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October 2013 |
drinkanddrugsnews
| 15
Needle exchange |
Education
www.drinkanddrugsnews.com
As a supplier of injecting equipment
to needle and syringe programmes
(NSPs), Daniels Healthcare wanted to
discover more about what appeared
to be a significantly changing profile
of the injecting drug users who are
our end-user clients. For a long time,
anecdotally, we had been aware that
steroid injectors were accessing
needle exchanges for their equipment
in ever-greater numbers. So over the
course of last year we began to think
it would be valuable to learn more
about how our provision to this client
group could be improved and also
see if we could provide further
information for commissioners and
drugs services to help them
understand the needs of a client
group that frontline drugs workers
often find very hard to engage with,
beyond a quick exchange.
We approached Kevin Flemen at
KFx to undertake research to use
alongside experience gained at his
workshops and training sessions, and
a simple questionnaire was created
and distributed by needle exchange
workers to people attending
exchanges and who used steroids.
Fifty-four completed responses
provided some interesting, and at
some points surprising, results.
KFx and Daniels were both aware
of worryingly wide variations in
knowledge among people who use
steroids, from the highly knowledge-
able and experienced to those with
only very basic understanding, so we
decided to develop a series of
information leaflets. We really liked
KFx’s idea of dividing the information
into specific knowledge areas and
creating resources which could be
distributed either with their pharmacy
packs, or individually by frontline
workers, and eventually free of charge
from our websites.
Starting with those who may not
have extensive knowledge, it was
decided that the following subjects
would be the most helpful in offering
straightforward harm reduction advice
for naive injectors, as well as those
who might be interested in exploring
potential alternatives to steroid use.
The five leaflets focused on:
When to start?
A leaflet for
younger people who either hadn’t
started using, or were just
thinking about starting to use,
performance-enhancing drugs.
IM injections:
a basic leaflet
covering intramuscular
technique, to be given out with
packs for IM injection.
SC injections:
for people using
any compounds subcutaneously,
describing SC technique and to
be given out to people taking
packs for subcutaneous injection.
Melanotan:
a specific leaflet for
people injecting tanning agents,
identified as a group for whom
there was little literature about
administration.
Polydrug users:
a leaflet for
people using steroids in a non-
structured way alongside other
substances such as alcohol and
ecstasy. This group of young
polydrug users was considered
especially high risk and lacked
any targeted literature.
By acknowledging the growing
numbers of steroid injectors who
were accessing drugs services, we
hoped to demonstrate to this group
that an exchange could also be part
of a tailored intervention.
We wanted to be part of a
conversation that acknowledged that
NSPs were as much for people who
used steroids as any other
substance. As part of the same
process, we concluded that if sharps
boxes were going to carry any
messages at all, some of these
should also be steroid-specific, so we
developed a series of educational
messages specific to steroid users,
delivered in an engaging way.
The relatively high response rate
to the survey allowed us to see some
clear trends emerging. However, as
the sample group were self-selecting
(
ie
the surveys were conducted in
needle exchanges) it provided a poor
impression of what went on for
people who didn’t use a needle
exchange.
We used a simple nomination
question to find out if service users
felt that most of the people they
knew already used needle exchanges.
The results indicated that the majority
of people attending services felt that
most of their peers were also using
exchanges, but there was also a
significant population that didn’t.
We asked people what aspects of
service were important to them, and
the results confounded expectations.
Despite our preconceptions, a
steroid-specific service was the least
important aspect and less than a
third considered evening or weekend
sessions necessary to them. The
crucial aspects were friendly,
knowledgeable staff delivering the
right equipment in a confidential
setting.
While the result was biased –
completed as it was by people
already using needle exchange – the
findings were still striking. They
highlighted the need for effective
staff training rather than a
concentration on extended opening or
steroid-only sessions.
We found the exercise of focusing
on the needs of steroid users
informative and enlightening and will
use the results to inform how we
develop our distribution of equipment
to this client group.
James Langton is harm reduction
planning officer at Daniels Healthcare,
www.daniels.co.uk
To receive a copy of the research,
contact Kevin Flemen at
www.kfx.org.uk
A survey of needle
exchange clients
revealed the need for
staff to keep up with
the times, as
James
Langton
explains
‘We asked
people what
aspects of
service were
important to
them, and the
results
confounded
expectations.’
Profile
Changing