Detached services

Workers from needle and syringe programmes deliver services away from the main venue.


The term 'drugs' is used in this guidance to mean: opioids (for example, heroin); stimulants (for example, cocaine) either separately or in combination (speedballing); novel psychoactive substances ('legal highs', for example, mephedrone); image- and performance-enhancing drugs (see below); and other drugs (for example, ketamine).

Image-and performance-enhancing drugs

The term 'image- and performance- enhancing drugs' is used in this guidance to mean any substance injected with the intention of enhancing image or performance (except under medical supervision). It includes:

  • anabolic steroids, growth hormone and novel drugs (such as those that stimulate secretion of growth hormone, IGF-1 and analogues, and human chorionic gonadotrophin)

  • melanotans, bremelanotide, botulinum toxin and dermal fillers.

Injecting equipment

The equipment supplied by needle and syringe programmes is regulated by a 2003 amendment to The Misuse of Drugs Act (2001). A Home Office circular on the supply of drug injecting paraphernalia clarifies that, in addition to needles and syringes, needle and syringe programmes may also supply:

(a) swabs

(b) utensils for the preparation of a controlled drug (that would include articles such as spoons, bowls, cups, dishes)

(c) acidifiers

(d) filters

(e) ampoules of water for injection.

In July 2013, a Home Office written ministerial statement on the lawful provision of foil explained it had accepted the Advisory Council on the Misuse of Drugs' advice advice to allow for the lawful provision of foil by drug treatment providers. This is subject to the strict condition that it is part of structured efforts to get people into treatment and off drugs.

Low dead-space injecting equipment

Low dead-space injecting equipment seeks to limit the amount of (potentially contaminated) blood that remains in the equipment after it has been used, by reducing the amount of 'dead space' it contains. It is believed that this may reduce the risk of transmission of infectious diseases among people who share injecting equipment. There are 2 types of low dead-space injecting equipment: one uses fixed needles and the other uses detachable needles.

Needle and syringe programmes

Needle and syringe programmes (NSPs) supply needles and syringes for people who inject drugs. In addition, they often supply other equipment used to prepare and take drugs (for example, filters, mixing containers and sterile water). The majority of needle and syringe programmes are run by pharmacies and drug services. They may operate from fixed, mobile or outreach sites.

The main aim of needle and syringe programmes is to reduce the transmission of blood-borne viruses and other infections caused by sharing injecting equipment. Many also aim to reduce the other harms caused by injecting drug use and provide:

  • advice on safer injecting practices

  • advice on minimising the harm done by drugs, including image- and performance- enhancing drugs

  • advice on how to avoid and manage an overdose

  • information on the safe handling and disposal of injecting equipment

  • access to blood-borne virus testing, vaccination and treatment services

  • help to stop injecting drugs, including access to drug treatment (for example, opioid substitution therapy) and encouragement to switch to safer drug taking practices, if these are available

  • other health and welfare services (including condom provision).

Outreach services

Workers from drug and needle and syringe programmes go out and encourage people to use the service.

Poly-drug use

Using more than one drug at the same time (although not necessarily in the same syringe). This practice is common among people who inject drugs. For example, people who use image- and performance-enhancing drugs often use one drug to enhance or counter the effects of another. They refer to this practice as 'stacking'.

Secondary distribution

Where someone collects needles, syringes and other injecting equipment from the needle and syringe programme on behalf of others.