Shooting Up, the annual report on infections among people who inject drugs in the United Kingdom, has been published by Public Health England. The report has been produced in collaboration with Health Protection Scotland, Public Health Wales, and Public Health Agency Northern Ireland. People who inject drugs (PWID) are vulnerable to a wide range of infections that can result in high levels of morbidity and mortality. The Shooting Up report provides an update on the extent of infections among PWID in the UK and of associated risk and protective behaviours. Key messages are presented below. Bacterial infections Preventable bacterial infections are increasing. The cause of the rise is not clear and there are likely to be several factors involved. Services that work with PWID should encourage people with skin lesions or other signs of infection to seek prompt medical attention, ensure easy access to needle and syringe programmes (NSPs) and emphasize safer and hygienic injection practices. Hepatitis C Hepatitis C continues to be a major problem among people who inject drugs in the UK, with around 1 in every 4 currently infected. There is early evidence of a modest reduction in the prevalence of current hepatitis C infection and this is likely attributable to the increase in uptake of testing and treatment. However, there has been little change in transmission of new infections among PWID and improved coverage of harm reduction such as NSPs and opioid substitution treatment (OST) uptake are needed to reach elimination targets. HIV The prevalence of HIV remains low, but outbreaks of HIV among PWID continue to occur. As HIV is often diagnosed at a late stage among PWID, regular testing should be encouraged. Hepatitis B Hepatitis B remains uncommon in PWID but vaccine uptake needs to be sustained, especially in younger age groups and recent initiates to injecting where the uptake of vaccination is particularly low. Sharing and re-use of injecting equipment Continued sharing and re-use of injecting equipment remains a concern. Adequate provision of new, sterile injecting equipment is vital to reduce sharing and re-use and the associated risks. Psychoactive drug trends Changes in psychoactive drug preferences could lead to riskier injecting practices, particularly the observed increase in injection of crack cocaine in England and Wales, and increase in injection of powdered cocaine in Scotland. Effective interventions Provision of effective interventions, including OST and NSPs, need to be maintained and optimised [1,2]. In addition, the appropriate provision of the following services needs to be maintained and optimised to prevent and treat infections [2]:
diagnostic testing for blood-borne infections, including HIV, hepatitis C and hepatitis B
access to care and treatment for those infected
vaccinations, including for hepatitis B
information on avoiding injection site infections and easy access to wound care services and treatment for injection site infections
Sufficient coverage of these interventions is vital to prevent infections and should be responsive to changes in the pattern and the nature of injecting drug use. References
NICE (2014). Needle and syringe programmes: providing people who inject drugs with injecting equipment Public Health Guidance, PH52.
DH (2017). Drug Misuse and Dependence: UK guidelines on clinical management.