer IDUs were not even aware that less safe alternative acidifiers exist,suggesting tha t the pro vision of the single use sa che ts is disco uraging IDUs fromexpe rimenting with o the r a cidifie rs. Furthe rmore , a s we ll a s re cognising the single usecitric sachets to be an effective acidifier, most of the IDUs interviewed recognised therelative safety of using them compared with using other acidifiers and indeed reportedthat they had chosen to use them because of this.Secondly, the current provision of 100mg of citric in each sachet seems to be adequate formost users’ needs. Almost all participants found that one sachet or less was sufficient todissolve the amount of heroin they usually injected. However, the reasoning behind thesachets being single use is not understood by all IDUs, with some saving the remainder oftheir sachet for their next injecting episode or sharing their sachets with their friends orpartner. Clearly, there is still some work needed to stress the importance of users notsharing any of their injecting equipment and paraphernalia.<strong>The</strong>re is also a need to further educate IDUs about the importance of using a clean needleand s yringe e ve ry time the y inje ct. As a s ignificant numbe r o f the pa rticipa nts in thisstudy expressed a preference for the needle exchanges to provide more than one sachetof citric per needle, it is evident that many continue to reuse their needles. Furthermore,some IDUs continue to use less safe acidifiers when they run out of the single use citricacid sachets. It is vital that these IDUs are encouraged to return to the needle exchangeas soon as they start to run out of clean needles and sachets. Part of this process shouldinclude continuing to educate users about the risks associated with using acidifiers such asprocessed lemon juice and vinegar.Indeed, this study has confirmed that processed lemon juice and vinegar are the acidifiersmost commonly associated with side effects such as blurred vision, severe headaches andsore eyes. Using the single use citric acid sachets, on the other hand, does not seem tolead to IDUs suffering from such afflictions. However, use of the sachets can still lead tocitric burns, and although their use does not increase the number of burns in comparisonto o the r a cidifie rs, it is impo rtant to stress tha t a s little as possible is use d to minim ise a nyrisk.In addition to offe ring IDUs a sa fe me thod of dissolving the ir drugs, the provision of singleuse citric acid sachets seems to have increased the frequency of use of the needleexchanges. This increase in visits not only means IDUs are more likely to be using cleanneedles but also that they are returning used ones, increasing the public’s safety as wellas their own.Given these findings, the following recommendations are made:• All fixed site needle exchanges and pharmacy exchanges in Greater Glasgow andLanarkshire to continue providing the 100mg single use citric acid sachets.• Ex tend this provisio n a cross the UK.• Repeal or change in the current law (Section 9A, Misuse of Drugs Act 1971) whichfo rbids the supply of drug inje cting pa ra phe rna lia (o the r tha n needle s andsyringes) to drug users. Since this research was carried out the Government has
22proposed to amend the misuse of drugs legislation (Section 9A, Misuse of DrugsAct 1971) so that certain articles of drug paraphernalia (including single use citrica cid sache ts) can be p ro vided to I DU s fo r the p u rposes o f harm m in imisation . Th isreport supports these moves.• Further educate IDUs on the importance of using a clean needle and syringe eachand every time they inject and on the importance of not sharing any of theirinjecting equipment and paraphernalia.
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