In June 2010 I wrote an article for Injecting Advice concerning fluorescent blue lights (and related harm) in public toilets. That previous article coincided with the publication of an academic paper in the journal Health and Place and both summarised research (from the city of Plymouth, UK) that considered the injecting practices of drug users who had previously accessed toilets lit with blue lights.

In this article, I’d like to provide a brief update of the issue of blue lights following my ongoing interest in this topic. More importantly, this update has been greatly inspired by numerous e-mails and requests I have received over the last few weeks requesting more information on the Health and Place paper cited in the aforementioned Injecting Advice ‘blue light blog’ (June 2010) – most of which have come from harm reduction practitioners located throughout Australia (and I am very thankful to Nigel Brunsdon of Injecting Advice and to Paul Dessauer of WASUA for circulating details of my work on this issue on various websites). However, these requests have come at a time when I have recently completely a study of public injecting drug use in another UK setting and where drug user experiences of fluorescent blue lights was also noted and recorded. Due to this interest, I feel it is vital to maintain the significance of recent research and provide, on-going, up-to-date, information for harm reduction practitioners and services regarding an issue that clearly has international relevance. That is, I aim to keep the issue ‘live’.

As a quick reminder, the purpose of fluorescent blue lights in public settings (especially toilets) is to make environments unattractive to injecting drug users by purposely making the process of injecting into superficial veins (those just below the surface of skin, such as those in the forearm) more difficult. This, in turn, is meant to have a ‘dispersal effect’ and prevent drug users from accessing premises that have been purposely modified to prevent injecting from happening. However, my initial ‘blue light blog’, about the Plymouth-based research, described 18/31 injecting drug users that were not deterred by blue lights and their ‘injecting experience’ became one characterised by touch rather than vision. Similarly, Plymouth injectors believed that the lighting did not make groin / neck / peer injecting impossible and these became viable injecting alternatives in blue light areas.

My most recent work on public injecting drug use recently concluded in Southend, (a coastal resort on the east coast of Britain) and was funded by the town’s Drug and Alcohol Action Team (Southend Borough Council). A total of 20 drug users with recent experience of public injecting were interviewed during this study and many similarities were noted with those from the Plymouth cohort. This was especially true about their injecting experiences in public toilets equipped with blue lights. Namely:

• over half of the research participants (11/20) had ever injected in an environment containing blue lights in a Southend location
• as such, 11/20 were not deterred by blue light environments and were prepared to inject there
• as with Plymouth, those that had injected in blue light environments stated that injecting episodes were made more difficult – but not impossible – in blue light settings. For these individuals, the lights merely prolonged the time required to complete injecting episodes
• others were able to counter the blue light effect by ‘feeling out’ veins or accessing established injecting sites (especially the femoral vein in the groin). For these individuals, injections could be administered ‘blindfolded’, or by locating existing scar tissue near particular injecting sites. These experiences provide wider confirmation that blue light settings influence a sensory (and potentially harmful) shift from sight to touch
• some of those undeterred by blue lights stated that the severity of individual withdrawal symptoms – or drug cravings – would often increase the preparedness to take greater risks (including within environments designed to prevent injecting drug use)

Why are these findings important?

The above findings from Southend were noted at a time when the issue of blue lights as a form of drug prevention in public places was noted as a sensitive and controversial issue amongst local agencies and organisations. In short, the issue of blue lights tended polarise agency opinion; with some in favour of installation and others against.

However, it is perhaps important to remind ourselves that (over 5 years ago) the UK government’s Department of Environment, Food and Rural Affairs (DEFRA) published guidelines for ‘Tackling Drug Related Litter’. In this, it advised that:

…due to the increased risks to users and lack of evidence as to its efficiency, blue lighting should not be used in public toilets to deter drug use

It is perhaps equally important to remind ourselves that since DEFRA’s report ’empirical’ research (that which has been ‘tested’ and ‘applied’) based in Plymouth (2010) – and now Southend (2011) – demonstrates and confirms the view that blue lights lack evidence of efficiency. Similarly, the common qualitative experiences noted from two injecting drug user cohorts, recruited from two diverse UK settings (geographically and socio-culturally), suggest that blue lights are actually more ineffective in preventing or deterring drug use from occurring (as in both settings, a cumulative total of 29/51 [57%] reported previous injecting experience under blue lights).

From these shared experiences, the following conclusions may be consolidated:

• blue lights do not completely prevent injecting drug use from occurring in public toilets
• they do not fully facilitate public safety or public health
• blue lights are not a panacea for social issues and problems relating to injecting drug use
• they do make injecting drug use more difficult – and thus more hazardous and potentially harmful

Conclusion

This research update indicates that there is perhaps a greater need for more strategic, multi-agency, approaches to public injecting drug use, in which organisations (including local authorities, police constabularies, drug and alcohol services, harm reduction practitioners and hospital services) attempt to formulate more considered approaches to intervention within specific drug using environments. Whilst prevention and dispersal procedures involving blue lights may be well-intended in design, the actual consequence of these installations may be typically overlooked, understated, or simply ignored. Furthermore, the interest I have received from international harm reduction organisations in this regard suggests that this is an issue not confined to coastal resorts in the UK. Indeed, blue lights appear to be a truly global concern with significant implications for harm reduction. In these times of evidence-based intervention, the continued (often unchallenged) presence of blue lights as an effective measure of drug control almost certainly requires further validation and legitimisation by the appropriate bodies that advocate such intervention.