Risky injecting practices associated with snowballing: A qualitative study

Introduction and Aims. Crack cocaine injecting is associated with a higher prevalence of sharing behaviours, increased rates of hepatitis C infection and a higher likelihood of homelessness. The limited available evidence on snowballing (co-injecting of heroin and crack cocaine) suggests that this is associated with an increase in risky injection practices. This study sets out to explore the views and experiences of a group of drug users who ‘snowball’, with a view to inform the improvement of harm reduction services for such clients. Design and Methods. This is a qualitative interview study of 18 male and female homeless drug users attending a needle exchange service in Nottingham, UK. Results. For all those interviewed, snowballing represented a communal activity which affected peer injection practices. The individual perceptions of the terms ‘sharing’ and ‘splitting’ affected the levels of concerns when snowballs were used with others. The study highlighted the importance of knowing current vaccination and screening history of injecting partners in order to manage risk behaviour when drugs are used communally. Discussion and Conclusions. Harm reduction services need to target information so it is meaningful and appropriate to those who engage in communal drug use.[Wilkins L, Bissell P, Meier PS. Risky injecting practices associated with snowballing: A qualitative study. Drug Alcohol Rev 2010]