Commissioning needle and syringe programmes
Needle and syringe programmes (NSPs) supply needles and syringes, and often other equipment, used to prepare and take illicit drugs. NSPs reduce the transmission of blood-borne viruses (BBVs) and other infections caused by sharing injecting equipment. Many NSPs also aim to reduce the harm caused by injecting drugs through providing information and advice and acting as a gateway to other services, including drug treatment such as opioid substitution therapy (OST). NSPs may be the only contact that some people (for example, those who inject performance and image-enhancing drugs [PIEDs]) have with health services. NSPs in England are based across a range of services including specialist services, pharmacies, outreach/mobile services, police custody suites, walk-in centres and accident and emergency departments. However, over 70% of NSPs are provided by pharmacies.
The true extent of injecting drug use is difficult to determine. The latest data suggest the number of injecting drug users aged 15-64 years in England is between 115,000 and 122,000, although it could be over 200,000. These estimates relate to people injecting heroin, other opiate drugs or crack cocaine and do not include people injecting PIEDs such as anabolic steroids. However, recent anecdotal reports from across the country suggest that the use of anabolic steroids is on the increase, particularly among young men.
Needle and syringe sharing has declined in recent years. However, in 2007 almost a quarter of respondents to the Unlinked Anonymous Prevalence Monitoring Programme reported sharing needles and syringes during the previous 4 weeks. In addition, almost half reported that they had shared filters, mixing containers and water during the same period.
In the UK almost half of injecting drug users are infected with hepatitis C and about 1 in 90 with HIV. The Advisory Council on the Misuse of Drugs 2009 report states that in England and Wales 120,000 to 300,000 people are infected with hepatitis C. Approximately one in five people recover, with the rest becoming chronically infected. There is no vaccine to protect against hepatitis C and chronic infection can lead to severe liver disease, liver cancer and death. Chronic hepatitis C can be cleared successfully in at least half of treated patients.
In 2006 there were 1469 deaths relating to drug use in England. This includes people who died as a result of accidental overdose, intentional self-poisoning, drug use and drug dependence.
The joint Healthcare Commission-National Treatment Agency for Substance Misuse improvement review of harm reduction services revealed that pharmacy and specialist NSPs provide a wide range of information and advice on harm reduction. However, the review highlighted that there was a clear national shortfall in the provision of out-of-hours NSPs, and that vaccination against hepatitis B and testing and treatment for hepatitis C were not provided widely enough by local drug partnerships. Currently, the accessibility and availability of NSPs (along with interventions to reduce harm) vary widely. There is also wide variation in the number of people who use NSPs and how often they use them.
The potential benefits of commissioning NSPs as part of a local treatment system that also provides OST are:
- increasing availability of injecting equipment, reducing risk behaviours such as sharing needles and syringes and lowering injection frequency
- reducing injection-site infections and the transmission of BBVs
- reducing accidental deaths and drug-related overdoses
- providing a route into a range of other treatment services
- reducing the number of attendances at accident and emergency departments (and subsequent hospital bed-days) for injection-site infections
- reducing harms caused by drug-related litter by providing safe disposal facilities and sharps bins
- reducing inequalities and improving access for people from specific groups such as homeless people and women who inject drugs, and speedball users (people who inject an opioid such as heroin in combination with a stimulant such as cocaine)
- increasing service user choice through offering flexible opening times and locations
- better value for money - NSPs are a cost-effective way of reducing the transmission of BBVs and the development of injection-site infections. If the gateway effects of NSPs are included, a fall in the number of people who inject drugs is likely. This would, in turn, lead to a reduction in crime. If that is the case, modelling shows that NSPs are likely to save society money in the longer term .
Key issues in providing effective needle and syringe programmes are:
- identifying, engaging and assessing all people who inject illicit drugs and encouraging them to access drug treatment
- encouraging people to find alternatives to injecting and/or helping people to stop injecting drugs
- commissioning a mix of generic and targeted NSP services to meet local need
- increasing the proportion of people who have over 100% ‘coverage' (that is, the proportion who have more than one sterile needle and syringe available for every injection)
- providing advice and information to reduce the harms associated with injecting drug use
- ensuring access to BBV testing, vaccination and treatment services
- promoting healthy and safe communities, reducing the fear of crime and reducing drug related litter
- providing the best possible outcomes for individuals, their families and communities
- providing a quality assured service.
National priorities and initiatives relevant to commissioning needle and syringe programmes include:
- World class commissioning.
- The NHS in England: The operating framework for 2009/10.
- The operational plans 2008/09-2010/11: vital sign 14: the number of drug users in effective treatment.
- Public service agreement (PSA) delivery targets: stronger communities and reducing the harm caused by alcohol and drugs, targets 21-25.
- The Government's drug strategy: Drugs: protecting families and communities - 2008.
- National Treatment Agency for Substance Misuse: Models of care for treatment of adult drug misusers: update 2006.
- Commissioning framework for health and well-being.
- The Expert patients programme for people in recovery from alcohol and substance misuse.
- A stronger local voice: a framework for creating a stronger local voice in the development of health and social care services.
- Implementation of NICE clinical and public health guidelines. These are currently core standards, and performance against these standards will be assessed by the Care Quality Commission in line with Standards for better health.
Although many or all of these priorities may be relevant to the services nationally, your local service redesign may address only one or two of them.
1. Evans-Brown M, McVeigh J (2009). Anabolic steroid use in the general population of the United Kingdom. In Elite sports, doping, and public health: Møller V, Dimeo P, McNamee M, editors. Odense, Denmark: University of Southern Denmark Press pp.75-97
2. Health Protection Agency (2008) Shooting up - infections among injecting drug users in the United Kingdom 2007. An update: October 2008. London: Health Protection Agency
1. Figures in relation to the size of gateway effects are subject to uncertainty, as are figures relating to any effect that an increase in NSPs will have on the number of people injecting drugs.
This page was last updated: 02 March 2012