WATER FOR INJECTION

WATER FOR INJECTION ENGLISH WATER TORTURE?

BACKGROUND August 2003 – Section 9a amended, 5 items legalised The Government will be laying a negative resolution statutory instrument to implement changes to section 9A of the Misuse of Drugs Act 1971. With effect from 1 August 2003, it will no longer be an offence for doctors, pharmacists and drug workers to supply swabs, filters, sterile water, certain mixing utensils (e.g. spoons, bowls, cups and dishes) and citric acid to drug users who have obtained controlled drugs such as heroin and cocaine without a prescription

Their own words… • Water, swabs, spoons, filters, citric • Not Vit C • (e) ampoules of water for injection, only when supplied or offered for supply in accordance with the Medicines Act 1968[4] and of any instrument which is in force thereunder • WFI still POM • In effect – not water either

June 2005 • "3A Persons employed or engaged in the provision of lawful drug treatment services.3A Ampoules of sterile water for injection containing not more than 2 ml[a] of sterile water.3A The supply shall be only in the course of provision of lawful drug treatment services.". • a -"…than 2 mg of sterile water." should read "…than 2 ml of sterile water.";

Naloxone • A SUMMARY OF THE COMMITTEE ON SAFETY OF MEDICINES MEETING HELD ON 11 MAY 2005 • However, following discussions between the Agency and all parties, the NPSA had withdrawn their objections provided appropriate systems are introduced by ambulance trusts to ensure subsequent safe practice.

Spirit of law change is clearly to allow provision of all paraphernalia necessary in a comprehensive harm reducing needle exchange • Home Office Minister, Caroline Flint said: "Providing these items is currently illegal. We know that treatment workers and doctors have been making sensible decisions to provide equipment anyway, but faced the risk of prosecution. We have decided to change the law to help reduce the health risks to drug users.”

Pressure paid off, eventually • However, no plastic amp is currently available • Situation is actually worse, at least in south London • Why should this matter? • ''We have walked into shooting galleries and seen water that was actually pink with addicts' blood,'' • Published: December 24, 1989

We always have, so we always will… • Needle Exchange & Harm Reduction are pragmatic responses to continuing drug use • Focus on health – BBV prevention/reduction as well as generally • SI amendments are in line with this • Research clearly shows need for increased NX provision

Breaking Glass • Assumptions: glass amps inherently less safe than plastic? • Cuts could pose BBV risk • Users prefer plastic? • Do users really need water? • Wildlife may consume amps therefore plastic is safer than glass?

If assumptions are followed, technically we are left with no WFI to supply • PGD has been invalidated by intent of law changes to limit supply to 2ml • Although police may agree prosecution isn’t in public interest MHRA consider this their jurisdiction • Interpretation locally has led to cessation of supply

Survey • Test assumptions: In April 2006 the Mainliners outreach team distributed 1,000 2ml glass ampoules and • 100 ‘safe snap’ amp snappers to injecting drug users as part of a pilot scheme to • evaluate the impact and response of the intervention. • Clients were surveyed at the time they were first given the ampoules • they were then followed up at subsequent visit and asked about their use of the ampoules/snappers • Mainliners had previously suspended supply of the 5ml plastic ampoules following clarification from the MHRA of the legal position regarding supply in relation to the Medicines Act

PART 1 (if you’ve had glass amps before, please go straight to part 2) • 1. We haven’t been giving out water amps for a while – what have you used in the meantime? • (Please tick all that apply) • boiled water from a kettle • tap water • bottled water • other (please state): • 2. Have you shared water in the last month? yes no • 3. Since we stopped supplying amps have you shared water: • more often less often the same never • 4. Do you think you’ll use the amp snapper? yes no don’t know • 5. Do you think mainliners supplying water amps will reduce water sharing amongst injectors? • yes no don’t know

PART 2 • If you’ve had glass water amps before: • 1. Did you use the water amps? yes no • 2. How do you normally dispose of your amps? • 3. Have you shared water since you were given the amps? yes no • 4. Do you want water amps this time? yes no • 5. Did you use the amp snapper : always sometimes never • 6. Did you (or anyone else) cut yourself with any of the amps? yes – please give details no

Results do support assumptions, but not those supposed: • what other sources of water have you used since Mainliners stopped supplying 5ml plastic ampoules? • boiled water from a kettle 0 • tap water 11 • bottled water 13 • toilet water 2 • puddle water 2

Sharing without amps • Shared in last month - 17 - said ‘Yes’, while just 6 said ‘no’ • Shared since supply stopped - More often: 16 • the same: 2 • less often: 0 • never: 5

Amps • Do you think you’ll use the amp snapper?” • 22 said yes • none said ‘no’ • 1 said ‘don’t know’ • Do you think that supplying water amps will reduce water sharing amongst injectors? • 22: ‘yes’ • 1: ‘no’.

Did you use the water amps? • yes: 18 • no: 5 • how did you dispose of the amps? • Sharps bin: 13 • Domestic waste: 8 • Tin can: 1

Sharing with amps • Do you think that supplying water amps will reduce water sharing amongst injectors? • 22 saying ‘yes’ • just 1 ‘no’. • Have you shared water since you were given the amps? • 8: yes • 13: no • 9 of the 17 who had shared water in the previous month at first interview, said had not shared water since they were given the ampoules

Safety • did you use the amp snapper? • always :16 • sometimes: 6 • never: 1 • did you (or anyone else) cut themselves on the amps? • 100%: NO!

Where next? • Supply of water is more than good practice – plenty of research to show ‘sharing’ message needs to be more than just syringes • Needle supply remains paramount, but of additional paraphernalia water supply is potentially next greatest hazard

From NIDA NOTES March/April 1997 • The researchers used HIV's distinctive genetic structure, its DNA, as a marker to detect its presence in the injection paraphernalia. They found evidence of HIV DNA in up to 85 percent of contaminated needles collected from shooting galleries and in up to 36 percent of cotton swabs, 54 percent of cookers, and 67 percent of rinse water samples.

Where next • NEEDLE EXCHANGE WATER FOR INJECTION SUPPLY • This petition has been compiled by the Mainliners SMART Service user group with regards to the following concern. If you require any further information please do not hesitate to contact us on Tel: 020 8677 9541 Fax: 020 8664 6017. Our office is at9b Mitcham Lane, Streatham, London, SW16 6LG • Water used for injecting is an integral part of Intravenous Drug Use. This means that users may resort to unhygienic and non-sterile practices to obtain water. Sterile injecting water has been available in the past, which is why we are now campaigning for its return. It is essential in Harm Reduction relating to reduce the risk and spread of Blood Borne Viruses. • Please register your concerns regarding this by signing the petition below. This petition will be brought to the attention of the National Treatment Agency as it is a very serious issue that needs to be addressed quickly, as well as locally to the funding bodies responsible • DateNameSignatureServiceOccupation(NFA)

Alternatives • Other WFI options - ? None of sufficient quality • Increased information on safe water use: - hierarchy of risks (boiled, tap etc.) - don’t use same bottle for more than a day - always pour, never dip - don’t use communal glasses (rinsing or cooking) - don’t assume water is clean (or any paraphernalia) - dispose of anything sharp responsibly - DON’T SHARE ANYTHING

Ignorance can be bliss • What’s the situation elsewhere?

WATER FOR INJECTION