Abstract
People who inject drugs (PWID) are potentially exposed to a large range of vascular injury, soft tissue injury and infection exposure as a result of injecting-related injuries and diseases (IRIDs). IRIDs are largely preventable, with research demonstrating that good injecting practice substantially reduces risk of complications. Abscesses and cellulitis are two of the most prevalent complications of injecting drug use, with Tsao et al. reporting 55.4% of hospital visits with injecting drug related complications were diagnosed as abscesses or cellulitis (Tsao, Marder et al. 2002). Moreover, evidence suggests that such abscesses and cellulitis can be prevented with correct equipment and aseptic technique with alcohol sterilisation (Vlahov, Sullivan et al. 1992). Other adverse injecting outcomes have more educational based protective factors, such as avoiding high risk injecting sites which lead to adverse vascular outcomes (Mackenzie, Laing et al. 2000). Any of these outcomes can have severe negative impacts on the health and wellbeing of PWID, as well as be a source of healthcare costs. International research has reported on the high prevalence and frequency of such outcomes, e.g. (Topp, Iversen et al. 2008, Dwyer, Topp et al. 2009, Larney, Peacock et al. 2017), and emphasised the importance of improved epidemiological data. Very limited data available in Aotearoa New Zealand suggests a similarly high prevalence (Noller 2014); however, the burden of disease of these IRIDs is currently unknown as no formal investigation of their prevalence has occurred.
DISC Trust is a peer-run organisation providing care, sterile injecting equipment, and harm reduction advice to the PWID community in the South Island (Te Waipounamu). DISC Trust’s peer-based approach has been advantageous in earning the trust of PWID, attributed to the shared understanding of lived and living experience of injecting between staff and clientele, which results in multiple benefits including client mental health (Hay, Henderson et al. 2017). For many clients, the DISC Trust may be the only health provider they have contact with. To be able to reach PWID who utilise the needle exchange, this may give insight into a population that may otherwise be avoidant of mainstream healthcare due to barriers to access.
This research aimed to provide preliminary data on IRIDs which can contribute to future estimation of national prevalence and frequency, as well as economic impact on the public health system. We currently have a large deficiency of knowledge in this space in Aotearoa, with very limited data on the burden or impact of IRIDs, or the knowledge of how mainstream healthcare may treat these injuries. This research will provide clarity for healthcare providers and also ensure PWID are provided with the best possible care pathways to enable them good access to care, whilst breaking down barriers to care. Specifically, this research sought to quantify and describe client’s experiences of IRIDS, including healthcare access, and to qualitatively explore the experience of DISC Trust clients and peer staff around their experience of managing IRIDs.