Latest Shooting Up report focuses on the changing nature of injecting drug use
The 12th annual report on infections among people who inject drugs (PWID) in the United Kingdom – Shooting Up – has been published by Public Health England.
PWID are vulnerable to a wide range of infections – including those caused by viruses such as HIV and hepatitis B and C, and bacteria such as botulism and group A streptococci – that can cause significant morbidity and mortality. The report examines the extent of infections and the associated risks among PWID under six headings:
Hepatitis C levels are still high
Among people who inject psychoactive drugs, such as heroin and mephedrone, around half have antibodies to hepatitis C (58% in Scotland, 50% in England, 47% in Wales, and 32% in Northern Ireland). As around a quarter of those infected with hepatitis C clear their infection, these data suggest that about two in five of those who inject psychoactive drugs are currently living with hepatitis C infection in the UK. Although the uptake of testing is high, about half of these hepatitis C infections remain undiagnosed, either because people have never had a test or have become infected since their last test. About one in 30 (3.6%) of those who inject image and performance enhancing drugs, such as anabolic steroids, are living with hepatitis C.
Hepatitis B is now rare and vaccine uptake has improved
Among people who inject psychoactive drugs the proportion ever infection with hepatitis B has declined (falling from 30% in 2003 to 16% in 2013 in England, Wales and Northern Ireland), probably reflecting the marked increase in the uptake of the hepatitis B vaccine. In 2013, only 0.57% of this group had a current hepatitis B infection. Vaccine uptake levels among people who inject psychoactive drugs have been stable in recent years (72% in England, Wales and Northern Ireland, 74% in Scotland in 2013), but could be increased further. Vaccine uptake is, however, much lower (40%) among people who inject image and performance enhancing drugs.
HIV levels remain low and the uptake of care is good
Around one in every 100 people who inject drugs is living with HIV. The level of HIV infection among those injecting image and performance enhancing drugs is similar to that among those injecting psychoactive drugs. Most people who inject psychoactive drugs report ever being tested for HIV (76% in England, Wales and Northern Ireland, and 78% in Scotland) and the majority of those with HIV are aware of their infection. Only 41% of those injecting image and performance enhancing drugs reported ever being tested for HIV. Overall, the uptake of HIV related care, including anti-retroviral therapy, is high among PWID.
Bacterial infections remain a major problem
Severe illnesses among people who inject drugs due to bacterial infections continue to place a significant burden on health services. Around a quarter (28%) of people who inject psychoactive drugs report a recent symptom of an injecting site bacterial infection. Among those who inject image and performance enhancing drugs, one in six (16%) report ever having a symptom of an injecting site bacterial infection.
Injecting risk behaviours have declined but remain a problem
Reported needle and syringe sharing among people injecting psychoactive drugs has halved over the last 10 years; in England, Wales and Northern Ireland this has fallen from 29% in 2003 to 16% in 2013. However, almost one in three (29%) of this group reported that they had injected drugs using a needle that they had attempted to clean. Sharing injecting equipment is less commonly reported among people injecting image and performance enhancing drugs; 13% of those surveyed in 2012-13 reported ever sharing a needle, syringe or vial of drugs
Changing patterns of psychoactive drug injection are a cause for concern
There has been a recent increase in the injection of amphetamines and amphetamine-type drugs, such as mephedrone – with more than one in two now reporting these as their main drug. The injection of these drugs has been associated with higher levels of infection risk. Although the injection of these drugs is much less common than the injection of opiates, crack-cocaine, or image and performance enhancing drugs, this increase is a concern.
The findings presented in the report indicate a need to maintain, and improve services that aim to reduce injecting-related harms and to support those who want to stop injecting. A range of services should be provided including needle and syringe programmes, opioid substitution treatment, and other drug treatment, as well as easy access to diagnostic testing for hepatitis C and HIV (including access to care pathways for those living with these infections), to vaccinations including that for hepatitis B, and to information and advice on safer injecting practices, on preventing infections and on the safe disposal of used equipment. These services should be developed in line with published guidelines to ensure that the interventions they provide have sufficient coverage to prevent infections.
Of course, the focus of our concern is the infection risk from discarded injection equipment (“gear”), not just the needles that are the focus of most attention and, for the general public of revulsion.
Clearly, the infection rate in users is high, and increasing, and therefore the infection risk from discarded needles and syringes etc must be similarly great. Perhaps the greatest ‘threat’ is the growing use of steroid infections in gyms and health clubs, and the relatively new problem of needle litter in these establishments. With a growing incidence of hepatitis C in this group, this is clearly an area for considerable concern.