I'm sure that most people who read this blog know what UYB means, but for anyone stumbling across it randomly what are unsure its Up Your Bum.
Although by most needle exchange workers UYB is a recognised tool for harm reduction there is still some confusion and disagreement on when and why to give this advice. Or even if we should give it in the first place. Hopefully this should answer some of the more common questions and give some tips for workers who want to give the advice but haven't yet felt comfortable doing it.
So whens it best to UYB?...
Well personally I'm not that convinced that anybody is ever likely to do this route on a regular basis. Even ignoring the fact that some men feel uncomfortable with putting a syringe up their arse (women are more used to the idea of 'inserted' meds in my experience), I don't see it being as effective with a constipated heroin injector, as meds inserted this route are with anyone else.
But to me there is one situation that really suits this advice, the struggling arm injector. You see, once you have blood in the solution you have about 10 minutes at most before it starts clotting. Once you have a clot you have a couple of options:
- Just inject the clot - not a great idea, clots tend to make their way to places you don't want them. Mainly to the heart, brain or lungs; none of which are good for continued health.
- Filter out the clot - to most people its not a great option, if a fresh filter is used then more of the gear is lost plus there is always the chance of the filtering process not being that effective. This option also means that blood has been introduced to the cooker/spoon increasing the risks of hepatitis transfer.
If I get someone struggling with a site that's when I go the UYB route, I'll discuss it with the injector as an option and give them a couple of 1ml barrels and lube.
Make the discussion quite light hearted, personally I start by saying "ok I'm going to suggest something that might sound strange if no one has mentioned it before, but bear with me." You'd expect most people to struggle with the idea, but from experience I can honestly say most people seem fine with this advice.
Just one last note, there has recently been a discussion on UKHRA's discussion list about possible complications caused by over acidified heroin being used rectally. The consensus seems to be that it may be a problem with long term use or if you have a pre-existing problem in the area, but on the most part it should be OK.
If you don't already have a copy in your exchange HIT produce a great leaflet that can be purchased from their website.
Nigel Brunsdon is the owner of Injecting Advice.com. He's been working in harm reduction since the 1990's, although he's previously a frontline needle programme worker he now spends most of his time developing online resources for drugs workers and users.