An addict’s needle – just what are the risks?

Actually, this is an almost impossible question since the risk depended on the type of needle – wide hollow-bore needles are far more dangerous – how much blood, , whether it is liquid or dried, and how old. Then there is the injury? Is it a deep wound or just a scratch, which still carries a risk though not as great and by no means is it a trivial or risk-free injury.

Needles discarded by addicts, IV drug users (IDUs) or the new softy softy term people who inject drugs (PWID) to include diabetics and others who are using needles and injectable therapies quite legitimately, are a constant risk for waste handlers and others. Picking lines and those tasked with litter picking and needle retrieval in toilets, parks and gardens, squats, and other locations where addicts congregate are frequent locations at which waste sector staff face the risk of sharps injury.

Now, the latest November 2012 edition of the Health Protection Agency publication ‘ Shooting Up ‘, clearly addressing issues of IDUs but trying hard to be politically correct in its – actually misleading – use of the term PWID.

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 anthrax and group A streptococci – that can cause significant morbidity and mortality.

Although the new report focuses primarily on hepatitis B infection, it also summarises data on other infections among PWID. The report’s key findings are that:

• Hepatitis B infection among PWID has declined over the last decade. Overall around one in six PWID have ever been infected with hepatitis B virus
• This decline most probably reflects the marked increase in the uptake of the hepatitis B vaccine among PWID over the last decade. Targeting vaccination to this group will need to be maintained if the current low level of new infections is to be sustained
• Around half of PWID in the UK have been infected with hepatitis C. The prevalence of HIV among PWID remains comparatively low in the UK with around one in every 100 PWID infected
• Bacterial infections remain a problem among PWID, with almost one-third reporting symptoms of bacterial infection (such as a sore or abscess) at an injecting site in the past year, and
• Needle and syringe sharing is lower than a decade ago, although one-sixth of PWIDs continue to share needles and syringes

So hepatitis B is decreasing, and HIV is at around 1 in 100. That is, of course, reassuring, but now if you don’t know the origin of a needle stuck in you thumb and with an incidence like this high enough to warrant specific, and sometimes quite challenging preventative treatment and a long, long wait for the final all clear. And for hepatitis C, the rate is a more threatening 50%, higher still in Scotland, and shows no sign whatsoever of a decline in the last 2 years.

So, the risks are clear, hepatitis C, hepatitis B, HIV and a modest range of bacterial infections that even in a healthy individual can cause a nasty, perhaps life-changing, infection is associated with a large and soiled wound.

Prevention relies of hepatitis B immunisation, careful selection and use of PPE and associated tools, effective wound hygiene and prompt medical care in the event of injury or other exposure, and perhaps above all a sound common sense and careful approach to high risks tasks approached with a well thought out SSOW.

In the clinical environment, safety-engineered sharps are beginning to appear though there is perhaps some brinkmanship to avoid additional expenditure until the deadline for their mandatory introduction. And even then, there will be some non-safety sharps in use, necessarily retained for patient care in circumstances where no alternative is available. Most devices will be of the cheaper manually activated design that require the user to take some positive step to make these safe. With training, that should become a routine, almost robotic act but so too should be the placement of a used sharp into a sharps bin and even in hospitals that still doesn’t happen so don’t expect complete elimination of post-disposal sharps injury.

The provision of clean gear – new syringes and needles – to IDUs is a politically contentious matter. It costs money and money is tight, even more so when the moral majority would walk over hot coals to prevent a penny of taxpayer money being spent on this group. And of course many, about one sixth still share needles, increasing the prospect of disease transmission and contamination of a discarded needle. The reasons for sharing are many and complex yet often include heavy police intervention that make needle supply uncertain and unpredictable. That drives addition further underground and inevitably those dodging Plod will not want a big yellow bin that might as well be labelled “Addict” or more simply “Criminal”.

Regrettably, community sharps bin provision is as unlikely as the provision of clean needles, with many communities rejecting the placement of bins in toilets and high risk locations in parks and graveyards, preferring instead the scourge of discarded needles that someone else will have to pick up.