“I try not to reuse picks and I’d prefer to be more on the ball and not have to but honestly shit just happens,” says Dave (62).
People who inject drugs in Australia can appear to be well provided for with regard to sterile needles and syringes. Across the country there are 3500 needle and syringe programs (NSPs) which distribute almost 50 million pieces of equipment a year. But the international best-practice for injecting drugs of a fresh needle for every injection is far from reality. People who inject drugs reuse syringes, share equipment like spoons, water and tourniquets, and a small proportion continue to share injecting equipment with others.
A 20-year survey by the Australian NSP Survey showed that the numbers of people who inject drugs who reuse and share have plateaued in recent years after steady declines since the 1990s. For instance one in three (31 per cent) injecting drug users reported that they reused syringes in 1997. Since 2011 the reuse had hovered around 21-25 per cent. The percentage of people who inject drugs who reported they shared syringes with others was also steady at 15-16 per cent from 2011-2015. And the sharing of equipment other than needles remained stable at 28-31 per cent.
The Bulletin spoke to three people who inject drugs about their reuse of injecting equipment. All agreed that they knew it was unwise to “recycle” syringes and share paraphernalia. But they also claimed it was unavoidable under certain circumstances.
Chris* (57) a single gay man from Sydney said he used to share and reuse needles but was vehement he did not share or reuse now.
I only ever used clean needles for myself but Tom, Dick and Harry would all show up. They’ve got the drugs and I’ve got the clean needles. What else am I going to do?
“I only ever used clean needles for myself but Tom, Dick and Harry would all show up. They’ve got the drugs and I’ve got the clean needles. What else am I going to do?”
Chris shared equipment out of social pressure and was very lucky not to have contracted any blood-borne viruses. But his arms are a vivid illustration of the damage that skin infections can wreak. Both forearms are a scarred and pitted moonscape as a consequence of bad injecting practices. Three months ago as he passed me a coffee a tiny rivulet of pus trickled across his arm and dripped onto the floor. Now the wounds are fully healed and Chris is justifiably proud of his achievement. He glows as he holds up his clean “summer” arms, as he calls them.
Chris credits his drug counsellor with encouraging him to use more safely and enable his arms to heal. He is fortunate the abscesses and other bacterial infections that caused the scarring did not develop into life-threatening conditions such as endocarditis, septicaemia or gangrene. Amputations are not unknown if infections get out of hand.
“A part of me likes to think I’m going to just stop and that using blunt needles will encourage me to quit.”
He visits his local pharmacy twice a week for medication. But will not use them to get needles for fear he will be stigmatised, so he collects clean needles from the community health centre.
Dave* (62) lives in Melbourne and is in a long-term relationship. He uses regularly and says he was a “voracious” drug user. Currently though he does not use every day.
“I did share needles when I was a young fella and I do have the hep C antibodies but I didn’t get it full strength. Two other mates from then got it properly and have just been on the new drugs to get clear.
“No matter how hard I try, though, I just accept now that reusing picks is a way of life for me.”
He says he is planning ahead more often and thinking more often about stocking up but his timescale runs into the decades. Dave first started injecting speed in 1973.
“I know fresh picks don’t grow on trees – you need to be organised.”
Dave is uncomfortable with primary NSPs and prefers to pick up five-packs from reception at a local community health service or a pharmacy. He used to think data was collected to pass on to police and is generally suspicious of non-drug users.
“I had the mobile outreach drop off boxes of 100 syringes a couple of times but then you have a lot of used syringes to get rid of. You can’t win really. I know how used picks bugger your veins but well…”
Sometimes impatience to use leads to reusing equipment.
“If you’ve picked up it doesn’t make much sense to make a separate trip to an NSP for clean needles when there are picks at home that have only been used a few times.
“At the end of the day, why do I reuse? Because I’m basically too lazy to stock up. True fact.”
Sasha* (32) is from northern New South Wales.
“I used to always get my boyfriend to do me up but one day it dawned on me that him using the same pick for both of us was madness. Then when I learned more about catching hep C I wouldn’t even allow us both to use the same water or spoon.”
Sasha has become extremely fastidious in making sure clean equipment is always on hand in the house.
“But because we live in a small town I have to be super organised because he won’t. This is a nosey town around here so I’m definitely not using the NSP at the community centre so they can look down their noses at me. And I know chicks who work there too.
“I have to take the responsibility for our health – so we don’t wreck our veins and all that.”
But she finds the opening hours of pharmacies and some services does little to help her use only sterile syringes.
“By the time you get organised and in the car the NSP is either closed for lunch or it’s after 4:30 and it’s shut. That’s a real bummer.”
* Names have been changed.
– Royal Abbott
What can NSPs do to help?
- Encourage clients to stock up. If someone just wants one five-pack at least see if they will take two.
- Equip yourself to provide informal verbal harm reduction information.
- Have printed information on safer using available at all times.
- Consider additional training (for NSP and pharmacy staff) to increase your understanding and reduce discrimination.
Lobby to open your NSP for expanded opening hours to help deliver a more accessible service.
Why do people reuse injecting equipment?
- Lack of knowledge of safer using practices.
- Social circumstances, peer pressure. A group of friends gathers to use drugs and there is insufficient injecting equipment to go around.
- No money to buy equipment from Secure Dispensing Units (vending machines) or buy petrol to travel to an NSP.
- Impatience to use.
- Opening hours for NSP are too restrictive and unsuitable for people who inject drugs.
- Limits on how much equipment can be collected.
- Disorganisation, poor planning. A lack of confidence that health services hosting NSPs will protect privacy, especially in rural and regional areas.
- Shame and stigma associated with injecting drug use.
- Prisons ban detainees from possessing syringes in custody. Former prison inmates tell of five or six prisoners at a time taking turns to inject with a well-used cut-down syringe which they sharpen on a match-box striker or concrete surface.
- Suspicion that data collected at NSP is compiled at the behest of the police.
- Judgemental attitudes on the part of NSP staff. A look that may be interpreted as condescending can deter a person who injects drugs from ever returning to a particular NSP.