In early February, Public Health England published the latest volume of their Shooting Up report - an annual report that seeks to understand the types of and numbers of infections amongst people who inject drugs (PWID). Using a combination of surveys, research studies and laboratory data, the report explores “infections, associated risks and behaviours among PWID in the UK to the end of 2019” - as well as a first glimpse into the impact of the COVID-19 pandemic on this group.
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Infections amongst PWID have long been a concern: the report reveals one in every four PWID is chronically infected with hepatitis C, and the authors stress the importance of maintaining high levels of vaccination and treatment - as well as reducing needle sharing where possible - to keep HIV and hepatitis B levels down.
The latest report and its accompanying dataset can be found here, but read on for an overview of the main points, and our take on the implications of this data for the future.
Infection rates
HIV incidence amongst PWID remains low across the UK - just 0.82% of PWID across England, Wales and Northern Ireland. However, testing needs to be increased, with just 39% in England, Wales and Northern Ireland having been tested in the current or previous year. Of those who stated they had never been tested, 97% had visited a GP, used a needle and syringe programme or been prescribed an opioid substitution in the previous year, meaning opportunities for HIV testing are there.
While HBV prevalence remains very rare - just 0.28% of those surveyed were infected with HBV at the time - vaccine take up has plateaued. Just 73% of PWID in England, Wales and Northern Ireland and 70% reported they had been vaccinated, with numbers significantly lower in younger age groups, and amongst those who had begun injecting more recently.
Chronic HCV prevalence is also down, but serious bacterial infections have continued to rise. This could be down to increased levels of homelessness in England, Wales and Northern Ireland, as well as significant numbers of PWID injecting into their groin - a high risk site due to higher levels of bacterial carriage.
Risk behaviours
Despite the work that has been done to reduce risk behaviours amongst PWID, the latest report shows no reduction in behaviours which include the sharing of equipment like needles, syringes, filters and spoons. In England, Wales and Northern Ireland two in five people report sharing such equipment - a figure lower in Scotland, at one in five.
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With blood-borne viruses more likely when equipment is shared or reused, it is vital PWID have access to injecting equipment which is new and sterile. Survey data shows just two-thirds of PWID believe this supply is adequate.
Blood-borne viruses can also be transmitted sexually. 40% of those surveyed who had had sexual intercourse in the last year had done so with two or more partners, and only 23% of this sub-group reported using condoms every time.
Psychoactive drug use
Heroin remains by far the most injected drug in the UK, injected by 93% of PWID in England, Wales and Northern Ireland who had injected in the last month, and by 89% of those in Scotland who had injected drugs in the last six months. However, the injection of other substances is on the rise.
In England and Wales, 57% of those who had injected in the last week reported injecting crack; while in England, Wales and Northern Ireland, injection of other forms of cocaine in the last four weeks rose from 6.6% in 2010 to 17% in 2019.
In Scotland, it appears that crack is less of a problem: injected by just 5% of those who had injected drugs in the previous six months. However, amongst Scottish PWID, powder cocaine injection rose from 9% in 2010 to 37% in 2019.
The impact of COVID-19
Preliminary data from PHE regarding the impact of COVID-19 on PWID reveals that it is unclear whether they are disproportionately affected by the disease. One in ten of those surveyed between June and October developed COVID-19 symptoms, with 32% attending hospital as a result of these symptoms.
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However, the pandemic has affected this group in other ways. 15% reported injecting drugs more often and 27% stated that they were smoking drugs more often. Cocaine and amphetamine use increased (both injecting and non-injecting), as well as alcohol use rising amongst this group.
The pandemic has also made it more difficult for PWID to access the services that they need - including drug and alcohol services, HIV and hepatitis testing, substitute drug treatment, and other medicines and healthcare. There were, however, some who saw the pandemic as a reason to decrease or stop their drug use.
Learnings for the future
While there are some positives to take away from the latest Shooting Up report, there are also areas of concern - and areas where authorities, medical facilities and testing providers could do more.
HIV, HBV and HCV incidence are low, but it remains important to keep access to testing and treatment services high, and increase the availability of HBV vaccines. It is clear that more could be done to reduce the likelihood of equipment sharing and blood-borne virus infections, while more needs to be done to identify and treat crack and powder cocaine users before their addiction becomes too strong.
As COVID-19 continues, it is vital that treatment and testing centres remain vigilant and continue to provide their vital services to PWID - who are already finding it hard to access the services they need, and a subset of whom is either increasing existing drug use or switching to alternative substances, possibly as a result of the pandemic.
At Cansford Labs, we have remained fully operational throughout the pandemic, meaning that drug and alcohol testing can still be carried out safely, reliably and accurately, even during the most challenging of times.
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