Case studies

The agency in Somerset that first piloted the foil has been keeping a record of who's been taking it and keeping track of the responses, below are a series of short descriptions of the responses by all the clients who've picked up foil from that agency, and one other, and been back to report.

It's early days and they're working to continue the data collection and hope to publish the stats and stories later in the year.

But the response has been so positive sumarised by the second site as "having frequent requests for the foil from injectors that were sceptical about it initially and are reporting back with very positive outcomes."

they thought it would be useful for other workers to see how thier clients had responded to the introduction of foil. Below are a series of un-edited vignettes/case studies as supplied by the agency.

Male 38yrs:
Was injecting 10x daily had not smoked in last 4 weeks. Given foil – now smoking twice weekly and injecting less – 5x daily. Says he is smoking at times he would normally inject. Thinks that supplying foil encourages people to smoke rather than inject and has made him consider his injecting behaviour.

Male 29yrs:
Was femoral injecting 3x daily had not smoked in the last 4 weeks. Given foil now smoking twice daily three times a week. Smoking at times he would normally inject. Injecting twice daily. About to start subutex script feels that smoking will help him stop injecting completely when script starts. 6 months later. Stopped smoking for a while – it was difficult to smoke at home as his partner did not like the smell and he could not hide his use. He has now split with his partner and living back with his parents – now starting to smoke again occasionally.

Female 31yrs:
Previous heroin smoker was Injecting 5x daily had not smoked in last 4 weeks. Had heard that we were providing foil and specifically asked for it. Given foil and now smoking twice daily, no longer injecting.

Male 40yrs
Injects 4-5x daily. Smokes 3x weekly. Given foil – smokes 4-5x weekly has smoked at times he would have injected. Having foil around made it easier and therefore more likely that he would smoke rather than inject. Has also been giving it to others to try – feels they all smoked more than they usually would because they had foil available.

Male 26yrs:
Took foil for someone else who he says smoked instead of injecting and stopped injecting.

Male 40yrs:
Was injecting 3-4x daily. Had smoked previously on average 2x weekly. Used foil most days – usually in the morning instead of injecting so now injecting 3x daily. Feels that foil should be stocked in the n/ex as people are more likely to smoke.

Female 32yrs:
Injecting into femoral vein twice daily had smoked previously but not in the last 4 weeks. Smoked rather than injected on a few occasions – felt that she missed the feeling of the hit – but wants to stop injecting (on a script) and will persevere with smoking as she feels it is a first step to stop injecting. Managed to stop using completely for 7 days last week. Also said it stopped the risk factor of having needles around (with children).

Male 26yrs:
Injecting 2-3x daily had also been smoking daily (was previously a heroin smoker). Used foil – now injecting every fourth day smoking daily – has cut down injecting and drug use.

Male 43yrs:
Injecting 2-3 times per week. Was already smoking 2-3 times per week. Used the foil and smoked at times he would have injected. “it’s better than other foil. Keep it up it’s reduced my injecting a bit”

Male 43yrs:
Injecting twice daily. Used the foil and smoked at times he would have injected. “Alright but a bit small”.

Male 28yrs:
Injecting twice daily. Already smoking occasionally (1-2 times in last four weeks). Tried foil – smoked at times he would have injected. “not as effective as injecting but should be given out in the needle exchange”

Male 21yrs:
Injecting twice daily. Had smoked occasionally in the last 4 weeks. Used the foil once daily but not at times he would have injected. “Alright good cause you didn’t have to burn it! There are less fumes than ordinary foil”

Female 26yrs:
Injecting 1-2 times a day. Had not smoked in the last 4 weeks. Used the foil 1-2 times a week and smoked at times she would have injected. “Very confident and helped me to cut down injecting as get embarrassed buying foil”

Female 36yrs:
Injecting every other day post detox (femoral) 3 previous DVT’s partner injecting daily (femoral). Had not smoked in the last 4 weeks – “not for years”. Both used foil daily smoked at times they would otherwise have injected – half injecting half smoked. “shop foil gets holes in it this is better. I wouldn’t bother smoking it unless foil was given in the needle exchange”

One month later. No longer injecting. Uses foil to smoke every other day. Partner still injecting, says she would not smoke if the foil was not available in the needle exchange – “I wouldn’t bother the foil here is good quality”

Male 34yrs:
Injecting 6 times daily. Used foil twice a day. Smoked at times he would have injected. “You get dirty fingers – it’s cut down my injecting by third”.

Male 34yrs:
Injecting 3-4 times daily. Used foil – smoked at times he would have injected. “Really useful used in the mornings if I had difficulty. Has reduced my injecting.” Also finds that because he has the foil around other people will use it – “makes heroin use more sociable”

Male 27yrs:
Injecting 3-4 times daily (femoral). Had not smoked in the last two weeks. Used the foil 1-2 times a week. Smoked at times he would have injected. “Good quality – o.k. size”. Asked for more but none in stock – encouraged to continue with own foil.

One month later still using foil now 2-3x weekly. On methadone script, has reduced his heroin use – foil has helped to reduce IV use.

Male 32yrs:
Injecting every 2-3 days (femoral). Had not smoked in the last four weeks. Smoked in the evenings at times he would have injected. “Good. Has reduced my injecting”

Male 23yrs:
Injecting 3-4 times daily. Had smoked in the last four weeks. Used foil twice a week – smoked at times he would have injected. “It’s good cause it’s the right size. Because it’s there, I use it wouldn’t have gone searching”.

Male 33yrs:
Injecting 1-2 times per day. Is using the foil daily when he has it and smoking at times he would have injected. The foil has helped him to reduce his injecting. He was previously smoking as well as injecting and now that he is having difficulty finding his veins and foil is being given out in the needle exchange he has increased his smoking and reduced his injecting.

Male 35yrs:
Was injecting 3-5 times daily before taking the foil and smoking his heroin once or twice weekly. On follow up he is now smoking heroin daily – at times he would have injected. He has reduced his injecting to twice daily. “I like the foil it is the perfect thickness for me. Good size and I don’t have to burn it off. I am more likely to smoke because the foil is available – I used to run out of money or not bother to buy it”. He says that he always smokes his heroin after drinking more than one can of alcohol now to lessen the risk of overdosing.

Female 28yrs:
Injecting twice daily was smoking approx twice a week. Now using the foil 3x weekly. Is smoking at times she would have injected because it’s more available. She has reduced her injecting to approx. three times a week (is on a substitute prescription) and now halves her heroin and if she can’t inject she smokes instead.

Female 24yrs:
Injecting 2-3 times daily had smoked in the past but not in the last 4 weeks. Used the foil once or twice but said that it made her feel sick and so stopped using it.

Male 43yrs:
Injecting once or twice daily had smoked in the past but not in the four weeks before being given foil. Used foil and is now smoking twice weekly at times he would have injected. “I liked the foil because it’s thicker than the normal stuff”.

Male 46yrs:
Previous injector – not seen in the needle exchange for six years now smoking heroin had used foil from the exchange given to him from some one else. Came in to ask for foil – now using it exclusively – “it’s the thickness this pack is a better size.”

Male 25yrs:
Injecting 4-5x daily smoking 2-3x per week. Used the foil now smoking more frequently 3-4x weekly at times he would have injected – says that it has helped him to reduce his IV use. “Spot on, handy, definitely a good idea”.

Female: non-injector.
Foil was being taken from the exchange by partner. Now using the foil every time and came in to request foil herself. “It is better to have the foil available – I do not need to buy it and don’t run out. I am trying to cut down my use and persuade (partner) to cut down his IV use.

Male 31yrs:
injecting (femoral) 3-4x daily has smoked in the past but not recently. Used the foil once or twice to try it and gave it to others to try. ”I’m groin injecting – not ready to smoke it yet but good to know it’s available.”

Second distribution site case reports

Male 26yrs:
Was injecting every day, given foil - now smoking daily has stopped injecting completely. “This foil is excellent, I would even pay for it, It’s clean nice and thick, it’s perfect. Foil from the shops is rubbish but I think this foil is 10 out of 10”.

non-injector.
Used foil every time. “Clean non-toxic manageable square and size and about time too! I think this will draw IV users to foil as most of the time it’s purely speed of effect.”

33yr old male
accessed our service on hearing that we supplied foil.. He is a non injector, he would not have accessed our service for any other reason. Through the discussion and assessment process he asked us to refer him to the prescribing service for a methadone prescription.

29yr old male
injecting for over 5 years. Has a partner who smokes only. took some home for her when collecting his equipment. On his next visit he told us that he had tried the foiland is now smokingat least every other day instead of injecting.

22yr old male.
He is a known dealer in town and took some foil for those that use heroin in his flat and do not usually inject, to reduce the initiation risk of those that may be tempted toinject or ask an injector to inject them. Break the Cycle completed at the same time

If you're giving out foil (or using it) and want to share your stories/case studies please feel free to drop andrew@exchangesupplies.org a line, and we'll put it up here.