Evaluation Of The Provision Of Single Use Citric Acid Sachets To ...

More documents

Recommendations

Info

1CHAPTER 1 BACKGROUNDIntroductionRecent estimates suggest that 2% of 15-54 year olds in Scotland misuse drugs. In theyear 2000, there were 22,795 known drug users and an estimated 55,800 drug users inall. In Greater Glasgow, the prevalence of problematic drug use was reported to beslightly higher at 3.1% of 15-54 year olds, with 7248 known drug users and an estimated15,975 drug users in total in 2000. In Lanarkshire the prevalence of drug misuse wasreported to be slightly lower at 1.6% of 15-54 year olds, with 1828 known drug users andan estimate d 5076 drug use rs in to tal in 2000. Acro ss the whole o f Sco tland, malesconsistently account for around 75% of the problem drug using population (Hay,McKeganey & Hutchinson, 2001).Much of the problematic drug use in Sco tla nd invo lves drug inje cting. In the yea r 2000,there were known to be 4542 injecting drug users (IDUs) with an estimated 22,805 intotal (0.8% of 15-54 year olds). The prevalence of injecting drug use is higher than thenational average in Greater Glasgow, where 1.4% of 15-54 year olds are thought toinject. In 2000, there were 1946 known IDUs and an estimated 7187 IDUs in total inGreater Glasgow. In Lanarkshire, the prevalence of injecting drug use has been reportedto be slightly lower at 0.7% of 15-54 year olds. Here, there were 279 k nown IDUs and anestimated 2369 IDUs in total in the year 2000 (Hay, McKeganey & Hutchinson, 2001).Table 1.1 Prevalence of drug misuse and drug injecting in 2000NHS B oardGreaterGlasgowProblem drug use 2000 Injecting drug use 2000KnownusersEstimatedusersPrevalence(15-54 yr olds)KnownIDUsEstimatedIDUsPrevalence(15-54 yr olds)7,248 15,975 3.1% 1,946 7,187 1.4%Lanarkshire 1,828 5,076 1.6% 279 2,369 0.7%Scotland 22,975 55,800 2.0% 4,542 22,805 0.8%Source: ‘Estimating the National and Local Prevalence of Problem Drug Misuse in Scotland: Executive Report’Hay, McKeganey & Hutchinson, 2001.Injecting drugs is known to increase the risk of overdose, abscesses and infections,vascular problems and blood-borne viruses. Recent estimates suggest that around 34% ofIDUs have shared their injecting equipment within the past month (ISD, 2001). Anotherstudy has found that a further 27% of IDUs reported that while they had not shared in theprevious month, they had shared in the past (Effective Interventions Unit, 2001). Whenthe definition of sharing equipment is extended to include all injecting paraphernalia, thefigures are even higher. Galbraith et al (2001) reported that 58% of IDUs reportedsharing needles, syringes, spoons, water and swabs in the past. Such sharing ofequipment significantly increases the risk of acquiring blood-borne infections such as HIV,Hepatitis C and Hepatitis BSince the early 1980s, when the infection was first evident in Scotland, the incidence ofHIV infected IDUs has steadily declined. Recent estimates suggest that the prevalencethroughout Scotland is very low at 1-2% (ISD, 2001). In 2000, there were only 19
2diagnosed cases of HIV infected injectors – the lowest annual number ever recorded (ISD,2001). This decline in cases has been accompanied by a rise in the average age at whichHIV is diagnosed and suggests that the few infections that are being reported werecontracted in the late 1980s or early 1990s. Recent HIV transm ission seems to be arelatively rare occurrence. Such reduction in incidence can be at least partly attributed tothe success of harm reduction interventions such as needle exchange and methadonemaintenance programmes (Hurley, 1997; Des Jarlais, et al, 1996).In contrast to the relatively low prevalence of HIV, the prevalence of Hepatitis C amongIDUs in Sco tla nd is ve ry high. By De cembe r 2001, the re we re 13,535 k no wn cases of HCVin Scotland (5019 in Greater Glasgow and 774 in Lanarkshire). Of these cases, 60% hadinjecting drug use as the probable route of transmission (SCIEH, 2002). Moreover, it islikely that a large number of IDUs are among the cases with an “unknown” cause oftransmission. Recent estimates suggest that as many as 10,000 IDUs in Scotland haveHC V and e ven this figure is likely to unde res tima te the true pre vale nce (Effe ctiveI nte rventions Unit, 2001). In Greate r Glasgo w, HC V is most pre vale nt, with e stima tes tha t64% of IDUs have the disease (Goldberg, et al 2001). While treatments for HCV arebecom ing more successful, prevention undoubtedly remains the key to halting theprogressio n o f this disease .He pa titis B is le ss pre vale nt among IDUs in Sco tla nd than Hepa titis C . In 2000, the re we re360 known cases of the virus. Of these, only 89 cases were attributed to injecting druguse, but it is likely tha t most case s had inje cting drug use as the pro bable ro ute o ftransmission (ISD, 2001).Harm Reduction: The Role of the Needle ExchangeReducing the prevalence of injecting drug use and the spread of associated blood-borneviruses in Scotland is a complex task. The best interventions are based on the principles ofharm reduction. Such interventions follow a set of practical strategies that aim to reducethe risks associated with injecting drug use and encourage safer use, which may or maynot lead to abstinence.One such harm reduction approach is to ensure that IDUs have access to clean needlesand syringes. Needle exchange programmes recognise that people who inject drugs are ata greater risk of contracting HIV, HBV and HCV and other health problems associated withsha ring needles and drug pa raphe rna lia . By pro viding clean equipment, info rmation andeducation on risk factors, and by making referrals to drug counselling services, their aim isto reduce the negative consequences associated with injecting drug use.First established in the UK in the mid 1980s, needle exchanges are an effective method ofdisease control. By reducing the length of time that each needle spends in the druginjecting population, they ensure that there is less chance of it being contaminated andsubsequently reused by another, potentially uninfected, IDU (Drucker, et al, 1998). Theirefficacy in reducing sharing behaviour has been well documented (Blumenthal, et al,2000). Other studies have reported that needle exchanges significantly increase single useof syringes and can reduce the number of injections per syringe by between 44% and85% (Heimer, et al, 1998; Kipke, et al, 1998).There is overwhelming evidence to suggest that needle exchanges decrease theprevalence of HIV among IDUs (Hurley, 1997, Des Jarlais, et al, 1996). In fact, all but twoo f the s tudies ca rrie d o ut to da te have co ncluded tha t needle ex changes reduce HI Vtransmission. Even the two Canadian studies, which concluded that needle exchange
Page 1 and 2: Effective Interventions UnitEVALUAT
Page 3: iABSTRACTThree hundred and sixty in
Page 7 and 8: 4and is so ld in poo rly so luble b
Page 9 and 10: 6CHAPTER 2 METHODOLOGYAims & Object
Page 11 and 12: 8CHAPTER 3 RESULTSStudy Group Chara
Page 13 and 14: 10more than any other drug also inj
Page 15 and 16: 12Table 3.5. Reasons for using curr
Page 17 and 18: 14The next most common eye problem
Page 19 and 20: 16That’s what I learnt from my ma
Page 21 and 22: 18s imply re turn to the needle ex
Page 23 and 24: 20rise in the numbe r o f visits is
Page 25 and 26: 22proposed to amend the misuse of d
Page 27 and 28: 24the era of needle/syringe exchang
Page 29 and 30: 26O live r, K. J., S. R . Friedman,
Page 31 and 32: APPENDIX B: Structured Questionnair
Page 33 and 34: US ING THE C ITRIC AC ID S ACHETS22
Page 35 and 36: 37. In the last 3 months, approxima
Page 37: APPENDIX D: C itric Acid SachetSour

Evaluation Of The Provision Of Single Use Citric Acid Sachets To ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?