Usually this topic would be more about the increased risk of vein injury, or the fact that injection can often be used as a control mechanism. But this time I'm going to focus more of the way I see injecting another person as a type of sharing behaviour, especially within trust relationships.
Who injects who
Normally we of course think of this as being an issue with a male partner injecting a girlfriend or wife, but remember that this can often be reversed with the woman injecting her partner. We even see this in other trust relationships like friends injecting each other, or more experienced injectors showing someone how to inject.
Another time we often see this is with steroid injectors who lack either the knowledge on injecting, or who have been advised to inject in the glute, but lack the flexibility to rotate their body enough to get this site, although I'm not going to specifically discuss the issues around this in todays article I will return to this at a later date.
Control or need?
We know that injection can often be used as a form of control (ie "you need me because I'm the only one who can find your vein") but this can still be in the environment of a trust/loving relationship. It may not even be perceived by either person as a form of control.
But you also have to understand that injecting another person may be seen as helping, if a friend or partner can't get a vein, it may be that there will be less vein damage caused by a more experienced or ‘calmer' person performing the injection. Of course from a worker point of view this is something we can never recommend because of the legal issues raised if someone then dies following an injection by someone else.
Part of the reason I still see this as a ‘sharing issue' even when its not the actual equipment being shared (tourniquets, needles etc) is because there will always be a quantity of blood involved. If you've see the footage from Avril Taylor's research into injectors in Scotland then you'll know that fingers are often used to wipe away blood from injecting sites. Add to this that hand washing is still often all too rare and we have a possible route for blood borne virus transmission.
The bigger problem
For me though there is a far larger problem. What happens when the relationship ends. This could be because of a breakup, a partner overdosing, going to prison or even rehab. At this point we are left with a vulnerable person whose route of choice is injecting, but who doesn't have the technique to inject themselves. I've seen far too many young women who have arms full of abscesses in this situation, or people who start having inappropriate abusive relationships based only on the fact the other person is willing to inject them.
It's at these times that we need to do ALL of the following:
- Rapid access to treatment - traditionally we have prioritised neck injectors, pregnant women etc when it comes to substitute scripting. I feel that we need to see people who have been injected by others in the same risk group and need to be able to get scripted or into rehab fast.
- Route transition interventions - we have to have access to foil within NSPs, in the UK this is still of course illegal under Section 9a of the Misuse of Drugs Act but it needs to change. Some services have letters from police stating it not a policing priority, and some are supplying foil without these. But we all need to push for a law change. However learning to use foil can take a while.
- Teach them how to inject - unless we have VERY rapid scripting or someone already has a good smoking technique then they are likely to inject at the very least a few more times, services need to make sure their staff are competent enough to show people better injecting technique.
- Self-detox advice - as with rapid access to treatment, we should also see this as an opportunity to shorten someones drug use career.
Injecting someone else or being injected by someone should be seen as a sharing behaviour, but we need to be aware of both the risks of BBV and the risks to someone when the relationship ends. At the very least we need to be giving people advice around handwashing and the legal issues. But we have to be ready to do so much more.
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.