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 Estimated no. of injecting drug users 18,737 Estimated no. of n/s required m No of n/s distributed in Scotland in m

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 A&E or ECUs Total: 188 (as of summer 2005)

4 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.

5 NEX activity Non-pharmacy servicesPharmacy services Number of transactions82,389 (36 services) 169,117 in 10 schemes (116 pharmacies) Number of clients14,229 (31 services) 17,726 in 3 schemes (37 pharmacies) Number of syringes distributed 1.81 million1.75 million Number of syringes returned 849,113714,119

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 Advocate’s 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.