13 About this guidance

What does this guidance cover?

In 2007, the Department of Health (DH) asked the then National Institute for Health and Clinical Excellence (NICE) to produce guidance to encourage the optimal provision of needle and syringe programmes to adults who are injecting drug users. Following a review of the guidance in 2012, NICE decided to update the guidance.

This guidance replaces 'Needle and syringe programmes: providing people who inject drugs with injecting equipment', NICE public health guidance 18 (2009). It supports the commissioning and provision of needle and syringe programmes, including those provided by pharmacies and drugs services. The guidance has been extended to include young people aged under 18 (including those under 16) and users of image- and performance-enhancing drugs.

The absence of any recommendations on interventions that fall within the scope of this guidance is a result of lack of evidence. It should not be taken as a judgement on whether they are cost effective.

Other guidance and policies

The guidance should be implemented alongside other relevant guidance and regulations.

How was this guidance developed?

The recommendations are based on the best available evidence. They were developed by the Public Health Advisory Committee (PHAC).

Members of the PHAC are listed in Membership of the Public Health Advisory Committee and the NICE project team.

For information on how NICE public health guidance is developed, see the NICE public health guidance process and methods guides.

What evidence is the guidance based on?

Original guidance

The evidence used to develop the original guidance included:

  • Evidence reviews:

    • 'Injecting equipment schemes for injecting drug users: qualitative evidence review'

    • 'A review of the effectiveness and cost-effectiveness of needle and syringe programmes for injecting drug users'.

  • Economic modelling:

    • 'Assessing the cost-effectiveness of interventions linked to needle and syringe programmes for injecting drug users: an economic modelling report'.

Updated guidance

The evidence that the PHAC considered included:

  • Evidence and policy reviews:

    • Review 1: 'Update of NICE guidance PH18 on needle and syringe programmes: qualitative and quantitative review updates', was carried out by Liverpool John Moores University. The principal authors were: Lisa Jones, Geoff Bates and Jim McVeigh.

    • Review 2: 'Update of NICE guidance PH18 on needle and syringe programmes: PIEDs review', was carried out by Liverpool John Moores University. The principal authors were: Geoff Bates, Lisa Jones and Jim McVeigh.

    • Review 3: 'Injecting drug use among young people – risk, harm and factors affecting access to services: a systematic review of the evidence' was carried out by the London School of Hygiene and Tropical Medicine. The principal authors were: Lucy Platt, Bethan McDonald, Neil Hunt, Adam Fletcher and Tim Rhodes.

    • Policy review and consensus development exercise: 'Analysis of national and local policy and protocols on the delivery of needle and syringe programme services to young people under 18: policy review and consensus development exercise', was carried out by the London School of Hygiene and Tropical Medicine. The principal authors were: Neil Hunt and Lucy Platt.

  • The fieldwork report 'Needle and syringe programme fieldwork' was carried out by AddAction and Tiny Spark project.

In some cases the evidence was insufficient and the PHAC has made recommendations for future research. For the research recommendations and gaps in research, see Recommendations for research and Gaps in the evidence.

Status of this guidance update

The draft guidance, including the recommendations, was released for consultation in October to November 2013. At its meeting in November 2013, the PHAC amended the guidance in light of comments from stakeholders and experts and the fieldwork. The guidance was signed off by the NICE Guidance Executive in February 2014.

The guidance complements but will not replace, other NICE guidance on substance use (For further details, see Related NICE guidance).

All healthcare professionals should ensure people have a high quality experience of the NHS by following NICE's recommendations in Patient experience in adult NHS services.

All health and social care providers working with people using adult NHS mental health services should follow NICE's recommendations in Service user experience in adult mental health.

The recommendations should be read in conjunction with existing NICE guidance unless explicitly stated otherwise. They should be implemented in light of duties set out in the Equality Act 2010.

The guidance is available on NICE's website. The recommendations are also available in a pathway for professionals whose remit includes public health and for interested members of the public.

NICE produces guidance, standards and information on commissioning and providing high-quality healthcare, social care, and public health services. We have agreements to provide certain NICE services to Wales, Scotland and Northern Ireland. Decisions on how NICE guidance and other products apply in those countries are made by ministers in the Welsh government, Scottish government, and Northern Ireland Executive. NICE guidance or other products may include references to organisations or people responsible for commissioning or providing care that may be relevant only to England.


NICE guidance can help:

NICE has developed tools to help organisations put this guidance into practice.

Updating the recommendations

This guidance will be reviewed 3 years after publication to determine whether all or part of it should be updated. Information on the progress of any update will be posted on the NICE website.

Your responsibility

This guidance represents the views of the Institute and was arrived at after careful consideration of the evidence available. Those working in the NHS, local authorities, the wider public, voluntary and community sectors and the private sector should take it into account when carrying out their professional, managerial or voluntary duties.

Implementation of this guidance is the responsibility of local commissioners and/or providers. Commissioners and providers are reminded that it is their responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way which would be inconsistent with compliance with those duties.


© National Institute for Health and Care Excellence 2014. All rights reserved. NICE copyright material can be downloaded for private research and study, and may be reproduced for educational and not-for-profit purposes. No reproduction by or for commercial organisations, or for commercial purposes, is allowed without the written permission of NICE.

ISBN 978-1-4731-0490-7

  • National Institute for Health and Care Excellence (NICE)