School of Education and Social Sciences, University of the West of Scotland, Paisley, PA1 2BE, Scotland.
School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland; Public Health Scotland, NHS National Services Scotland, Glasgow, Scotland.
Int J Drug Policy. 2021 Dec;98:103369. doi: 10.1016/j.drugpo.2021.103369. Epub 2021 Jul 30.
In the UK, legislation was implemented in 2014 allowing needle and syringe provision (NSP) services to offer foil to people who inject drugs (PWID) to encourage smoking rather than injecting. This paper aims to examine the association between foil uptake and smoking or snorting heroin among PWID. This is the first large scale national study to examine foil uptake and smoking or snorting heroin among PWID post legislative change.
Data from 1453 PWID interviewed via Scotland's Needle Exchange Surveillance Initiative in 2017-2018 were analysed using multivariate logistic regression.
Overall, 36% of PWID had obtained foil from NSP services in the past six months. The odds of smoking or snorting heroin were higher among those who had obtained foil (Adjusted Odds Ratio (AOR) 3.79 (95% CI 2.98-4.82) p<0.001) compared to those who had not. Smoking or snorting heroin was associated with lower odds of injecting four or more times daily (AOR 0.60 (95% CI 0.40-0.90) p = 0.012) and injecting into the groin or neck (AOR 0.57 (95% CI 0.46-0.71) p<0.001) but increased odds of having had a skin and soft tissue infection (SSTI) (AOR 1.49 (95% CI 1.17-1.89) p = 0.001) and having experienced an overdose (AOR 1.58 (95% CI 1.18-2.10) p = 0.002) both in the past year.
The promotion of smoking drugs via foil provision from NSP services may contribute to the package of harm reduction measures for PWID alongside the provision of injecting equipment. We found that those in receipt of foil were more likely to smoke or snort heroin, and that smoking or snorting heroin was associated with a lower likelihood of some risky injecting behaviours, namely frequent injecting and injecting into the groin or neck. But it remains uncertain if the provision of foil can lead to a reduction in health harms, such as SSTI and overdose. Future research is needed to understand PWID motivations for smoking drugs, obtaining foil from NSP services, and its uses particularly among polydrug users.
在英国，2014 年实施了立法，允许针具供应（NSP）服务向注射毒品者（PWID）提供箔片，以鼓励吸烟而非注射。本文旨在研究箔片使用与 PWID 吸烟或吸食海洛因之间的关联。这是立法改革后首次大规模全国性研究，旨在调查 PWID 接受箔片使用和吸烟或吸食海洛因的情况。
对 2017-2018 年通过苏格兰针具交换监测计划接受访谈的 1453 名 PWID 进行数据分析，采用多变量逻辑回归。
总体而言，36%的 PWID 在过去六个月中从 NSP 服务中获得了箔片。与未获得箔片的人相比，获得箔片的人吸烟或吸食海洛因的可能性更高（调整后的优势比（AOR）3.79（95%置信区间 2.98-4.82）p<0.001）。吸烟或吸食海洛因与每日注射四次或更多次的可能性降低相关（AOR 0.60（95%置信区间 0.40-0.90）p=0.012）和注射到腹股沟或颈部的可能性降低相关（AOR 0.57（95%置信区间 0.46-0.71）p<0.001），但感染皮肤和软组织感染（SSTI）的可能性增加（AOR 1.49（95%置信区间 1.17-1.89）p=0.001）和经历过量用药的可能性增加（AOR 1.58（95%置信区间 1.18-2.10）p=0.002），均在过去一年。
通过 NSP 服务提供箔片促进吸毒可能有助于与提供注射设备一起成为 PWID 的一整套减少伤害措施。我们发现，那些接受箔片的人更有可能吸烟或吸食海洛因，而且吸烟或吸食海洛因与一些更危险的注射行为的可能性降低有关，即频繁注射和注射到腹股沟或颈部。但尚不确定提供箔片是否会减少 SSTI 和过量用药等健康危害。需要进一步研究，以了解 PWID 吸烟、从 NSP 服务获取箔片以及在多药使用者中使用箔片的动机。
