For Tully, improper filtering almost cost him his life.
Tully contracted endocarditis (inflammation of the heart’s inner lining) after injecting heroin filtered through a cigarette filter and dissolved in what he believes was dirty tap water.
Tully became ill shortly after injecting the drugs, and initially, he attributed the illness to poor quality drugs. He didn’t seek treatment for a few days but when his condition worsened Tully says he realised something was seriously wrong.
“I was in and out of hospital for months. It made me really, really sick. I knew a dirty shot could make me crook, but not that bad. I’ve never not used a proper filter again after that. I even tell all my mates too now. I wouldn’t wish that on my worst enemy.”
Many people who use drugs opt to filter using cotton wool, cigarette filters, tampons and dried swabs. These contain insoluble fibres, says Penington Institute Project Lead Crios O’Mahony, and don’t properly filter out impurities from common street drugs – which can cause immediate infection and illness, and over time, can lead to major health problems.
“Filters like these have got little fibres in them. Not only are they unsterile and don’t properly filter out bacteria and dirt, the fibres can also end up in your veins and congregate in your eyes, in the valves of your heart, and cause all kinds of nasty damage to blood vessels,” Crios says.
“There are all sorts of things that can happen through not properly filtering: bacterial infections, dirty hits, and blocked veins. If you’re doing that continually over time you’re going to end up with a lot of problems including collapsed veins and serious illness. Not filtering properly is a risky business.”
Commercial filters work by filtering bacteria and impurities through a permeable membrane. They are attached to the needle and used to draw up the dissolved solution. Harm Reduction WA (formerly WASUA) spokesperson Kevin Wilder says the filters act in a similar way to the plunger device on a coffee percolator – allowing liquid to pass through but blocking solid particles.
It’s important to remember that the commercial filters are single use only – bacteria accumulate in a used filter. But Kevin says he is aware that cost is a deterrent for many people who inject drugs, and they are likely to reuse their filters.
“It defeats the object of filtering if you’re injecting accumulated bacteria. We understand people are reluctant to pay for them, and we say to people, if they do intend to use a filter more than once they should make up their shots for the day and store them in the refrigerator.”
Many primary and secondary NSPs provide filters at cost price while some, like Barwon Health Clinic, provide filters for free. Barwon Health harm reduction team senior clinician Craig Harvey says the cost of injecting equipment is compensated for in preventing serious illness.
“It’s counterintuitive to do anything different. When we were charging for them, very few people were collecting them and we know poor filtering has an impact on people’s health.”
“When we started giving them out for free there was a huge uptake and it’s a greater assumed health benefit to the community,” Craig says.
“As an example, if we spend $20,000 per annum on injecting equipment, if that saves one person from a case of endocarditis as a result of poor injecting, a ten-day stay in the hospital costs between $100,000 and $150,000. If we save someone from just one of those occasions, we’ve paid for the next five years of equipment. It’s a common sense approach to overall health care. It’s a no-brainer.”
Commercial filters are available at primary NSPs for free or at cost price. Filters are also available from some secondary NSPs, like hospitals, pharmacies and community health centres.
The effectiveness of each type of filter is measured in units of microns. Commercial filters work to filter out particles smaller than the average vein, which is five microns wide, while makeshift filters can cause blockages and infection, says Kevin.
“The lowest rung of the filtering ladder are swabs. A swab will only filter out particles bigger than 50 microns, so if you’re using these, you could be injecting particles up to 10 times the size of your vein. These aren’t ideal, and we don’t recommend it, but we understand that cost can be a deterrent for people who inject drugs and we do provide sterile cotton with fit-packs [at Harm Reduction WA].”
The next best and most popular option is a steri-filt, which filters out particles down to 10 microns wide, and at cost price are 30c per filter. Needle-filts filter out particles down to five microns and cost 50c per filter, while wheel filters, says Kevin, are the best and are recommended practice.
The wheel filters are available in different colours and ratings. For example, the green filter is rated at 0.8 microns and is used to filter out fillers and insoluble particles, while the blue filter is rated at 0.2 microns and is used to filter bacteria.
While filters remove microscopic particles from a liquid mixture, they can’t prevent the transmission of blood-borne disease like HIV or hepatitis C, and must be used alongside safe injecting practices.
– Tom de Souza