1. NEX in treatment services 8 August 2008

2. The guidance Ensure services offering opioid substitution therapy also make needle and syringes available to their clients, in line with the National Treatment Agency Models of care – an update (2006).

3. The current national picture We dont know!

4. Barriers Confidentiality (esp. pharmacy)? Potential change to treatment? Staff competency (esp. tier four)? Cost?

5. Confidentiality pharmacists who are also operating a needle exchange scheme will not usually share information with the prescriber that a patient receiving prescribed medication is also obtaining supplies of injecting equipment from the pharmacy, except where the pharmacist has the permission of the patient to do so. (Clinical guidelines 2007 p.47) Child protection crime

6. Changes to treatment Opportunity to engage with client Guidance is clear – if treatment not working, optimise, dont withdraw If nothing else, realistic approach to relapse prevention

7. Staff competency Skills needed Tick boxes? Referral – child protection, primary health care etc.

8. Cost More, less, same as NEX? Who does it?