'Dead space' is the space between the needle and the plunger that still has liquid in it following an injection; injecting equipment contains either low or high amounts of 'dead space'. There is a growing body of evidence that suggests low dead space (LDS) injecting equipment may reduce the risk of bloodborne viruses and infections, such as HIV and hepatitis C, that are associated with sharing equipment (1). LDS injecting equipment includes low dead space syringes (LDSS), reduced dead space modified syringes and more recently developed, detachable low dead space needles. When people who inject drugs (PWID) share needles and syringes, the volume of dead space is an important determinant of the volume of blood that is transferred from one PWID to another.

The main facilitators to the uptake of low dead space (LDS) injecting equipment for people who inject drugs (PWID) are:

• Provide accessible information about the beneficial features of LDS injecting equipment, such as less wasted drug and lower risk of transferring infections. Encourage PWID to use new equipment for every injection, but supplement this with instructions for proper rinsing and disinfection of equipment.
• Ensure LDS injecting equipment is available for PWID to try alongside their current equipment. Gradual transition – make LDS equipment available and over time reduce the availability of high dead space equipment.
• Place PWID at the heart of any further research into implementation of new equipment.
• Make use of peer networks to share information among PWID, particularly positive experiences.
• Train staff involved in the provision of needle and syringe programmes (NSP) in the benefits of LDS equipment, as well as how to respond to any safety, health or practical problems.
• Any intervention should be viewed as a component of comprehensive harm reduction policies, not as a lone intervention. 

The main barriers to the uptake of LDS injecting equipment for PWID are:

• Many PWID are happy with their current equipment and have not reported problems with injecting, so do not feel it is necessary to change.
• Familiarity with current equipment and its place in the routine of injecting; length of time injecting.
• The need to learn how to use new equipment.
• Potential lack of availability of comparable equipment, such as size of barrel or length of needle.
• Getting a 'hit' can sometimes be viewed as more important than harm prevention.
• Lower risk of infection transmission may encourage sharing or reuse of equipment.