We talk to people a lot about how they inject, what they inject and where on their body they inject it.

But how often do we talk to people about their injecting environment? And the effect this has on both their injecting risks and their perception of drug use.

We’ve seen from the previous articles by Dr. Stephen Parkin on ‘Blue Lights‘ and ‘Displacement of Public Injecting‘ that where someone chooses to inject can have a real effect on risk. But how often is this missed out on at the assessment stage? In fact think back over the recent conversations you’ve had with any injectors, has the discussion ever got to the stage where you’ve talked about environment? Different environments of course have different risk factors, here are some examples:

Public toilets

Although they can offer a level of security for people who are homeless these can be quite high risk sites.

• Water sources are normally in public areas, so fear of discovery often stops people accessing them, instead choosing to use water from the toilet cistern.
• There are many public toilets installing blue lights to discourage injectors, however rather than discouraging injecting these lights instead make people move to the higher risk sites like the groin which don’t require seeing the vein.
• The main issue is though that most people injecting in public toilets are likely to be lone injectors, and because of the environment they will have locked themselves into a cubicle with little or no chance of being discovered if they overdose.

Public areas

This would include areas like alleys, car parks and waste ground.

• Again there is an issue with clean water sources in this kind of environment, both for handwashing and preparation water.
• The fear of discovery can push people to using higher risk factor injecting sites like the groin.
• Poor lighting in outdoor injecting environments can also stop people accessing visible veins on arms and make them move to sites like the groin.
• Preparation of injectable drugs can be a problem in outside areas due to the lack of stable, clean surfaces as well as problems caused by wind and rain.

Communal injecting spaces

By this I of course don’t mean safer injecting sites like the ones provided at services like Insite, but instead the kind all over the country (and around the world) with people who inject grouping together in a shared environment for the perceived safety and community it offers.

• A major risk here is of course either deliberate or accidental sharing of equipment and preparation surfaces. This can lead to increased chances of contacting blood borne viruses, and have also been identified as increasing the risks of contracting tuberculosis.
• Increased chance of vulnerable people being physically or financially abused, this kind of environment is often ‘managed’ in some way often by the home owner and the perceived safety offered normally comes at a price, either financially or with ‘payment in kind’. (Although this isn’t always the case it is an aspect that needs to be discussed.)

Injecting at home

Although at first this may seem one of the lowest risk environments it can in fact have all the risk factors above …. and more. Some things to consider are:

• Do the people living with the injector know about the drug use? If not this can lead to hidden, rushed injecting that can often be in higher risk sites like the groin.
• Does the person inject alone with the awareness of partner (to be away from children etc) if so how long would they be left after an overdose before someone checks on them?
• Do they share with a partner, and do they even see this as sharing?
  How are they storing their drugs and injecting equipment if there are children in the home?

This is just a short article and it’s only meant to cover the basic of a few locations people inject in, there are far more that will come up but first you have to actually start the conversation with people to raise the issue.