Concerning rates of injecting-related injuries for drug users – study

New research from the University of Otago, Christchurch – Ōtakau Whakaihu Waka, Ōtautahi, has exposed the large number of health-related injuries suffered by people who inject drugs in Aotearoa New Zealand, exacerbated by the significant barriers many face in accessing healthcare.

The study, published in today’s New Zealand Medical Journal, shows more than 90 per cent of people injecting drugs surveyed for the research had experienced injecting-related injuries and diseases (IRIDs), with 40 per cent reporting more than 10 IRIDs. Sixty-three per cent had never sought medical attention, and concerningly, 32 per cent who had experienced a severe IRID had also never sought treatment.

Funded as part of a Health Research Council of New Zealand grant, the research surveyed 57 clients at the South Island’s two largest needle exchanges (in Christchurch and Dunedin) run by the Drug Injecting Services in Canterbury Trust, between 31 October 2023 and 10 February 2024. The majority of clients were men (63 per cent), with Māori making up 22 per cent. Forty-seven per cent of participants were injecting at least once daily with 7 per cent injecting more than three times daily.

Ten clients, as well as needle exchange staff members, undertook extended interviews for the study.

An estimated 10,000 people inject drugs for recreational purposes in New Zealand (1.3 per cent of those aged 16-64), the majority of whom inject methamphetamine. The authors say that given the increasing use of meth, this number is likely to grow – with some needle exchanges already reporting an increase in client presentations.

Lead author, Christchurch-based University of Otago 6th year medical student Stephen Potter, carried out the study as part of the University’s summer break Future Health Researcher Programme. He says the results highlight the stigma, discrimination and cost barriers experienced by injecting drug users in New Zealand.

Lead author Stephen Potter

“We know that people who inject drugs are a marginalised and vulnerable population group at heightened risk of medical complications from injecting, some of which can be life-threatening, including abscesses, septicaemia, thrombosis, endocarditis and soft tissue injury, yet they are reluctant to seek, or unable to access, appropriate medical care,” Mr Potter says.

He says study participants reported their reluctance was due to concerns around discrimination and stigma from healthcare workers, past negative experiences when seeking help, concerns regarding the repercussions of their seeking healthcare, and a lack of social supports or financial stability. They therefore relied on support from other injecting peers and the needle exchanges.

“Almost all participants reported an unwillingness to seek healthcare. This is of particular concern for the almost half of our sample who’d experienced at least one severe IRID, for whom delays to medical care could have posed life-threatening implications.”

The authors say the study results highlight the importance of expanding harm reduction services in Aotearoa and the further de-stigmatisation of healthcare to ensure access to these vulnerable and marginalised communities.

“There is a real need for a health service within harm reduction services to ensure both prevention and early intervention of injecting injuries. This will lead to much better outcomes for patients and be enormously cost-effective compared to late-stage illness presenting to the ED,” Mr Potter says.

“Leading this research opened my eyes to the vital harm reduction services provided by DISC Trust in the South Island and other needle exchanges, and to the realities faced by their clients when they become unwell. They go above and beyond for their people and provide compassionate care, community, and helpful harm reduction advice.”

Mr Potter says the needle exchanges could perhaps form a point of connection to other services or a site to provide healthcare access.

The authors also say healthcare providers need to be more aware of the risks of injecting-related injuries, and contribute to efforts to de-stigmatise drug use, and minimise barriers to accessing healthcare.

“Health practitioners have a responsibility to provide respectful care, free from discrimination, and care that respects the patient’s dignity. I think our research shows quite clearly that is unfortunately not always happening at the moment with people who use drugs,” Mr Potter explains.

“We would like to see health professionals and medical students receive greater education about drug use, and the health needs of people who use drugs, so that they feel better equipped to provide care”.

Senior author Dr Rose Crossin, from the campus’s Department of Population Health, says this research highlights the importance of hearing direct experiences from people who use drugs rather than making assumptions about what is best for them.

“The needle exchanges are trusted by their clients and provide an opportunity for other wraparound healthcare, harm reduction, and social services. It is important that the needle exchanges are appropriately funded to fulfil these vital functions,” Dr Crossin says.

The authors say these study findings will provide important preliminary data on IRIDs for New Zealand – an area currently deficient in healthcare knowledge, with limited data on the burden or impact of IRIDs or how mainstream healthcare systems such as hospitals and general practitioners are treating these injuries.