Needle and syringe programmes

Implementing NICE guidance

2009

NICE public health guidance 18

What this presentation covers

Background

Scope

Recommendations

Discussion

Find out more

Background

115,000 - 200,000 injecting drug users (IDUs) in England

23% of IDUs report recently sharing needles

Over 40% of IDUs are Hepatitis C positive

IDUs are ten times more likely to die prematurely than the rest of the population

In 2006, over 1400 deaths were linked to controlled drugs

Scope

The optimal provision of needle exchange and syringe programmes (NSPs) for people who injectillicit substances and non-prescribed anabolic steroids

Majority of NSPs are run by pharmacies and drug services

Some NSPs offer other services such as help to stoptaking drugs

This guidance refers to people of 18 years and older

Planning, needs assessment and community engagement

LSPs, PCTs and D(A)ATS should collect and analyse localdata on:•problems/harms linked to injecting drug use e.g. infections•number and characteristics of people who inject•number of IDUs in regular contact an NSP•number who have sterile injecting equipment available

LSPs, PCTs and D(A)ATS should

• Use data gathered to ensure services meet local need• Consult people who inject drugs when planning NSPs• Consult local communities • Use the information collated to ensure NSP

services meet local need• During consultations with local communities:

- promote the benefits of the service- actively involve communities

Planning, needs assessment and community engagement

LSPs, PCTs and D(A)ATS should commission generic and targeted services to:

• increase the number of people who have more than one sterile syringe and needle available per injection

• reach more people from specific groups who inject

• offer advice, information and referral to harm reduction services

Meeting need

LSPs, PCTs and D(A)ATS should

• Develop needle and syringe disposal plans

• Encourage needle and syringe identification schemes

• Commission integrated care for people who inject drugs

• Audit and monitor services

Meeting need

LSPs, PCTs and D(A)ATS should

- use pharmacies, specialist NSPs and other settings to provide a balanced mix of services:

• Level one - injecting equipment (loose or in packs)

with written information on harm reduction

• Level two - bespoke equipment plus harm reduction and health promotion advice

• Level three - bespoke equipment, harmreduction advice plus specialist services

Types of service

LSPs, PCTs and D(A)ATS should

• Ensure injecting equipment is available for a significant time during any 24-hour period

• Consider using community pharmacies that operate extended opening hours

• Ensure opioid substitution services also offer needles and syringes

Types of service

Equipment and advice

Needle and syringe programme providersshould provide people who inject drugs with

• needles, syringes and other injecting equipment

- at quantity based on need, not subject to arbitrary limit

- where possible, in a range of sizes

- including sharps bins and advice on safer disposal

• safer injecting advice when providing long needles

Equipment and advice

Needle and syringe programme providers should

• encourage people who inject drugs to:

• use syringe identification methods

• use harm reduction services

• stop using drugs or to switch to non-injecting methods

• address their other health needs

• advise where these services can be accessed

• Provide sharps bins, advice on safer disposal

• Provide a service for safe disposal of used equipment

• Ensure Hepatitis B vaccination is available for staff

• Ensure staff can provide signposting and referral to local agencies offering further support

Community pharmacy NSP

• Staff should be trained for the level of service they offer

• Staff should receive health and safety training

• For level 2 or 3 services, staff should be trained to provide health promotion advice

• Training should also incorporate how to treat controlled drug using clients in a non-stigmatising way

Community pharmacy NSP Training

• Provide a selection of individual needles, syringes and other injecting equipment

• Offer harm-reduction services including: - safer injecting and overdose prevention advice - help to stop injecting drugs - and referral to opioid substitution therapy (OST)

• Offer (or refer to) specialist services including, OST, vaccinations, wound care and welfare and advocacy

Specialist NSPs

Discussion

• How can we engage NSP clients in service planning consultations?

• What is the profile of our NSP clients?

• Are we also meeting the needs of people who inject stimulants?

• How are we dealing with drug-related litter?

• How can we monitor the training and competencies of staff working for commissioned services?

Find out more

Visit www.nice.org.uk/PH18 for the:

• guidance• quick reference guide• Costing statement and costing template• audit support• local authority planning checklist • factsheet for commissioners