1

Needle Exchange Provision in Scotland

Selected results from theNational Needle Exchange Survey

Dawn GriesbachGriesbach & Associates

28 February 2007

2

Needle / syringe distribution in Scotland - 2003

Estimated no. of injecting drug users

18,737

Estimated no. of n/s required

6.8-20.5m

No of n/s distributed in Scotland in 2003-04

3.9m

3

How many NEXes are there?

• 136 pharmacy exchanges• 43 specialist exchanges

of which 22 offer mobile / outreach services

• 6 police custody suite exchanges• 3 based in A&E or ECUs

Total: 188 (as of summer 2005)

4

How many NEXes are there? (cont)

• Pharmacy exchanges outnumbered specialist services by 3:1.

• Just over half of specialist services were located in a wider drug treatment service.

• In some areas of Scotland, service provision was almost exclusively through pharmacies.

5

NEX activityNon-pharmacy

servicesPharmacy services

Number of transactions 82,389

(36 services)

169,117

in 10 schemes

(116 pharmacies)

Number of clients 14,229

(31 services)

17,726

in 3 schemes

(37 pharmacies)

Number of syringes distributed

1.81 million 1.75 million

Number of syringes returned

849,113 714,119

6

NEX activity – syringe distribution

• In general, more syringes were given out by non-pharmacy (specialist) services

• Exception was Glasgow• Very wide variations in number of syringes

distributed per injector per year• Overall, insufficient numbers of syringes being

distributed

7

Services’ own policies on syringe distribution

Is there a limit on the number of n/s you would give out in any one transaction?

• 8 (out of 45) said there was no limit• 28 said there was a limit, but in a third of these,

it bore no relationship to the Lord Advocate’s guidance

• 11 said the limit depended on certain circumstances.

8

Interventions offered by NEXes

0 5 10 15 20 25 30 35 40 45

Other

Steroid clinic

GP/primary care sessions

Well-woman clinic

Housing / social / legal advice

Nutrition advice

OD prevention training

Complementary therapies

Care for minor infections

Structured counselling

Keyworking

Motivational interviewing

Referral to structured treatment

List of other NEXes in area

Face-to-face HR advice

Number of services (out of 45)

9

On-site interventions - comparison with England

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Steroid clinic

GP / primary care sessions

Well-woman clinic

Housing / social / legal advice

Nutrition advice

OD prevention training

Complementary therapies

Care for minor infections

Structured counselling

Key working

Motivational interviewing

Referral to structured treatment

List of other NEXes in area

Face-to-face HR advice

Percentage of services

Scotland

England

10

On-site BBV interventions

0

5

10

15

20

25

HIV pre / posttest

counselling

HCV pre / posttest

counselling

HCV testing HBV testing HBV immun HIV testing HAV immun Tetanusimmun

11

On-site BBV interventions - comparison with England

0%

10%

20%

30%

40%

50%

60%

HIV pre /post-test

counselling

Hep C pre /post-test

counselling

Hep Ctesting

Hep Btesting

Hep Bimmun

HIV testing Hep Aimmun

Tetanusimmun

Per

cen

tag

e o

f se

rvic

es

Scotland

England

12

Paraphernalia distribution

• Strongly associated with NHS Board.

• Lack of citric acid was a significant issue in Grampian and Highland.

• Some services were being threatened with cut-backs on paraphernalia that they had previously been distributing for free.

13

Polices on NEX for young people

Under 16s– 26 out of 45 said they did not supply to under 16s.– 18 services said they would supply under certain

circumstances

16-17s– 34 out of 45 said they would supply to this age group– Many services treated young people of this age the

same as adults

• Nearly two-thirds of services did not have a written policy on NEX for young people.

14

Good practice

• Use of outreach services• Good joint working• Use of pharmacy consultation rooms• Getting service users involved in development /

delivery of services• Developing good rapport and trust• Providing on-going training / support to

pharmacy NEXes.

15

Other issues

• Poor data collection systems among DATs• Client assessment / review is uncommon• Lack of standardised training for workers• Service users views appear to play little part in

service provision• Negative attitudes among some pharmacy

workers (due to poor training / support?)

16

Conclusion

Variation, variation, variation…

Is this variation acceptable?

17

Recommendations to the Scottish Executive

• Develop standards for NEX• Develop standard training for NEX staff• Develop guidelines for paraphernalia distribution• Ensure that services are able to distribute an

adequate number of syringes and other paraphernalia.

18

Recommendations to NHS Boards & DATs (1)

• Provide funding to all NEXes for citric acid• Ensure a balance between pharmacy and

specialist NEXes.• Put in place systems for regular monitoring

and reporting• Put in place systems for regular reporting

on discarded sharps / needle stick injuries

19

Recs to NHS boards & DATs (2)

• Ensure all NEX providers receive training (esp. in relation to injecting techniques) prior to providing a service

• Ensure that pharmacy exchange providers receive on-going training and support from a specialist harm reduction provider.

• Ensure all NEXes have written protocols on distribution to under-18s and under-16s.

20

Recs to NHS boards & DATs (3)

• Reduce barriers to BBV testing / immun. by offering through NEXes.

• Improve integration between NEXes and other local services by offering primary care sessions, wound clinics, nutritional advice / housing, social welfare / legal advice through NEXes.

21

Recs to NEX providers

• Put in place mechanisms for assessing client need and regularly reviewing that need.

• Put in place mechanisms for assessing client satisfaction.

• Develop policies re: distribution to under-18s and under-16s.

• Develop methods of better engaging with and education IDUs.