Our unique, specially manufactured foil, is supplied interleaved with tissue, in shrink wrapped packs of 50 sheets.

Brown heroin is manufactured to be smoked, and smoking heroin is much less dangerous than injecting it. Smoking heroin is associated with lower levels of dependence than injecting, and every dose of heroin that is smoked rather than injected, has no risk of HIV, hepatitis C, or hepatitis B transmission, and far less risk of overdose.

Quantity	Price (exc VAT)	VAT	Price (inc VAT)
1	£3.67 each	20%	£4.40 each
10	£3.36 each	20%	£4.03 each
50	£3.05 each	20%	£3.66 each
100	£2.82 each	20%	£3.38 each

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To help encourage transition from injecting to smoking, and to encourage heroin smokers into contact with services, Exchange Supplies have arranged for the manufacture of unique foil packs containing both 50 and 20 sheets of high quality 100% aluminium foil, each interleaved with tissue.

We have made a short video with clear instructions on how to make an efficient foil pipe for smoking heroin or crack cocaine - to see it on our youtube channel, click here.

We made this video because many people who inject went straight to injecting as a route of administration, and don't know how to smoke. Demonstrating how to make a pipe (tooter) can help encourage injectors to move to smoking as the way in which they take their drugs.

The custom made sheets of foil measure 200mm x 125mm, and are shrink wrapped into packs of 50, each interleaved with tissue.

Quality
The foil in our packs is the finest 100% pure aluminium. It is rolled without lubricating oil, so there is no smoke to be burnt off before it's used.

The interleaved sheets remove the need for a cutting blade, which reduces risk of injury.

Research
There is a study, published in the online peer reviewed Harm Reduction Journal, that describes the impact and effectiveness of the provision of foil as part of a comprehensive service for injecting drug users.

To read the study in full go to: the Harm Reduction Journal Website (opens in a new window.

FAQs
Q:Why don't we just give out kitchen foil?
The provision of foil to injecting drug users to encourage them to reduce or stop injecting (and as a tool to engage heroin smokers) is an important health intervention.

The Exchange Supplies foil packs are presented in a professional way, which gives a clear message to drug users about the importance services that distribute it attach to facilitating the transition away from injection (as well as early engagement of heroin smokers).

A roll of kitchen foil is not very discreet to carry away from the service, so is far less appealing to drug users than the handy packs of 50 or 20 ready cut sheets.

Finally, kitchen/cooking foil is often coated with vegetable oil (see below) which drug users don't like, and which doesn't fit with the delivery of a health intervention.

'Burning off'
Q: Is it better that you don't have to burn anything off the surface of Exchange Supplies foil?
A. A bit. ...it's a feature that will make the exchange supplies foil popular with users, but it doesn't make our foil much safer than ordinary kitchen foil.

This is why: Aluminium foil is rolled into thin sheets from solid blocks. Sometimes, to reduce friction during manufacture, a thin coating of vegetable oil is used. However, the manufacturing process to make our foil does not use oil, so there is no need to 'burn off' before using it.

We aren't in the business of making inflated claims and want to stress that the vegetable oil used for making other aluminium foil products is non-toxic and the fumes do not represent a health hazard, providing they're not actively inhaled. When using kitchen foil that is coated with oil, heroin smokers burn it off before putting the drug on the foil.

This means that the fact that there is no oil used in the manufacture of our foil is a small benefit, that will be popular with users, but will not result in significant health gains.

Q; Is it illegal?
A: No. The provision of foil by drug services was legalised by its addition to section 9a of the misuse of drugs act as exempt from the general prohibition on supplying articles to be used for the preparation or consumption of illicit drugs in September 2014.

No Alzheimer's risk!
Q. Is it true that there’s a risk of Alzheimer's disease when chasing drugs off aluminium foil?
A. No. Aluminium foil is manufactured to be placed in close contact with food, while it is baked in very hot ovens: it has been used for this purpose for many years and there is no evidence of risk or harm resulting from this. There are all sorts of risks associated with drug use, but aluminium poisoning from chasing is not one of them!

Practice Notes
The following practice notes have been written in collaboration with the services who have been distributing foil... below we have described the key messages and conversations that have been shown to maximise the effectiveness of providing foil.

We have also made a video with clear instructions on how to make a foil pipe (tooter) for smoking heroin - to see it on our youtube channel, click here. We made this video because many injectors went straight to injecting as a route of administration, and don't know how to smoke. By showing people how to make really good pipes, we hope to make smoking more attractive than injecting as a route of administration.

Of course, the foil packs are being supplied because smoking heroin is associated with lower levels of dependence than injecting, and every dose of heroin that is smoked rather than injected has no risk of HIV, hepatitis C, or hepatitis B transmission, and far less risk of overdose. Of course, helping injectors switch from injecting to smoking is a new area of practice for many workers. We hope that the information on these practice notes pages will enable you to feel confident in promoting the use of foil.

If there's an issue that isn't covered, or if you have developed interventions that we could include on the site, please do not hesitate to drop us a line.

Of course, many people do not want to move to smoking as an alternative route of drug use. These injectors must feel comfortable continuing to use the needle exchange and undue pressure should not be exerted on them to stop injecting.

However, there are significant groups of injectors who may be open to switching to smoking some or all of the drugs they take, in particular those who:

• Would chase if they had foil available;
  

• Have recently started to inject;
  

• Are injecting partly because a partner is injecting;
  

• Are having trouble getting venous access;
  

• Have recently moved to femoral injecting;
  

• Are experiencing serious problems as a result of femoral injecting; or
  

• Have recently detoxed or been released from prison.
  

The foil packs are useful tools to encourage discussion, and provide an ideal opportunity to give essential advice:

• To move from injecting to smoking;
  

• About the relative dangers of injecting compared to smoking; and
  

• About the relative benefits of smoking over injecting (these will often change over time as people have increasing difficulty getting venous access).
  

Raising chasing with injecting drug users
Having foil available immediately makes the issue of raising chasing easier. The lead in to the conversation will often be:
"did you know we now have foil in the needle exchange? …have you ever chased heroin?"

This will usually lead into a discussion about chasing, in the same way that asking injectors about their injection sites usually quickly leads into a discussion about injecting practice.

The response will be:

• Yes, it was ok but…
  

• Yes, I hated it - it made me feel sick/I didn’t like the taste etc; or
  

• No, never.
  

However you deal with the response, it's important to be positive about chasing as an option, while at the same time understanding people's position. It needs to be promoted, without being over forceful, or making people feel guilty about injecting.

As with all harm reduction interventions, the key is demonstrating that you accept and understand why people do what they do, but at the same time want to provide advice and resources to enable them to reduce the harm they are doing to themselves by injecting.

For confirmed injectors who are reluctant, you can frame chasing interventions not as pressure to stop injecting forever, but as a vein preservation measure that could prolong the number of years they can inject…

If any other practice issues arise, please feel free to contact us (details on the about us pages) to talk them through.

Target groups
Obviously all injectors would be exposed to less drug related risk if they smoked their drugs instead. Aside from the obvious reduction in vein damage, overdose and blood borne virus transmission would be massively reduced.

However, there are particular groups of injectors who may be more amenable to foil as an intervention.

looking at where they’re at, but looking at options, challenging assumptions, pointing out consequences… main target groups

• Groin injectors (understanding the big hit concept proves empathy, increases willingness to listen/engagement… ‘save that’ ‘use it as a treat’)
  

• Subcutaneous injectors (no hit from that).
  

Positive aspects
There are a number of positive things about chasing which were reflected back to the pilot sites by people who'd taken the foil and tried it. Making injectors aware of them, suggesting them as positive aspects of switching to smoking, might help encourage people to make the switch, and be aware of the benefits if they experience them.

The main positive things that are reported by people who chase are that:

• It's more sociable;
  

• There's less injecting related harm;
  

• The drugs last longer;
  

• There are no needles in the house (particularly beneficial for parents) and;
  

• Once a day… particular situations
  

Main objections:
The main objections people raise to smoking are:

• Smell;
  

• Taste;
  

• It takes too long; and
  

• Convenience especially in some locations.
  

If you get a strong objection to using foil, still get it out, show it to your client – the fact that it is purpose made does engage people and you are, at least, planting the seed of smoking as a reverse transition as a possibility, and the agency as a place to talk about it.

If people hated the smell, all you can do is suggest that they try it again: tastes change, it may be some years since they last tried it. Also, the ‘cost benefit analysis’ of the discomfort vs the effect may have changed, especially if they’re now suffering consequences of injecting and taking ages to find a site - the comparison between injecting vs smoking when they first switched may be very different to the comparison now.

Never chased
If someone has never chased, it can also be a hard ‘sell’.

The first response would probably be to ask if they know anyone who smokes who could show them how to do it.

Harnessing the experience within the drug using community is a powerful intervention – if drug services can value the teaching of smoking to injectors, and even find popular figures in the drug using community to teach their peers to chase, it could deliver big changes in behaviour. Certainly if you get people who switch readily, it would be good to encourage them to tell their peers.

There is a lifeline booklet on how to chase heroin, and there are pipe making instructions on this website.

Foil is listed as being exempt from section 9a of the Misuse of Drugs Act which prohibits of the supply of 'articles to be used for the preparation or consumption of illicit drugs'. For more background and information on section 9a, click here.

Service User Groups
As with all aspects of service provision, discussion with service user groups should form part of the implementation process. Support from service users may be a powerful weapon in overcoming objections from people who oppose the provision of foil, it is also likely to maximise the positive impact (and uptake) of the new service.

Alternative routes of administration
UYB stands for 'up yer bum' and is a realistic alternative administration route, although resistance to its use is often very high.

The group of injectors that are most like to at least give this route a try, are those for whom injecting has become very difficult because of progressive vein damage. Injectors who do not perceive themselves to be experiencing real problems are much less likely to try this route or to stick with it.

The anal route is effective because the rectum has a very rich blood supply, and fluids are readily absorbed into it through the wall of the lower bowel. The anal sphincter is a very effective double seal of muscle rings, helping to ensure that the solution does not leak out.

The drug solution should be prepared in the same way as for injection, although (obviously) a syringe without a needle should be used. There is a risk of overdose by his route, so for the first time at least, injectors should use no more than they would normally use when injecting. The syringe barrel should be introduced gently - using a small amount of lubricant makes this easier and lessens the risk of accidental injury.

The experience of using drugs in this way is likely to be very subjective, to some degree depending on how dubious about the route an individual is, but the theory is sound, and some individuals do find it effective and much easier and safer than a seemingly endless hunt for a viable vein.

There are some medical conditions that need to be taken into consideration before using this route. For example, constipation or diarrhoea should be resolved before starting UYB and some other medical problems mean that it should not be recommended. These include:

• Anal fissures;
  

• Haemorrhoids;
  

• Crohn's disease; and
  

• Irritable bowel syndrome.
  

Links to further information:
Template letter for services to send to the police
Article on the history of drug paraphernalia supply and the law in the UK