The law

When we first began selling citric sachets in 2001 they were illegal because their supply was a breach of section 9a of the misuse of drugs act.

However, a change to the Act in July 2003 made the supply of citric acid to injecting drug users by drug services completely legal.

For a complete explanation of how the Misuse of Drugs Act relates to the supply of paraphernalia, and the changes that have been made to the Act in the last few years, click here.

Quality, duty of care and civil law

We are alone in supplying citric acid sachets of the highest pharmaceutical grade, manufactured to pharmaceutical industry 'Good Manufacturing Practice' standards, with all the checks, proceedures and safety mechanisms necessary to ensure that the product in the sachets is the right amount of the right powder, there are no contaminants, that it is completely sterile and that there are full batch records, stored samples and traceability.

We, and our customers, belive that given the end use of the product, this is the standard of care and recording that is required.

You can supply our sachets in the certain knowledge that your legal obligations are fully satisfied. For the record, these are set out below.

People have rights set down by law, known as 'basic statutory rights'. A customer's basic statutory rights with regard to supplied products are that goods must be:

• Of satisfactory quality
• Free from defects

The citric acid we supply in sachets has been manufactured to British Pharmacopoeia (BP) standard.

It is packaged in surroundings that comply with strict pharmaceutical industry standards of hygiene. The sachets are manufactured in a 4 crimp seal sachet in carefully selected laminate that is made from a combination of paper, aluminium and plastic laminates that keep the citric free from contamination by particles, air and moisture.

Basic statutory rights also state that goods must be:

• fit for all the purposes for which goods of that kind are commonly supplied; and
• safe

Citric acid is not designed for injecting – the high levels of acidity can cause vein damage. It is normally manufactured and sold for the purposes of making jam, lemonade and for de-scaling kettles. Citric is supplied by needle exchange schemes because it is likely to be less harmful than injecting with other, more dangerous, acidifiers.

However, the basic statutory rights described above do not apply if the supplier explains that the goods are not fit for the purpose the customer wanted them for.

Each sachet of citric acid we supply carries a clear health warning:

Warning: injecting citric acid damages veins

Furthermore we supply citric with handy wraps which protect the sachets from damage in peoples pockets and give give advice on the risks of injecting (including the risks of injecting citric).

They make it clear that injectors are responsible for any damage caused to their veins. Where possible this information should also be discussed with clients. The 'wraps' are an improvement on the leaflets that were approved for use by our barrister when citric sachets were launched, and represent additional clear evidence that we, and the services that dispense citric, are taking every possible step to ensure that clients are aware of the risks they are taking.

A successful action for negligence would have to demonstrate that a duty of care had been breached (see below) and that any damage caused was due to the product supplied rather than another aspect of the injecting process.

Citric in single-use sachets is preferable to other, more dangerous, acidifiers. This fact and the clear warnings on the sachets, and on the free leaflets given away with each sachet, mean that it is very unlikely that there could be a successful claim against a drug service providing citric sachets, either under the Consumer Protection Act or for negligence.

Duty of care

All healthcare professionals and drug services owe a legal duty of care to their clients.

The question as to whether there has been a failure to exercise a duty of care is decided by considering whether or not, in the circumstances, the care was of an acceptable standard.

The measure for this is 'that care which would be given by a prudent and reasonable person'. The professional standing of the person providing the care is taken into account, and the care given is expected to be that of a reasonably competent person in that role.

Where a services has selected a product designed to reduce harm that has been manufactured to the standards Exchange Supplies employ – we are the only citric sachet supplier that guarantees full compliance with pharmaceutical industry 'Good Manufacturing Practice' (GMP) guidelines – the duty of care to the client has clearly been excercised.

Informed consent
in addition to demonstrating that they have selected an appropriate product to supply, services should be able to demonstrate that their service users give informed consent to their use of citric acid. To be able to give informed consent, service users must fully understand the pros and cons of using it.

Our sachets give clear warnings and information (each sheet of 10 carries both a core warning on every sachet, plus a range of other harm reduction messages). This alone discharges the duty of care to warn clients of the risks.

In addition, services giving out our citric can give their clients a free copy of our 'how much citric?' on DVD or video (for full details of how to order, click here) which fully explains the issues.

We would recommend that services record the giving/offering of advice, 'how much citric?', and/or the fact that leaflet/wraps.

Pharmacy syringe exchange packs with citric acid sachets should contain one of the leaflets supplied free with the sachets, and can also contain a reply paid card for service users to send to us requesting a copy of how much citric?.