Inadequate Needle and Syringe Provision Among People Who Inject Psychoactive Drugs Across England and Wales

Author: Lucinda Slater Claire Edmundson Eva Emanuel Jacquelyn Njoroge Vivian Hope Emily Phipps Monica Desai Sara Croxford

Theme: Epidemiology & Public Health Research Year: 2022

People who inject drugs (PWID) are an underserved group, with higher risk of poor health outcomes
than the general population. Provision of needles and syringes (PoNS) is a proven intervention for
reducing harms associated with injecting drug use, effectively limiting the spread of blood-borne
viruses and bacterial infections. We describe self-reported coverage of PoNS in England and Wales
(E&W) and identify factors associated with inadequate provision.
This study utilised 2017-2019 data from the annual Unlinked Anonymous Monitoring (UAM) Survey
of PWID recruited through specialist services. We characterised people who injected psychoactive
drugs in the past month in E&W who did not have access to sufficient injecting equipment to meet
their requirements. Logistic regression was carried out to identify demographic, social and risk
factors associated with inadequate PoNS. For sensitivity analysis, the number of injection attempts
contributed to the PoNS calculation.
Of 2,442 people injecting in the past month, 34.2% reported inadequate PoNS to meet their needs
(51.3% including unsuccessful injections). Those who injected powder cocaine in the past month
were more likely to inject more frequently, and report inadequate PoNS, than those who did not.
Following adjustment in multivariable modelling, younger age (adjusted odds ratio (aOR): 2.05, 95%
confidence interval (CI): 1.23-3.41), initiating injecting in the past three years (aOR: 1.52, 95%CI:
1.10-2.08), injecting more frequently (aOR: 12.58, 95%CI: 8.53-18.57), and sharing injecting
equipment (aOR: 1.31, 95%CI: 1.08-1.59) were associated with inadequate PoNS.
Given the poor reported coverage of injecting equipment in E&W, the lack of national policy
addressing this since data were collected, and recent negative impacts of the COVID-19 pandemic,
there remains urgent need to increase access and provision to prevent serious infection outbreaks
and reduce other injecting-related harms. Younger PWID may require more injecting equipment due
to increased stimulant injection among this cohort.
Disclosure of Interest Statement:
There are no conflicts of interest.

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