Where does the water come from? Elizabeth Hutchings - Substance Misuse Pharmacist Helen Coulter – Harm Reduction Pharmacy Technician

Background 2010 – “Guidelines for services providing Injecting Equipment” Recommendation 6: Water for Injections, included in paraphernalia, should be made available. Amendment to the Medicines for Human Use, Order 2005, permitted the supply of Water for Injections without a prescription. Available from specialist sites for about 3 years – last year 23% of syringes Back in 2010, as one of the actions of the Hepatitis C Action Plan, the Guidelines for services providing Injecting Equipment were published and included a recommendation that Water for injections should be supplied as part of the “paraphenalia” accompanying needle and syringes. The reason behind this was evidence that the Hepatitis C Virus was found in 33% of water samples that had been collected and tested and that if water was shared amongst injecting drug users this could be a source of transmission of the virus. A previous amendment to the Medicines for Human Use Order 2005 allowed the supply of Water for injections without a prescription The lack of a suitable product (2ml plastic ampoule) meant a delay in adding water to IEP supplies Addaction have been supplying Water for Injections for the last three years or so and last years stats indicated that 23% of syringes supplied were accompanied by an ampoule of water for injection. A number of issues have delayed the introduction of Water for Injection – not least finding the budget for this and we needed to know what our clients were using at the moment – hence the survey.

The Survey Where do service users obtain water? Is this a safe source? Sharing Sources of water. Using clean equipment or NOT!!

Sources of Water Unopened Ampoule Water for Injection Boiled and cooled Water from a Kettle. Kitchen Tap-Cold Water. Bottled Water. Hot Water from Tap. Water from (public) toilet Puddle Water. Part-Used Ampoule Water for Injection. Shared cup of water

Unopened amp- gold standard Boiled water- virtually kill all organsims, this is the advice given to injectors Kitchen Tap – reason – water fed from the rising mains which in the UK is virtually or completely free from bacteria. Bottled Water- bacteria count higher than in tap water, varies depending on temperature it is stored.(Injecting not drinking) Hot Tap- water not hot enough to kill bacteria- encourages bacterial growth.

Have you prepared drugs or rinsed works with water that had already been used by someone else? Never Previously but not currently Often(once a week or more) Regularly (once a day or more) Sometimes ( less than once a week)

Of all the needles & syringes used in the last six months, how many were new & unused (where 0 is none & 10 is all) 1 2 3 4 5 6 7 8 9 10 Spot the mistake!!

This leaflet has been included in the pharmacy packs in the past (possibly now?). It is a great pictorial representation indicating best to worse sources of water but does imply that all users should aspire to using Water for Injection. Realistically we need to promote boiled and cooled water or cold water straight from the mains for the majority of clients

Water Risks Never share a cup, bottle or an ampoule of water Boiled and cooled -easy and safe Cold water from the kitchen tap – good but if you’ve got a kettle boil and cool it as well Hot water from the tap – risk of bacterial infection – use the cold water tap. Bottled water – risk of bacterial infection - better to use tap water Water from a toilet – high risk of bacterial infection - use water for injection Puddle water – high risk of bacterial infection – use water for injection Never share a cup, bottle or an ampoule of water So – a little recap Water for injection will be available from Injecting equipment pharmacies soon This short training will have to be undertaken - I hope those of you here tonight will feel able to cascade to your staff and we will deliver the water for injections very soon. Having it available provided you with an opportunity for a “brief intervention” to check current practice, correct any misinformation ensure that clients with no alternative but to use water with a high risk have a safe source Reinforce the message that sharing water – however risk free it started out – is a very risky business. GOOD BAD

Any Questions ?