Needle exchange programmes

Published: 01 October 2011

In the UK, needle exchange programmes, or needle and syringe exchange programmes (NSPs) supply needles and syringes to people over 18 who inject illicit substances, including opioids (for example, heroin) and stimulants (for example, cocaine), as well as those who take non-prescribed anabolic steroids and other performance- and image-enhancing drugs. They often supply other equipment used to prepare and take drugs, such as filters, mixing containers and sterile water.

Most NSPs are run by pharmacies and drug services. A key aim of these programmes is to reduce the transmission of blood-borne viruses such as HIV. Services offered include:

  • Provision of injecting equipment, in quantities to meet the individual’s needs.
  • Advice on safer injecting practices. This might include information on avoiding more dangerous injecting practices, such as injecting into the groin and encouraging people to mark their injecting equipment or use other techniques to avoid inadvertent sharing.
  • Help with safe disposal of injecting equipment, including providing sharps bins and advice on disposal.
  • HIV and hepatitis testing and counselling services, or advice on where to access these services.
  • HIV and hepatitis treatment services, or advice on where to get these services.
  • Other health and welfare services, including condom provision and sexual health services.

For the UK, the National Institute for Health and Clinical Excellence (NICE) has published guidance on needle and syringe programmes, outlining the minimum set of services that should be commissioned.1 Further recommendations come from the Advisory Council on the Misuse of Drugs.2

More detailed and practical guidance on setting up and running a needle exchange programme can be found in documents from the World Health Organization3 and the US-based Harm Reduction Coalition.4

A recent meta-review summarised studies of the effectiveness of fixed-site needle exchange programmes, and found that there was clear evidence that programmes reduce self-reported sharing or re-use of equipment. Less high-quality research has investigated the impact of needle exchange programmes on HIV infections, and the evidence for programmes being effective in reducing HIV transmission is described as ‘tentative’.5

A further meta-analysis of UK studies investigating hepatitis C infection (the incidence of which is higher than HIV infection) found that in order to have a substantial impact, injectors need to make very frequent use of both needle exchange and opiate substitution therapy. Injectors who only accessed one intervention, or did so on occasion, had much higher infection rates.6

The two interventions have a synergistic effect: by reducing the frequency of injecting, methadone programmes reduce the opportunities for sharing equipment. Meantime, the role of needle exchanges is to see that uncontaminated equipment is used for each remaining injection. Treatment can also address lifestyle and psychosocial factors.

However needle exchanges in the UK are often patchily provided, under-funded and hampered by restrictions on the number of needles which can be distributed.

Furthermore, in a great many other countries, needle exchange and other harm reduction programmes are completely unavailable or extremely limited.7

References

  1. National Institute for Health and Clinical Excellence Needle and syringe programmes: providing people who inject drugs with injecting equipment. NICE public health guidance 18, 2009
  2. Advisory Council on the Misuse of Drugs The primary prevention of hepatitis C among injecting drug users. www.homeoffice.gov.uk/publications/alcohol-drugs/drugs/acmd1/acmdhepcreport2, 2009
  3. World Health Organization Guide to starting and managing needle and syringe programmes. www.unodc.org/documents/hiv-aids/NSP-GUIDE-WHO-UNODC.pdf , 2007
  4. Harm Reduction Coalition Guide to developing and managing syringe access programs. www.harmreduction.org/downloads/SAP.pdf, 2010
  5. Palmateer N et al. Evidence for the effectiveness of sterile injecting equipment provision in preventing hepatitis C and human immunodeficiency virus transmission among injecting drug users: a review of reviews. Addiction 105: 844-859, 2010
  6. Turner KME et al. The impact of needle and syringe provision and opiate substitution therapy on the incidence of hepatitis C virus in injecting drug users: pooling of UK evidence. Addiction 106: 1978-1988, 2011
  7. Mathers BM et al. HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage. Lancet 375(9719):1014-28, 2010
This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.
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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.