As with the discarding of any litter, drug related litter is undoubtedly unsightly, unpleasant, anti-social and a potential hazard to public health (including those involved in clearance, community residents and also individual drug users). However, unlike most other forms of littering, DRL has provoked a number of local, regional and national responses that each aim to minimise needlestick injury (to non-drug users), promote safer communities and encourage appropriate discarding practice by IDU.
Despite his controversial views surrounding substitute prescription and abstinence, I recently found myself applauding and cheering the University of Glasgow’s Professor Neil McKeganey for making the following statement:
In this regard I am in total agreement with Prof. McKeganey. I believe that sociological research is an activity that should, in part, seek to challenge and question established views of issues that may somehow perpetuate inequality, exclusion and/or stigmatisation of minority groups. Qualitative research with injecting drug users (IDU) therefore is an area that provides fertile ground for making such a stance, in which issues of ‘public concern’ may be raised, scrutinised and challenged on a regular basis.
Take the issue of drug-related litter (DRL) in community settings for example; and more specifically discarded injecting equipment. As with the discarding of any litter, DRL is undoubtedly unsightly, unpleasant, anti-social and a potential hazard to public health (including those involved in clearance, community residents and also individual drug users). However, unlike most other forms of littering, DRL has provoked a number of local, regional and national responses that each aim to minimise needlestick injury (to non-drug users), promote safer communities and encourage appropriate discarding practice by IDU. From a more sociological perspective, DRL has also provoked a number of responses that typically inspire fear and loathing within non-IDU populations (of both drugs and drug users); that in turn may justify various sanctions and legitimate continued negative stereotyping of the ‘irresponsible junky addict’.]
During the course of my research into public injecting environments (at the University of Plymouth) I have encountered each and every one of these views and responses to DRL and IDU – by both non-drug users and amongst those that choose to inject illicit drugs. Indeed, the issue of DRL is perhaps one of the most emotional and politically sensitive issues associated with public injecting and associated harms to public health. Similarly, whilst I have encountered countless examples of inappropriately discarded needles and syringes during fieldwork (i.e. used equipment with needles still attached left in places that may injure others), I have also gathered a wide range of qualitative data that may challenge the stereotype of the reckless, anti-social public injector. That is not to say I believe all public injectors are conscientious individuals and are not involved in contributing towards DRL (my research would contradict this!). However I am of the opinion that some public injectors are involved in what may be best described as a street-based harm reduction practice, which serves to minimise risk and hazard to others that may access sites of public injecting.
This latter finding is based upon my study of public injecting environments in which I have visited over 70 sites frequented by IDU for the purposes of drug administration in the local setting; interviewed IDU/non-IDU about their experiences in these settings and collected video / photographic data from within these public and semi-public venues.
During interviews with 31 IDU it became (curiously) apparent that none of these individuals were currently involved in any form of reckless or inappropriate discarding. Instead, each described the use of portable sharps containers (from needle exchanges or improvisations such as drink containers); or discarding in situ after snapping off the needle or plunging the syringe barrel into soft surfaces (such as soil) and/or dropping equipment into drains or conventional street-based litter bins.
Furthermore, all concerned were of the belief that most of these strategies were not entirely appropriate, but were adamant that they were genuine attempts to minimise other peoples’ contact with discarded sharps and equipment in relevant settings. Despite this range of views denying participation in any ‘harmful’ littering, I was initially very sceptical of this socially responsible behaviour being described to me during all interviews. In fact, I was convinced that this was an example of the ‘interviewer effect’ in which research respondents attempt to portray a more positive self image of themselves regarding involvement in potentially sensitive issues. However, my visual data (photos and video) of DRL gathered during 18 months of fieldwork provided grounds to reconsider these suspicions and actually validated IDU claims regarding their reported disposal strategies in some settings.
During my visits to those places used, and attended almost exclusively (i.e. hidden places, not known or frequented by the public), by local IDU, there was typically large amounts of DRL present. These were typically places used by numerous IDU throughout the day and night. This provided opportunities to build a substantial database of DRL images that could be subsequently categorised into examples of both irresponsible and responsible discarding practice. Whilst the former is perhaps well established, there is no need to include images of potentially harmful, discarded, equipment. What is perhaps more interesting, more challenging and more provocative are those images that may provide validation of IDU responses initially considered to be biased or influenced by the presence of an interviewer (i.e. those that support IDU claims regarding ‘safer’ discarding practices).
This photograph clearly shows 5 sets of discarded equipment taken in an outdoor setting that ‘was used on a daily basis by IDU (at a site of which many of the interview sample had direct experience). This particular site was used almost exclusively by drug users and was not a location frequented or attended by members of the general public. What is perhaps most noteworthy about this image is the almost regimental manner in which the 5 items have been placed onto and into the earth. From this image one could assume at least 5 injecting episodes have taken place at this particular spot, and each episode would almost certainly have not involved the same individual due to the frequency with which the site was used. As such, it is feasible to infer that more than one person had injected at this spot and the equipment had been carefully positioned (rather than thrown aside in a random, haphazard manner) in an attempt to maintain some degree of ‘safety’ within this public injecting setting. Further inspection of this image reveals other significant and relevant features of outdoor injecting; features that further illustrate and reflect the interview responses summarised above. Of the insulin syringes pictured, those numbered 1-4 have had the fixed needle removed from the syringe barrel, whereas Syringe 5 is partially submerged into the soil. This image (and others like it) would appear to provide a forensic resource of injecting behaviour previously described by respondents, in which attempts to ‘make safe’ used, discarded equipment may be visualised’ (Parkin and Coomber, 2009; 27-28).
Furthermore, this photograph is not unique and there are many others showing equally ‘neutralised syringes’; others that have been unearthed or placed ‘pin-first’ into surfaces (such as soil, trees), within nearby items (boxes, discarded boots) and/or placed out of reach of unsuspecting hands (on ledges, behind grills, in plant boxes) and on surfaces above eye-level. Whereas, from a non-IDU perspective, each of these strategies may be considered anti-social and/or dangerous, when viewed from an alternative (IDU) perspective a ‘practical logic’ emerges that perhaps prioritises harm reduction within public injecting settings. That is, the application of a limited street based harm reduction by IDU within outdoor settings that does attempt to discard in a manner that is thoughtful and without malice. Whilst this form of harm reduction is not perfect, it should also be contextualised in the social and political circumstances that surround public injecting.
That is, a wide range of explanations were provided regarding the rationale for such alternative forms of ‘littering’ and these typically related to homelessness, hostel residency (that often prohibit paraphernalia possession), involvement in sex work, ‘grafting’, avoiding police searches and a need to evade interruption and/or detection by the public/police/employees when injecting in public settings (i.e. a need to ‘hit and run’). All of which runs parallel with health issues relating to drug dependency and/or avoiding withdrawal symptoms.
Another contributory factor to DRL discarding related to the nature of needle/syringe distribution from community pharmacies. In the present setting this pack typically contained equipment for 10 injections; however, more often than not (and given the unstable lifestyle of my mainly homeless sample) there was only the immediate need for one set of works. As such, the unused equipment was equally discarded as the remaining 9 sets were surplus to immediate need (and considered by IDU as legitimate reasons to justify stop and search by local police).
As I said, I consider academia to be a valid vehicle for questioning prejudice and stigma. I hope I have provided food for thought with this piece that seeks to present an account of images that challenge.
Stephen is a Research Fellow at the National Addiction Centre at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London. His most notable ethnographic work relates to a multi-site study of street-based injecting drug, drug-related litter and associated harm and hazard from the perspectives of people who inject drugs and frontline staff who encounter such issues in their daily employment. The views expressed in this article are those of the author and do not necessarily reflect those of his employer.