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. 2017 Jan;39:99-108.
doi: 10.1016/j.drugpo.2016.09.005. Epub 2016 Oct 24.

Acceptability of Low Dead Space Syringes and Implications for Their Introduction: A Qualitative Study in the West of England

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Acceptability of Low Dead Space Syringes and Implications for Their Introduction: A Qualitative Study in the West of England

Joanna M Kesten et al. Int J Drug Policy. .
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Background: It is recommended that needle and syringe programmes (NSP) distribute low dead space syringes (LDSS) to reduce blood-borne virus transmission. We explored the acceptability of detachable LDSS among people who inject drugs (PWID) and staff who work to support them.

Methods: Semi-structured interviews were performed with 23 PWID (15 men and 8 women) and 13 NSP staff members (6 men and 7 women) in Bath and Bristol, England. Recruited PWID reflected varying demographic characteristics, drug use and injecting preferences. Interviews explored experiences of different types of injecting equipment, facilitators and barriers of changing this equipment and attitudes towards detachable LDSS. Interviews were audio recorded, transcribed verbatim and analysed using the Framework Method.

Results: Decisions about injecting practices were underpinned by several factors, including early experiences and peer initiation; awareness and availability of alternatives; and the ability to inject successfully. Rinsing and re-using syringes represented a quandary where rinsing could encourage re-use, but not rinsing could result in the re-use of unclean equipment. Most PWID were reluctant to change equipment particularly in the absence of any problems injecting. Prioritising getting a 'hit' over the prevention of potential problems was an important barrier to change. Overall detachable LDSS are likely to be acceptable. Lower risk of transferring infections and reduced drug wastage were valued benefits of detachable LDSS. There was a preference for a gradual introduction of detachable LDSS in which PWID are given an opportunity to try the new equipment alongside their usual equipment.

Conclusion: Detachable LDSS are likely to be acceptable and should therefore be offered to those using detachable high dead space syringes and/or fixed 1ml LDSS syringes to inject into deeper femoral veins. An intervention is needed to support their introduction with 'training', 'education', 'persuasion' and eventual 'restriction' components.

Keywords: Acceptability; Low dead space syringes; Qualitative research.


Figure 1.
Figure 1.
Illustrations of dead space in common needle and syringe designs (artwork licensed by Creative Commons) Reproduced with permission from William Zule. From left to right: Standard detachable needle on standard syringe, Standard detachable needle on low dead space syringe, Low dead space detachable needle on standard syringe, Low dead space syringe with fixed needle

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