Research
2ml glass amp pilot studies – interim report and summary of results so far.
In order to evaluate the provision of 2ml glass ampoules of water for injections we have funded an inital trial and outcome audit in over 70 services, the report below summaries the trial results so far.
Introduction
The sharing of water is known to be a significant vector of bacterial infection and blood-borne virus transmission. To reduce injecting related harm, since 2003 changes to both the Misuse of Drugs Act and Medicines Act have allowed water for injection to be distributed to drug users without prescription.
However, the only 2 ml licensed water for injections available in the UK is in a glass ampoule. Exchange Supplies are actively persuing a licence for water for injections in a plastic ampoule. In the meantime, to reduce the risk of bacterial and blood borne infection among injectors, we have included water for injections in glass 2 ml amps – supplied with a free ‘safesnap’ ampoule breaker – as part of our range of harm reduction products.
To test the effectiveness and response to the supply of the glass water amps, Exchange invited services to run a free trial within their needle exchanges.
This report summaries the responses from the 18 trial sites that have reported to date, and covers a total of 265 client survey forms.
Conclusion
The provision of 2ml water ampoules was, in general, very well received by both injecting drug users and service providers. Fears of widespread glass cuts from the ampoules were not realised, as most injectors were happy to use the free safesnap amp snappers.
There is still an understandable preference for a small volume plastic ampoule and we are actively trying to make this available, however in the interim the majority of the services who took part in the pilot are either supplying the 2ml glass ampoules and amp snappers, or are seeking funding to do so.
We are continuing with the trial, and will update this summary report when we have more results back from participating services.
Data collection
Between July 2006 and May 2007, over 70 services signed up to trial 2 ml glass water amps and safesnap amp snappers. Each service was supplied with 1000 2ml glass ampoules of water for injections, 100 ‘safe snap’ amp snappers (for risk-free opening and disposal) and 30 survey forms containing a semi-structured short questionnaire for user feedback.
Once water was sent out to each service, a follow up telephone call checked the water had been received offering a meeting to demonstrate how the safe snap worked. Any questions or concerns were answered prior to the distribution of the water to clients. Services were also reminded to collect the views of their service users via the survey questionnaires to inform both local and national evaluation of the amps.
Several services stated they were only going to offer their homeless clients the water amps in order to provide this intervention where they felt it would reduce the most harm. Other services offered all clients equal access to the water amps.
People were asked to fill out the survey form after using the water amps at least once.
The results
Total number of forms returned: 265
Male 75% (201)
Female 16% (42)
Did you use the amp snapper?
Yes 89% (237)
No 8% (22)
Almost 9 out 10 clients used the safe snap with the water amps to reduce the risk of cuts and transmission of blood borne disease. Despite associated risks, a minority of clients appear to have broken the glass amps open without the use of the safe snap.
If yes, did it work well?
Yes 84% (218)
No 9% (25)
A few user comments indicated some difficulty with using the snapper e.g. “due to withdrawing unable to see blue dot and place amp in correctly” and “Its an ordeal to put bottle in snapper the right way”. However, nearly 85% of people stated the safe snap was effective in preventing cuts. Feedback included, “They are easy to use and you don’t cut yourself”.
Did you cut yourself, or see anyone else cut themselves, on the glass amps?
Yes 12% (32)
No 84% (223)
There were a small number of cuts during the introduction of the ampoules, some people reported (unsurprisingly) that they would, in future, use the safesnap as a result of cutting themselves once. It is also unlikely that the cuts resulted in blood contamination that would have placed anyone at risk from a blood borne virus, wheras shared water –which is a common occurrence when water is not supplied – carries a high risk of blood borne virus transmission.
Although technically not covered by the changes to the Medicines Act, 5ml plastic amps are available from some services and we wanted to compare risk so respondants were asked:
Have you ever seen more than one person draw up from a 5 ml plastic amp?
Yes 15% (40)
No 78% (208)
It is concerning, although not surprising, to note that even though 5ml plastic amps were not available from all the services involved in the trial, overall 15% of respondents stated they had seen sharing taking place from the 5 ml amps.
Did you see more than one person draw up from a glass amp?
Yes 9% (25)
No 77% 203)
A significantly lower 9% had seen sharing of water from the 2ml amps (although this was a larger sample as, clearly 2ml amps had been available to all respondants) however, the figure of 9% indicates the need for workers to address this issue specifically with injectors coming into the needle exchange.
Would you like to see glass 2 ml amps and amp snappers as a permanent option available from the needle exchange?
Yes 86% (227)
No 10% (27)
An overwhelming majority of injectors felt that 2 ml glass amps would a useful addition to their needle exchange supplies.
Notes:
All percentages are rounded up or down to the nearer whole number.
Not all respondents answered all the questions on their form e.g. several forms did not indicate whether the respondent was male or female.
