Impact of the 2003 ‘paraphernalia law’ change on UK needle exchange agencies Jenny Scott Dept Pharmacy & Pharmacology University of Bath

Background  ‘Injecting paraphernalia’ is the collective term for equipment used to prepare drugs for IV use e.g. spoons, water, acids, lighters, filters, swabs, needles and syringes (N&S)

Background (2)  In the UK it was illegal to supply items of paraphernalia except N&S before August 2003  The law was changed in light of concerns about paraphernalia sharing and transmission of hepatitis C  The law now permits doctors, pharmacists and drug workers to supply certain items: swabs, sterile water, spoons/cups, filters and citric acid, for harm reduction purposes  (Misuse of Drugs Act s. 9A, SI No. 1653/2003; Misuse of Drugs Regulations (Northern Ireland) s.6A. SI No. 324/2003)

Aims To measure the ‘before’ and ‘after’ extent of paraphernalia supply from UK needle exchange co- ordinators To identify factors that impact on paraphernalia supply from UK NX schemes To explore initial thoughts on response to impending Water for Injection reclassification

Methods A paper-based questionnaire sent to all identified UK needle exchange agency co-ordinators with 2 reminders then telephone follow-up ‘Before’ version sent Spring 2003 and ‘After’ version set Spring 2005 Before 225 co-ords identified, after 469 co-ords. Before NAM only, After NAM plus online information Ethics approval Scottish MREC (B) ref: 05/MRE10/1

Results ‘Before’ (2003) ‘After’ (2005) No. co-ords identified Response 403 (86%) 193 (86%) Provide NX Supply at least ONE item of paraphernalia 221 (92%) 147 (86%)

Number in 2005 who currently DO supply (% of total n =240) Number in 2005 who started supplying since law change (% of no. supplying) Number in 2003 who supplied (% of total, n =171) Swabs 200 (83%)Not asked131 (89%) Citric acid sterile sachets 155 (65%)114 (74%)39 (27%) Citric acid loose powder 34 (14%)9 (27%)21 (14%) Vitamin C sterile sachets 69 (29%)53 (77%)1 (0.5%) Vitamin C loose powder 6 (2.5%)3 (50%)5 (5%) Sterile water 52 (22%)28 (54%)39 (27%) Filters 106 (44%)49 (46%)34 (23%) Spoons 102 (43%)82 (80%)9 (6%) Tourniquets 34 (14%)6 (18%)26 (18%)

Impact of the law change Top reasons for not supplying paraphernalia: 2003: ‘legal restrictions’ and 2005; ‘lack of funding’ 55 responders (23%) reported receiving more funding for paraphernalia since the law had changed and 126 (53%) said they had not [59 (24%) missed out this question] 76 (32%) of responders said the law change had impacted on their services in other ways, examples given included ‘attracting more clients’, ‘more requests for paraphernalia’ and ‘easier to source paraphernalia’ 106 (44%) said the law change had not impacted on them in other ways [58 (24%) missed out this question]

Staff training 143 (60%) of respondents reported that their staff had undertaken training on paraphernalia supply, 22 (9%) said they had not and 8 (3%) did not know [67 (28%) missed out this question] In-house training, various specific course providers and conferences were given as examples of training

Sterile water supply 13 of the 52 responders (25%) were already supplying sterile water reported doing so under Patient Group Directive (PGD) One reported obtaining a prescription for each client, one reported a ‘blanket’ prescription for all clients, 5 said they had another form of arrangement e.g. written consent from the public health department, and 29 said they ‘just supplied’; 3 did not respond to this question Those who did not supply water (n=188) were asked how they thought the impending reclassification of Water for Injections to allow supply by needle exchanges would impact on their service –92 (49%) said they would supply if they received additional funds – 49 (26%) said they would definitely start to supply –25 (13%) did not know –16 (9%) said they would not supply –Reasons given for choosing not to supply included ‘we have no demand for water’ and concerns about discarded equipment in the community –[6(3%) omitted this question]

Conclusions The number of co-ords supplying paraphernalia has increased since the 2003 law change Lack of funding remains a pertinent issue The impending water for injection reclassification needs to be planned for carefully The need for research into the outcome of paraphernalia use remains –this work is ongoing

Acknowledgements Co-workers: Miss Emma Burton, Miss Leela Gill, Miss Aimee Goodwin, Miss Emma Harrigan, Mrs Amanda Inkpen, Miss Yiki Mok, Miss Claire Oakshott and Miss Ubah Yahie All the agency staff who took the time to respond, thank you!