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Needle Exchange Provision in Scotland
Selected results from theNational Needle Exchange Survey
Dawn GriesbachGriesbach & Associates
28 February 2007
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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
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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)
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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.
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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
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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
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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.
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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)
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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
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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
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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
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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.
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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.
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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.
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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?)
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Conclusion
Variation, variation, variation…
Is this variation acceptable?
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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.
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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
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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.
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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.
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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.