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This entry is our account of a review or synthesis of research findings selected by Drug and Alcohol Findings as particularly relevant to improving outcomes from drug or alcohol interventions in the UK. Entries are drafted after consulting related research, study authors and other experts and are © Drug and Alcohol Findings. Permission is given to distribute this entry or incorporate passages in other documents as long as the source is acknowledged including the web address http://findings.org.uk. However, the original review was not published by Findings; click on the Title to obtain copies. Links to source documents are in blue. Hover mouse over orange text for explanatory notes. The abstract is intended to summarise the findings and views expressed in the review.

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Needle and syringe programmes: providing people who inject drugs with injecting equipment.

National Institute for Health and Clinical Excellence.
National Institute for Health and Clinical Excellence, 2009.

England's national health advisory body recommends high coverage 24-hour needle exchange plus opiate substitute prescribing and infection treatment to combat not just HIV, but also the hepatitis C epidemic.

Abstract These guidelines result from a request by the Department of Health for the National Institute for Health and Clinical Excellence (NICE) to produce public guidance on the optimal provision of needle and syringe programmes for injecting drug users. The guidelines cover adults NICE's Public Health Interventions Advisory Committee has asked NICE to consider producing separate guidance on exchange programmes for young people aged under 18. only. Their remit was to consider what constitutes optimal provision, not whether these programmes should be provided in the first place. NICE's Public Health Interventions Advisory Committee developed these recommendations on the basis of two reviews of the evidence, an economic analysis, expert advice, stakeholder comments and fieldwork, available from NICE's web site.

Particularly significant recommendations include:
• Commissioning bodies should assess the percentage of injections in their areas for which sterile needles and syringes were available, and use this and other information to ensure services meet local need with a view to moving towards over 100% 'coverage' for all local injectors (ie, increasing the number who have more than one sterile needle and syringe available for every injection).
• Commissioning bodies should develop services which offer referral to other harm reduction services, encourage people to stop using drugs or to switch to non-injecting methods (for example, opioid substitution therapy), and address visitors' other health needs.
• They should also not only audit and monitor services to ensure they meet the health needs of injectors, but also address the concerns of the local community.
• The local service mix should include three levels of service providing: 1. injecting equipment either loose or in packs with written harm reduction information; 2. 'pick and mix' injecting equipment plus health promotion advice; 3. level two plus provision of or referral to specialist services (for example, vaccinations, drug treatment and secondary care).
• Commissioning bodies should ensure services offering opioid substitution therapy also make needles and syringes available to their patients.
• Needle exchange services should distribute equipment numbers and type according to need rather than subject to an arbitrary limit.
• They should also provide disposal bins/advice and other injecting equipment, and encourage injectors to switch to other methods of drug use and to attend services which can help them do so.
• Pharmacy-based services in particular should provide information about local agencies offering further support, including opioid substitution clinics.
• Specialist services operating at level 3 (see above) should offer comprehensive harm reduction services including advice on safer injecting practices, assessment of injection site infections, advice on preventing overdoses, help to stop injecting, and referral to opioid substitution clinics.
• They should also offer (or help people to access): opioid substitution; treatment of injection site infections; vaccinations for hepatitis A and B and tetanus; testing and associated counselling for hepatitis B and C and HIV; psychosocial interventions; primary care services (including condoms and general sexual health services, dental care and general health promotion advice); secondary care services (for example, treatment for hepatitis C and HIV); welfare and advocacy services (for example, advice on housing and legal issues).

The NICE committee reached these conclusions partly on the basis of a cost-effectiveness analysis. In estimating benefits this took in to account the potentially important role exchanges can play in bringing people who inject drugs in to contact with a range of services. However, the contribution made by this 'gateway' function was uncertain. Nevertheless the conclusion was that providing clean injecting equipment is cost effective for NHS and personal social services and also for society as a whole.

This work also suggested that while increasing the coverage of syringe distribution and the recruitment rate in to substitute prescribing programmes are sufficient to control HIV, they are not sufficient to reduce the prevalence or incidence of hepatitis C infection. Only multi-faceted interventions including for example these interventions and treatment of hepatitis C infection can achieve substantial decreases in new hepatitis C infections.

Last revised 27 February 2009
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Needle and syringe programmes: providing people who inject drugs with injecting equipment.

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