NICE consults on proposed update to public health guidance for limiting harm caused by injecting drugs

Tens of thousands of people across England and Wales inject drugs like heroin and anabolic steroids each year, with others turning to botulinum toxin products or other cosmetic injections like tanning agents. Now, the National Institute for Health and Care Excellence (NICE) is updating its guidance on how best to provide needle and syringe programmes to encourage people who use these drugs to access other health services and prevent the spread of blood-borne diseases like HIV and hepatitis C. A consultation has begun on the provisional update so organisations can have their say.

Recent figures suggest nearly 93,500 people inject opiates (like heroin) and/or crack in England[i]. Up to another 70,000 people aged between 16 and 59 in England and Wales are thought to have injected anabolic steroids in the last year[ii]. The guidance also covers people who inject so-called ‘legal highs', tanning agents, dermal fillers (for example, collagen) or botulinum toxin products.

Needle and syringe programmes aim to stop people sharing potentially contaminated injecting equipment - thereby limiting the spread of infectious blood-borne diseases - by providing them with sterile needles and syringes. Earlier this month, research by Public Health England revealed that men who inject anabolic steroids and tanning drugs are at greater risk of developing HIV and viral hepatitis.

While cases of some infectious diseases have either remained low or declined over the years in the UK (like HIV and hepatitis B respectively), hepatitis C continues to be a widespread problem. In 2011, nearly half (43%) of all those injecting drugs tested positive for the virus[iii].

Dr Vivian Hope, a Public Health England expert in infections among people who inject drugs, said

“Anyone who injects drugs is at risk of HIV and other blood borne viruses, regardless of their substance of choice.

“Our recent research suggests that levels of HIV and hepatitis infection among men using image and performance enhancing drugs have increased since the 1990s.

“We must maintain and strengthen public health interventions focused on reducing injection-related risk behaviours to prevent HIV and hepatitis infections in this group. This includes ensuring easy access for those who inject image and performance enhancing drugs to voluntary confidential testing services for HIV and hepatitis, as well as to appropriate sterile injecting equipment through needle and syringe programmes.”

Professor Mike Kelly, Director of the NICE Centre for Public Health Excellence, said: “Although it's always preferable for anyone using drugs to give up completely, needle and syringe programmes can play an important role in helping to reduce the harm caused by injecting drugs. They can also offer help to people who inject drugs by offering or referring them to a range of other health services, including drug treatment.

“Since we last published our guidance on needle and syringe programmes in 2009, we've seen an increase in the use of performance and image enhancing drugs such as anabolic steroids, botulinum toxin products, tanning agents and the use of dermal fillers like collagen. We've also heard anecdotal evidence that more teenagers are injecting these performance and image enhancing drugs too. We're updating our guidance - and our public consultation on the draft update is an important part of this process - to make sure all of these groups of people are considered in the planning and delivery of needle and syringe programmes. These services must continue to be configured in the most effective way to reach and support the people who need them the most, wherever they live, and protect their health as much as possible.”

One proposed recommendation suggests that areas could consider providing drop boxes (also known as public sharps boxes) to dispose of used needles and syringes. The location of these boxes should be agreed between local authorities, the police, local communities and people who inject drugs. This is an extension of NICE's 2009 recommendations that said needle and syringe providers should develop plans for needle and syringe disposal in line with the Government's 2005 “Tackling drug-related litter” policy, and that people who use needle and syringe programmes should be provided with individual sharps boxes and advice on how to dispose of needles and syringes safely.

Andy Dudley, who co-ordinates a needle and syringe programme in Sheffield, uses drop boxes to help people dispose of used injecting equipment. He says he's seen first-hand the effect they can have: “Sharps bins and drop boxes don't only make the situation safer for the individual who is using the needle and syringe but also for their community. It ends where you don't find needles and dirty works in parks, in public places and the user's neighbourhood.

“I have had instances where people have come to me whilst we are out with our service van in the community; they have said that we're to blame for the needle waste in the area. In those situations we explain to them what we do and how we encourage the use of drop boxes and sharps bins and overall the response is really good. It is about educating the individual user and the local community, drop boxes are a good thing.”

Other new or updated recommendations in the draft version of this updated guidance include:

  • For people using performance or image enhancing drugs, commissioners and providers of needle and syringe programmes should provide them with the equipment they need, at times and in places that meet their needs (e.g. by offering outreach services in gyms or outside normal working hours), and by properly trained staff.
  • Organisations working together to develop local, area-wide policies to provide services that meet the needs of young people aged 16 and under who inject drugs. This should include thinking about how to achieve the right balance between protecting the young person and providing them with advice on harm reduction and other services.
  • Services should be co-ordinated so that people who need injecting equipment can get it when they need it. For example, this could include the use of out of hours vending machines or late night pharmacies.

Professor Kelly continued: “We're keen to receive comments on this draft version of the updated guidance from anyone who is likely to be involved in providing needle and syringe programmes, from Health and Wellbeing Boards and commissioners to charities and pharmacies. All comments submitted during the consultation will be fully considered and will help to ensure our guidance on this topic remains a beacon of best practice.”

The consultation will close at 5pm on Tuesday 5 November 2013; the updated guidance is due to be published next year and will replace the previous guidance published in 2009.


Notes to Editors

About the guidance

A copy of the draft public health guidance update for needle and syringe programmes, will be available from Tuesday 24 September 2013. Please contact the NICE press office for an embargoed copy of this guidance.

In this draft guidance, the term ‘drugs' is used to mean: opioids (e.g. heroin) and stimulants (e.g. cocaine) either used separately or in combination (referred to as ‘speedballing'). The term also includes novel psychoactive substances (so-called ‘legal highs' like mephedrone), performance and image enhancing drugs (for example, anabolic steroids) and other drugs (e.g. ketamine).

The original 2009 public health guidance on needle and syringe programmes is available to view on the NICE website.

About NICE

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[i] Hay et al. 2011

[ii] Home Office 2012

[iii] Health Protection Agency 2012a

This page was last updated: 24 September 2013