In the 1980s, the UK and many other countries started developing needle programmes in an attempt to limit the impact that HIV was having on the injecting community and by extension the general public. Needle programmes have also become early engagement tools to help people get into treatment
The range of equipment provided has gradually increased with (in the UK) minor law changes to allow distribution of citric, filters, spoons and water. 30 years later and these projects are still helping keep HIV levels low and now they’re helping minimise the risks of HepB and HepC.
But this intervention only works with injectors. Injectors are likely to have been using drugs for a number of years already, so surely supplying equipment to people smoking or snorting their drug of choice should be a logical next step in early engagement.
There have been studies into distribution of foil to heroin smokers (Pizzey and Hunt: Distributing foil from needle and syringe programmes (NSPs) to promote transitions from heroin injecting to chasing: An evaluation) These demonstrate that as well as being a good engagement tool the supply of foil can also act as a route transition away from injecting.
In 2008, I presented at the National Needle Exchange Forum meeting about a crack equipment project I’d started that had resulted in an increase in clients to the service, many of whom had never attended before. These new attendees engaged with the HepB vaccination programme and counselling . Both clients and staff said they’d become more confident in delivering and receiving support.
In 2010, the ACMD gave Theresa May a detailed report on foil provision and in November 2012, she wrote to them asking “what evidence [is there] that provision of foil would get people off drugs” (you can see her letter, and the ACMD reply).
Where the provision of smoking equipment has been embraced (like Holland for foil, or some states in the US for pipes) there have been more great successes in engaging with people before they move to injecting. But in the UK, we’re prevented from expanding in this way by Section 9a of the Misuse of Drugs Act, a law that was devised to prevent ‘head shops’ from selling drug paraphernalia. Head shops still sell drug kits, now they just put a sign on them saying ‘novelty use only’, but many drug services have become so risk averse that they are unlikely to give out this equipment, although there has never been a successful conviction under this law and the Crown Prosecution Service state that prosecution of “bona fide operators” of drug services is not in the public interest. (UPDATE: As of September 2014 foil is now legal in the UK, but with strong restrictions).
It’s clear that needle programmes can only do so much, we need pipe programmes and foil projects as well if we want to engage people earlier.