Recently I’ve been reading and listening to some interesting talks on the advice that we give alongside syringe delivery. I think that in many Needle Programmes (NSP) workers are overly focused on the equipment an injector chooses to use rather than on the process of injecting.

Of course the equipment used is very important, syringe choice can have a direct impact on risk factors relating to blood borne virus or injecting injury. But having a focus just on this aspect leaves people at a greater risk, and does nothing to challenge existing bad practices that are common in some communities of injectors (just think how often someone mistakenly thinks licking a needle is a good idea).

Change of focus

Well not so much a change of focus, but rather making sure we don’t forget to talk about the rest of the process. While I was following the latest IHRA conference online I saw the presentation that Greg Scott gave which included a lot of talk on processes.

So why should we focus on the process?

Well, mainly because that’s where things go wrong.

Even with a good supply of equipment out there if people aren’t always aware of what they are doing at each step then there will always be a risk of viral or bacterial contamination of equipment. On a recent podcast from the Harm Reduction Coalition Allan Clear spoke to Robert Heimer who was calling for a focus on processes rather than equipment, he spoke about an injecting session where two people batch shared a solution each using their own equipment but using the same ‘cooker’. Although there was a clear risk of contamination both of the people afterwards stated that they hadn’t been at risk because they used their own works.

If clear from the above description that in this situation having identifiable syringes wouldn’t have significantly reduced risk. But having people talk about processes may have highlighted one for them.

Stages of an injection

In Greg Scott’s presentation he goes though the stages of injecting, this is something all drugs workers and peer educators need to think about when discussing injecting risk with people:

1. Getting stuff ready
2. Preparing drug for use/cooking
3. Getting the drug into the syringe
4. Finding a vein
5. Getting the skin ready
6. Puncture
7. Post puncture

As I’m sure you can see, each of these stages would could be a discussion itself, and each stage has more than ample opportunity for things to go wrong. This is especially the case where people are using with friends/partners. I’d also add to the list above the stage of ‘Clearing up and disposal’.

We need to remember that not every injecting episode happens in a nice clear space with plenty of time. The advice we give and the discussions we have should be based in the real world. We need to ensure we talk to people about what they are actually doing from day to day rather than just what equipment they are using to do it with.