Needle Exchange Provision in Scotland

1
Needle Exchange Provision in Scotland

• Selected results from the
• National Needle Exchange Survey
• Dawn Griesbach
• Griesbach 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 AE or ECUs
• Total 188 (as of summer 2005)

4
How many NEXes are there? (cont)

• Pharmacy exchanges outnumbered specialist
  services by 31.
• 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 activity
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
  Advocates guidance
• 11 said the limit depended on certain
  circumstances.

8
Interventions offered by NEXes
9
On-site interventions - comparison with England
10
On-site BBV interventions
11
On-site BBV interventions - comparison with
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.