Free Foil for UK Heroin Users, But at a Price

Section 9a of the 1971 Misuse of Drugs Act has been amended across a period of time to control the supply of "articles for administering or preparing controlled drugs." This was supposedly a move to enable the prosecution of drug dealers who were selling drug "kits," but in reality has hampered the development of needle and syringe programmes (NSPs) in delivering equipment that can reduce harms and save lives.

The only exemption at the time of the first draft was syringes/needles All other items were included. Since then, there have been pushes from services and drug users to include other crucial equipment and materials in this exemption list. In 2003, citric acid but not Vitamin C (either can be used to acidify heroin base for injection), swabs, spoons and filters became legal. The absurdity of the slow changes to this list over the last decade can be found here. Particularly interesting is the two year struggle to legalise the supply of sterile water, which was finally achieved in 2005, albeit that only ampoules under 2ml are legal, still to this day.

The use of foil and encouraging the use of it for smoking heroin as an alternative to injecting is not a new idea. Injecting is the most harmful method of consuming drugs, particularly for longer term users. Smoking/inhaling heroin and crack greatly reduces the chances of a fatal overdose, the likelihood of transmitting blood borne viruses (HIV, Hep C & B), and eliminating the risks of abscesses, DVT, gangrene and other injecting-related complications. Inhaling is not without its risks, notwithstanding, the thermal effects on the lungs and the risks of infections that are contained within the drug -- e.g. anthrax and clostridium, or infections from non-injecting routes -- but, on balance of associated harms, it is still considered better than injecting.

The necessity of promoting and allowing services to provide foil is part of this continued drive to transit injecting drug users to alternative routes of administration. This was predominantly headed by the UK’s National Treatment Agency ("Reducing Drug Related Harms," 2004). Things have somewhat changed since then. The drug strategy of 2010 and its message to promote "a drug free life" became the government’s mainstay response and ideology in drug treatment. This is also around the time that the Advisory Council on the Misuse of Drugs (ACMD) first approached the Home Office with a report on the benefits favouring the exemption of foil from Section 9a.

In 2012, the ACMD responded to the request by the Home Office to analyse the provision of foil, but this was not worded as a form of reducing harms associated with injecting drugs, but in order to help people become "drug free."

So, an exemption of foil was no longer part of the standard "harm reduction" lexicon, but part of the larger framework of the "Recovery Agenda" Consequently, this change in legislation was not without its restrictions. The changes came with innumerable conditions attached to it, as part of the structured efforts to get people into treatment.

In simple terms, the main condition is that the provision of foil is conducted to either engage patients into a drug treatment plan or if it is part of a patient’s treatment plan. The confusion appears in the definition of "drug treatment plan":

"… is a written plan, relating to the treatment of an individual patient, and agreed by the patient and the person employed in the lawful provision of drug treatment services. A written plan is not a requirement at the stage of taking steps to engage someone in a treatment plan."

Drug treatment plans have traditionally been verbal consensual agreements, a general guideline that is drafted between the two parties during the initial assessment and is used broadly to help the patient achieve their desired end -- this could be abstinence, reduction in use or a transition to another form of administration, amongst many other outcomes from treatment. In the last couple of years, this has changed with a new focus on written "commitments" and form-filling.  This is to show commissioners that the outcomes demanded by central government policy are being met. That goal is now total abstinence.

There is more than a hint of "doublespeak" here. In order to deliver an obvious health benefit, foil will now be distributed with an ideological baggage that does not apply to any other paraphernalia exempted under the Act. Foil is, of course, widely available from other sources (such as grocers, corner shops etc.) and it is important that people are not dissuaded from coming into services by the loss of confidentiality or an excess of paper bureaucracy. 

All in all, the change can be considered a positive one, but the almost ludicrous length of time in processing this change, as well as implementing perplexing conditions to the change, further complicate an issue that is quite clear and simple; foil is one of many tools used in reducing harms associated with injecting drugs that should be supplied by drug treatment services without question, criminal sanctions or conditions of an individual’s treatment plan.

Technical information:

  • Tin or aluminium. Most foil is aluminium foil which can be referred to as "tin foil" as well. Aluminium is cheaper and more durable than tin and replaced tin foil after the Second World War.
  • During the manufacturing process, all foil is given a thin layer of vegetable oil to keep it lubricated.
  • It is actually advised, and is usually part of the user’s ritual, that the foil is burnt first to release the fumes on the surface.
  • Drugs that can be smoked on foil include heroin, crack cocaine (this is the base form, as opposed to the salt form) and methamphetamine, amongst others. It can also be used as part of homemade cannabis pipes.
  • Foil is a universal material, thin, malleable, with a high melting temperature and is fairly cheap.
  • Tourniquets and matches are still excluded from section 9a of the MDA (1971) so are still technically illegal.
*

Basak Tas is a drugs advisor and researcher for Release