Merchants Quay Ireland (MQI) has published the profile of a cohort of people attending its Health Promotion Unit (HPU) needle exchange.1 The main objective of the HPU is to minimise the risks associated with injecting substances by providing sterile injecting equipment and information and instruction on safe injecting techniques.
Data were collected from 338 attendees using an instrument developed specifically to meet the information needs of the HPU in MQI and included items from internationally validated survey instruments and items fashioned specifically for the present study. Staff in the HPU collected data on socio-demographic characteristics, substance use, injecting risk behaviour and blood-borne virus (BBV) status and treatment. This article presents some of the key findings in the report under the four domains of enquiry.
Socio-demographic characteristics
A total of 338 participants took part in the study, including 290 males (85.8%). Participants ranged in age from 20 to 59 years; the majority were in the 20–34-year age group. Participants included 19 different nationalities; the majority 297 (88%) were Irish nationals. Approximately a third of the cohort reported living in conditions which can be categorised as homeless (Table 1).
Substance use
Participants who used heroin were found to consume an average of 2.35 bags per day, and to spend an average of €45.72 per day on the drug. Route of administration for the vast majority of heroin users was injecting, 245 (84.4%); 34 (11.7%) reported both injecting and/or smoking heroin and six (2.7%) reported smoking only.
There were no differences between the genders for most substances used. Where differences did arise, proportionately more females than males reported using prescribed methadone (73% v 46%), illicit benzodiazepines (25% v 17%) and prescribed benzodiazepines (23% v 14%) (Table 2).
Seventy-five per cent reported using two or more substances in the last month (current use). Thirty per cent (102) reported using two substances in the past month, the most frequent combination being heroin and methadone, used by 49 (48%) of the sub-sample. Almost 9 out of 10 users of prescribed methadone reported using heroin. Heroin users who did not report using methadone were reported to consume higher average amounts of heroin per day, to spend more money on heroin per day and to use heroin on the greatest number of days in the past month.
Injecting risk behaviour
The report states that 329 (97%) of the cohort were currently injecting substances. Almost three quarters of the current injectors who provided a response reported that they had not shared injecting equipment or paraphernalia during the previous month. The most-used sites of intection reported were: the arm, 174 (53%), and the groin, 91 (28%), with 81 (25%) reporting using more than one site.
Blood-borne viral infection status
Table 3 gives the profile of the cohort in terms of blood-borne viral infection status, testing and treatment, as reported by the participants. Among those who tested positive for HIV (22), hepatitis C (125) and hepatitis B (12), uptake of treatment was poor, being as low as 14% in the case of hepatitis C. Of those who tested negative for any BBV, and who responded to the question, more than half had been tested within the past year. While reported co-infections for hepatitis B and C (3%) and HIV and hepatitis C (6%) were low, 73% of those who were HIV positive were also hepatitis C positive.
The research group involved in this study make recommendations in three main areas:
- Policy – relating to needle exchange programmes, screening for BBVs, and ‘further consideration of safer injecting facilities in an Irish context …in future national policy deliberations’.
- Research – relating to the specific needs of certain groups, including older, female and homeless users, polydrug users and steroid users, and the need for further research on needle-exchange services, serological testing and the management of hepatitis C.
- Practice – relating to improving service access and use by female and migrant drug users, familiarising staff with the profile of polydrug and steroid use, developing collaborative relationships with external agencies to improve uptake of BBV testing and treatment, encouraging safer injecting workshops, and, particularly in the case of drug users who are homeless, greater integration of voluntary and statutory services in a multi-disciplinary case management approach that is client-centred.
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- Jennings CJ (2013) Re-establishing contact: a profile of clients attending the Health Promotion Unit – needle exchange at Merchants Quay Ireland. Dublin: Merchants Quay Ireland. www.drugsandalcohol.ie/19914
