Cookers

Product Description

This is a Safer Injecting product.

Prior to injection, drugs in powder, solid and tablet form must be mixed with sterile water and possibly an acidifier (depending on the drug) and broken down into a liquid solution. Cookers are the containers used for this drug preparation process, often heated to create a desired drug consistency. Cookers do not contain harmful products or chemicals so the user will not be harmed when the product is heated. If reused, this piece of equipment can be a transmitter of blood-borne viruses, HCV and HIV. Therefore, it is important to remind clients that just like needles, cookers are for single use only.

There are two types of cookers provided through OHRDP: the stainless steel Spoon and coloured Stericups, which contain a filter and a dry swab. Both types of cookers are sterile and a much safer container to mix drugs in than tablespoons, cans, or bottle caps, as they heat more evenly and are not contaminated with the bacteria as other household items may be.

Best Practice

Best Practice:

Use a pre-packaged, sterile cooker to prepare drugs for each injection to reduce transmission of HIV, Hepatitis C (HCV), and other pathogens.
  • Provide individually pre-packaged, sterile cookers with flat bottoms for even heat distribution and heat-resistant handles in the quantities requested by clients with no limit on the number of cookers provided per client, per visit
  • Offer a sterile cooker with each needle provided
  • Provide pre-packaged safer injection kits (needles, syringes, cookers, filters, sterile water for injection, alcohol swabs, tourniquets and ascorbic acid, if necessary) and also individual safer injection supplies, concurrently
  • Dispose of used cookers and other injection equipment in accordance with local regulations for biomedical waste
  • Educate clients about the risks associated with sharing and reuse of cookers and the correct single-person use of cookers
  • Educate clients about the correct disposal of used cookers
  • Remove cooker packaging
  • Place cooker on a smooth, flat, clean surface
  • Add drug and water and ascorbic acid, if necessary, to the cooker
  • Heat the base of the cooker until solution has reached desired consistency
  • After use, cooker is to be disposed of in a biohazard waste container in accordance with local regulations for biomedical waste
  • Clients should be informed to heat their drug mixture for a minimum of 15 seconds to kill as much bacteria as possible (City of Ottawa Memo File # 003, Dec 2004). The handle is shorter than that of a cutlery spoon so clients need to be careful when heating. Depending on the source used for heating, the time may need to be increased or decreased, accordingly. For example, a lighter emits less heat than a gas burner so, if using a gas burner, individuals may need to reduce heating time
  • The two types of cookers, spoon and stericups, are slightly different in shape and depth. These characteristics can affect their stability on a surface and increase the potential of spilling the contents. Therefore, cooker use on a flat surface is important
  • It is recommended to estimate approximately 1,000 needles per person, per year, so a Needle Syringe Program should estimate 1000 cookers per person per year
  • It is important to rotate inventory to ensure that the shelf life of the product does not expire prior to distribution to clients
  • Studies have shown people injecting drugs share other injection equipment more often than they share needles
  • In a review by Strike et al.1, several studies revealed that individuals share cookers more frequently than other injection supplies
  • Further studies have revealed that although people may inject with their own new sterile needle they may have shared other injection equipment like, cookers, filters and water containers
  • A Seattle study measuring the HCV seroconversion among a cohort of 317 active Seattle residents who inject drugs, who tested negative for HCV antibody at recruitment found that those who shared cookers and filters (but not syringes) had elevated the risk of HCV seroconversion six-fold. It was determined that 54% of HCV infections among this group were attributed to cooker and filter sharing

Sources & Resources

  1. Strike C, Hopkins S, Watson T, Gohil H, Young S, Buxton J et al. Best practice recommendations for harm reduction programs: needle and syringe distribution, other injecting equipment distribution, safer crack kit distribution (interim version). 2012
  2. City of Ottawa memo, from Paul Lavigne, Harm Reduction Project Officer, December 2004
  3. Strike C, Leonard L, Millson M, Anstice S, Berkeley N, Medd E. Ontario needle exchange programs: Best practice recommendations. Toronto: Ontario Needle Exchange Coordinating Committee. 2006
  4. Getting off Right, A Safety Manual for Injection Drug Users, Harm Reduction Coalition