Should Alcohol Swabsticks Be Mandatory For All Injections?
What is the issue?
A concerning proportion of people who inject drugs (PWID) do not use alcohol swabs to clean injection sites, putting them at risk of complications like abscesses and cellulitis. A recent Australian study found 28% said they never or almost never use swabs, and 26% did not swab before their last injection. This highlights an urgent need to promote awareness of injecting hygiene.
Who is most affected?
The study found older PWID with more years of injecting experience were more likely to use swabs. In contrast, younger and more recent initiates were less likely to swab. People injecting methamphetamine were also less likely to swab compared to those injecting opioids like heroin. This suggests education efforts should target newer and younger PWID as well as methamphetamine users.
Why don't they swab?
Most PWID who don't use swabs said they just "don't bother" or are in a hurry. Some perceived swabbing as unnecessary or even harmful. This indicates a concerning lack of awareness about the importance of injecting hygiene to prevent infections. Myths that swabbing is dangerous need to be dispelled. Some may swab after injecting, finding it painful, showing education on proper technique is needed.
How can we promote swabstick use?
Needle and syringe programs (NSPs) are well placed to promote swab use and injecting hygiene through nurses and health workers, who can build trust and rapport with PWID. Longer engagement at supervised injecting sites also encourages proper technique. Peers and outreach workers can share educational messages and positive stories about how swabbing prevents health issues. Framing it as protecting vein and skin health may resonate more than abstract concepts like hygiene.
What are the barriers?
Many NSPs are overloaded handling HIV, hepatitis C, and overdose prevention. Adding injecting hygiene to the mix is difficult. Limited funding and resources make peer outreach and long engagement challenging. Younger methamphetamine users may be harder to reach outside fixed sites. Still, small improvements could make an impact. If messages are tailored appropriately, most PWID are receptive to health promotion.
What are the next steps?
This study shows over half of PWID already use swabs, so the foundation is there. NSPs should keep providing swabs and integrate hygiene promotion into their services. Peers and outreach workers can share messages and model techniques. Younger methamphetamine users require targeted engagement strategies. Advocacy is needed for policymakers to support NSPs to deliver these programs. With some innovation and effort, it is possible to increase awareness and prevent unnecessary health issues for PWID.
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Gibbs D, Peacock A, O'Keefe D, Butler K, Bruno R, Lenton S, Burns L, Larney S. Use of alcohol swabs to clean injecting sites among people who regularly inject drugs in Australia. Drug Alcohol Rev. 2020 Jan;39(1):83-92. doi: 10.1111/dar.13006. Epub 2019 Dec 11. PMID: 31828864.