Quality

We developed the UK's first sterile single-use citric acid sachets, and they are manufactured to an exacting and consistent standard.

Quality Control
The citric acid BP in our sachets is manufactured in a clean room under strict hygiene and quality control procedures.

The citric acid is carefully measured into sachets that are made up of 4 bonded layers to keep them airtight, watertight and free from contamination. There is a layer of paper on the outside that can be printed on. Beneath that is a layer of waterproof plastic over a layer of aluminium foil. The final layer that lines the sachet is of waterproof plastic.

As the sachets come off the production line, every sachet is checked by an electronic fill checking device, to make sure that they contain powder (the filler nozzles are very fine and they can become blocked). Every hour, several sheets of 10 are tested for weight, print clarity, and water tightness (this is tested by placing the sachets in a water chamber with a vacuum above that shows any leaks by pulling a stream of air bubbles from the sachet).

The sachets are carefully logged, certificated and most importantly, are fully traceable through a system of daily batch numbering. The citric acid is guaranteed chemically stable for 3 years by the manufacturer. For added safety we have stipulated a 'use-by' date of 2 years from the date of packing.

Each sachet is tracked from manufacture, through sterilisation and out to the customer so that we can, if necessary, conduct a highly selective recall.

Problems?
Because we have put so many quality control safeguards in place, problems with our products are unlikely. But, if you do experience any problems with our sachets, please contact us straightaway so that we can put in place our procedures to:

• recall and replace your faulty sachets (they will be sent back to the manufacturer so that they can be examined. We will let you know the results of those tests); and depending on the nature of the problem

Research

Since citric was introduced, its supply has been researched in several places.

To date, the findings of all these studies and surveys has been very positive.

Original Scottish evaluation:
Citric sachets were first introduced in a systematic and organised way across Greater Glasgow and Lanarkshire. As a part of this implementation, the Scottish Executive Effective Interventions Unit conducted an independent evaluation of their introduction. The findings of this survey (published in March 2003) were very positive, concluding amongst other things, that citric acid sachets should be supplied by needle exchange services across the UK.

To view the summary of the study go to Scottish Executive website (opens in a new window).

Introduction on Merseyside
The widespread introduction of citric in Merseyside services was monitored by the local Public Health service, to ascertain what effect (if any), it had. They concluded that the provision of citric did not appear to attract more heroin injectors to services - perhaps because most of them were already attending needle exchanges. However, it did appear to have a significant positive effect on the number of visits to services. Attendees were taking the same number of syringes at each visit as they had been doing previously, meaning that more sterile syringes were in circulation amongst local heroin injectors.

This study was presented by Dr Caryl Benyon at the 2005 National Conference on Injecting Drug Use, and was very positive about the consequences of acidifier distribution, which included increased frequency of use of NSPs.

One sachet per syringe

Many injectors re-use syringes - the Centre for Research into Drugs and Health Behaviour estimates that on average across the UK, needle and syringe exchanges are distributing less than one needle and syringe per injector per day. Given that many people inject a number of times a day, it is likely that a large amount of syringes are being re-used.

Part of the aim of introducing citric sachets is to increase both the numbers of people attending and the number of visits to needle exchanges. Most agencies currently distributing citric sachets are sticking to a 'one sachet per syringe' rule, and we support this. Where unrealistic limits on the amounts of injecting equipment given out are in place, they should be reviewed.

Links to further information:
Requests for more sachets