Driving the use of low dead space injecting equipment among people who inject drugs

Low dead space injecting equipment has less space between the needle and the plunger after injecting. Blood and drug remain in this space, so if needles are shared the risk of spreading blood borne viruses such as HIV and Hepatitis C is lower when there’s less space for blood to be left in the equipment. The traditional injecting equipment with detachable needles supplied by needle and syringe programmes has a higher volume of dead space.

Earlier research by NIHR CLAHRC West and NIHR Health Protection Research Unit (HPRU) in Evaluation of Interventions at the University of Bristol found that people who inject drugs would be willing to switch to this safer equipment, if the benefits were explained and they were introduced gradually.


Explanation taken from the materials of where dead space is found in injecting equipment


Dead space compared, taken from the materials

Project aims

This project aimed to increase the adoption of this new, safer equipment in needle and syringe programmes, their commissioners and service users.

What we did

We developed posters, a booklet and animation to promote the benefits and use of low dead space equipment, and broader harm reduction messages, for people who inject drugs, the needle and syringe programmes that support them, and policymakers.

Funded by the Economic and Social Research Council (ESRC), Deborah Hussey, Assertive Engagement Worker from Bristol Drugs Project, joined the CLAHRC West team as Knowledge Mobilisation Fellow for the project. Deborah visited needle and syringe programmes around the UK, from Glasgow to London, to understand barriers to the uptake of low dead space equipment, and how different programmes operate and share harm reduction messages. The team’s academic lead was Jo Kesten and communications expertise was brought by Zoe Trinder-Widdess.

Deborah and the rest of the team then worked with Michael Linnell of Linnell Communications, a designer who specialises in information product design for drugs, alcohol and public health campaigns.

Through a series of workshops, the materials were co-designed by service users from Bristol Drugs Project, who shaped the messages, language and look and feel of the materials. Working closely with the intended audiences means the materials have been tailored to their needs and preferences, so will have a greater impact and resonance with them.

The project was overseen by a steering group that included Bristol Drugs Project, Exchange Supplies, Public Health England, the Bristol Health Partners Drug and Alcohol Health Integration Team (HIT), CLAHRC West and HPRU.

The final products are now available to download from Exchange Supplies’ website. Exchange Supplies is a social enterprise that has pioneered the use of detachable low dead space equipment among people who inject drugs.

How we involved people

Deborah visited needle and syringe programmes around the UK, from Glasgow to Wales, to understand barriers to the uptake of low dead space equipment, and how different programmes operate and share harm reduction messages. This information was used to develop the content of the materials. Deborah also invited a group of five service users from Bristol Drugs Project to co-design the materials through workshops. They were a diverse group in terms of age, level of experience in injecting drugs and equipment preferences.

What next?

We plan to share the materials widely to service users, needle and syringe programmes, commissioners and public health stakeholders.

The materials are on public display in the gallery space at the Station on Silver Street from 8-31 January 2019. A special launch event, with the opportunity to hear from the people involved in the project, is being held on 24 January at the Kitchen café in the same building. Speakers include some of the service users involved in the project and Deborah Hussey, Michael Linnell, Andrew Preston from Exchange Supplies.

We will monitor downloads and sharing of the materials and changes in the equipment provided by needle and syringe programmes. We will assess any changes to risk behaviours, such as equipment sharing and cleaning, through routinely collected data.

We are working with Exchange Supplies to develop training for staff and volunteers working in needle and syringe programmes.

Links and downloads

Lead collaborators

  • Deborah Hussey, Bristol Drugs Project

CLAHRC West staff

Zoe Trinder-Widdess

Zoe Trinder-Widdess

  • Communications Manager
  • Management and administration

Partners on this project

Bristol Health Partners

Bristol Health Partners exists to improve the health of those who live in and around Bristol and to improve the delivery of the services on which they rely. It also acts as a mechanism for change in the Bristol health and care community and city region. It is a strategic collaboration between the city's six NHS bodies, two universities and its local authority.

University of Bristol

The University of Bristol is internationally renowned and one of the very best in the UK, due to its outstanding teaching and research, its superb facilities and highly talented students and staff. Its students thrive in a rich academic environment which is informed by world-leading research. It hosts the Elizabeth Blackwell Institute for Health Research.