HPR volume 16 issues 1 and 2: news (10 February 2022)
Updated 30 December 2022
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Infections and other injecting-related harms among people who inject drugs in the UK: annual report in summary
‘Shooting Up’, the annual report on infections and other injecting-related harms among people who inject drugs (PWID) in the UK, has been published by the UK Health Security Agency. The report has been produced in collaboration with Public Health Scotland, Public Health Wales, and Public Health Agency Northern Ireland.
PWID are vulnerable to a wide range of blood-borne viral and bacterial infections, which can result in high levels of morbidity and mortality. The Shooting Up report describes infections, associated risk behaviours and other injecting-related harms among PWID in the UK to the end of 2020, in the context of the coronavirus disease (COVID-19) pandemic.
Main messages from the report
Preliminary bio-behavioural and other surveillance and research data indicate PWID in the UK have been adversely affected by the COVID-19 pandemic in 2020, with access to services severely limited. Overall, 22% of PWID surveyed in England, Wales and Northern Ireland reported difficulties accessing HIV and viral hepatitis testing in 2020 compared to 2019 and 25% difficulties accessing equipment for safer use, or injection of drugs.
It will be crucial to continue to monitor trends in access to services affected by the pandemic, as well as COVID-19 among PWID, to estimate the impact on national HIV and viral hepatitis elimination efforts.
Hepatitis C (HCV) continues to be a major problem among PWID in the UK, with around 1 in 4 currently infected with HCV and no evidence of a reduction in new HCV infections over recent years. There is evidence for a reduction in chronic HCV prevalence concomitant with the scale-up of direct-acting antiviral treatment among PWID since 2015.
It is important to continue to test those with ongoing risk regularly to identify re-infection and reduce the risk of transmission early; it is also essential that diagnostic services and care and treatment pathways for those with HCV are optimised to meet the needs of PWID, ensuring no-one is left behind.
Although hepatitis B virus (HBV) vaccination is recommended as high priority for all people who currently inject drugs, around a third of PWID have never been vaccinated. Even though HBV infection among this group is currently rare (12% among PWID surveyed in England, Wales and Northern Ireland), it is essential that guidelines on vaccination are followed. Vaccination should be particularly promoted among PWID of younger age and recent initiates to injecting, for whom uptake is known to be low.
HIV infections and outbreaks continue to occur among PWID, although prevalence in this group remains comparatively low at 1.1% in England, Wales and Northern Ireland in 2020 and 3.8% in Scotland in 2019 to 2020. It is important that testing for HIV is offered regularly to all those at risk and that care pathways for those with HIV are optimised and maintained.
Cases of bacterial infections among PWID dropped in 2020, although this is thought to be due to limited hospital activity as a result of the pandemic. There were 106 invasive group A streptococci cases associated with injecting drug use, as well as 35 meticillin-resistant Staphylococcus aureus (MRSA) and 319 meticillin-sensitive Staphylococcus aureus (MSSA) cases.
To prevent rates of bacterial infections increasing, drug and alcohol services should facilitate easy access to needle and syringe programmes (NSP), embed regular opportunities to discuss safe and hygienic injection practices with clients and provide low threshold and outreach wound care services.
The recent increase in the sharing and re-use of injecting equipment is of concern. Sharing of needles, syringes and other injecting paraphernalia, such as filters and spoons, was reported by over 2 in 5 PWID in England, Wales and Northern Ireland and 1 in 5 PWID in Scotland. A third of PWID in 2020 report inadequate provision of NSP.
A range of easily accessible harm reduction services for all PWID, including NSP and opioid substitution therapy (OST), needs to be provided. Socially excluded communities, such as PWID experiencing homelessness and those not currently in contact with drug and alcohol services, should be specifically supported to access harm reduction services, regular BBV testing and care.
Changes in psychoactive drug preferences could lead to riskier injecting practices. Crack cocaine injection in England and Wales remained high in 2020 at 58% among PWID who had injected in the preceding 4 weeks.
More common in Scotland, injection of powder cocaine continues to rise to 37% among people who injected in the last 6 months, up from just 11% in 2011 to 2012. There is a need for local treatment and harm reduction systems that can respond to both the increasing numbers and the specific needs of people who use crack and powder cocaine.
Reports of both fatal and non-fatal overdose have increased in the UK, with overdose most common among people using and/or injecting opiates. This is in the context of improved availability of naloxone, an emergency antidote for opioid overdose, and increased self-reported carriage of take-home naloxone among PWID.
In 2020, 19% of PWID surveyed across drug and alcohol services in England, Wales and Northern Ireland reported overdosing to the point of losing consciousness in the preceding year and of those, 61% reported receiving naloxone.
In Scotland, these figures were 16% and 56% respectively in 2019 to 2020. Services working with PWID should provide materials to increase awareness of and information about overdose risks and provide training for peers and family members in overdose prevention, recognition and response, in addition to providing and encouraging consistent carriage of take-home naloxone and providing OST.
Infection reports in this issue
Common animal-associated infections (England and Wales): up to fourth quarter 2021.
Meningococcal disease: laboratory-confirmed cases in England: annual and quarterly reports.
Laboratory confirmed cases of pertussis in England: April to June 2021.
Laboratory confirmed cases of measles, rubella and mumps, England: July to September 2021.
Acute hepatitis B: national enhanced surveillance report January to June 2020.