Not All Syringes Are The Same
As you’ll know if you’ve spent any time either working in a needle programme or injecting there are many different kinds of needle available.
The assumption is normally that the needle you’ve used in the past is always the best one for the job and most NSP workers will just go along with this, but at the end of the day not all needles are equal. This article will compare some of the main equipment you can get.
NOTE: This article is only covering injecting into surface veins and not meant for advice on equipment for deeper veins (like the groin).
Standard 1m insulin syringe
This is by far the most popular syringe supplied by needle programmes, available from a number of different companies. This is usually the first needle that people use when injecting and as a result it’s usually the one they’ll use until they either stop, or progress to a higher risk injecting site.
The only problem though, is that this needle was never originally designed for injecting into a vein (IV) but was instead meant for injecting just under the skin (subcutaneous).
It was pointed out during the Avril Taylor study into injecting practices that it’s very difficult to tell whose needle is whose. Although you can still tell the difference by scratching off a number on the side or burning the plunger. (The best bet is of course to never run out of equipment.)
On a plus point though, a recent study into HepC transmission found that this kind of needle keeps back far less blood post injection. This then reduces the risk of passing on the HepC virus via a reused syringe. (NOTE: in reality this isn’t that much less of a risk as most needles that are reused are within a short time of initial use, this makes HepC transmission risk from one of these fixed units only very slightly less than from a separates system.)
I’ve never made it a secret that I’m a big fan of this kind of syringe. The Nevershare was developed by Exchange Supplies in response to the Avril Taylor study as a way of identifying each persons syringe by the colour of the plunger (5 colours available).
This doesn’t mean that these syringes are designed to be reused (no syringe is), but it is a pragmatic response to the unfortunate reality that people do occasionally reuse either deliberately or out of desperation.
As well as being different colours, these also have Nevershare written along the side. Now you might think that this is pointless, but it is in reality called a ‘nudge’ (for more information on the psychology of nudges read Thaler & Sunstein’s great book Nudge).
The needle on the Nevershare is also thinner than most 1ml insulin syringes; this means less damage to the vein. Plus, the needle can be removed from the barrel (although this is not mentioned in the guidance notes for this syringe). Removing the needle allows you to use a filter far more effectively than with a standard insulin syringe.
I have only two problems with this syringe; the first is that the green ones are more difficult to see if they have been inappropriately disposed of (e.g. in grassland or woods). But the second problem is the biggest one for me. Although the needle (including cap) can be removed, it’s not colour coded. The colour coding is only on the plunger, so if the needle is removed it’s still possible to get confused over which needle belongs to you. It’s also worth thinking about where the end is kept while removed (I’ve even caught myself putting one towards my mouth a couple of times when delivering training).
One of the newest needles available is the Filter Syringe from Frontier Medical. This syringe is made in a single fixed system like the insulin syringe. However, the cap includes a tiny filter allowing you to not have to use makeshift filters. And when I say tiny I really mean it; the filter is less than 2mm wide. The good thing about this is that it doesn’t retain any significant quantity of drug. Because a makeshift filter is usually larger it can hold up to 10% of the drug solution, which of course gives it a reuse value which the filter in this syringe doesn’t have.
Frontier have a different approach to syringe identification. They’ve included a number of scratch off sections on the side so people can mark them themselves (although you can also do this with any other syringe). The needle on the Filter Syringe is a 29 guage so slightly thicker than the Nevershare.
As I mentioned previously, once people start using a brand of syringe they tend to stick with the same one for years. I can remember working in one NSP that changed from BD syringes to Terumo and, although both essentially the same thing, we got lots of people complaining that the new syringes where blunt. I spoke to another worker I know in a different area and she told me she had exactly the same complaint from people when they changed from Terumo to BD.
This is why it’s important with introducing these new syringes that people are shown exactly how they are different. Personally, I always take them out of the packaging and physically show people. Frontier Medical have even produced a film showing people how they should use their filter syringe, and Exchange Supplies have supporting guidance notes for the Nevershare.
If your local needle programme doesn’t stock these syringes, and you think they should, then ask them. Both of the companies that produce the syringes are usually happy to send out free samples to NSPs to trial, in many cases they’ll even come and show the staff how to use them. If your service says they can’t get them then you may need to approach your local drug action team (who fund the NSPs) or the local user group (who can advocate for you). In both cases the workers in the NSP should be able to put you in contact with them.
Just a quick note on ‘difficult to reuse’ syringes. I’ve been asked before if I would endorse these in any way, and I won’t. Both the National Needle Exchange Forum (NNEF) and the UK Harm Reduction Alliance have said that these are unsuitable for drug users and that they promote hoarding behaviours of non-retractable equipment. Because of this and the extra costs they incur I personally feel they should be avoided.
There is no perfect syringe for injecting street drugs. Both Exchange Supplies and Frontier Medical have developed good ideas into really innovative equipment, but in reality we need these two syringes to be merged into one.
Since writing this article there have been some changes, Exchange Supplies no longer produce the 1ml Nevershare, but they now produce a fixed needle unisharp in both 29 and 30 gauge and a range of colours. Frontier Medical are now ‘Vernacare’.