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Needle Exchange Provision in Scotland

Needle Exchange Provision in Scotland. Selected results from the National Needle Exchange Survey Dawn Griesbach Griesbach & Associates 28 February 2007. Needle / syringe distribution in Scotland - 2003. Estimated no. of injecting drug users 18,737 Estimated no. of n/s required 6.8-20.5m

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Needle Exchange Provision in Scotland

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  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 - 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

  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

  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.

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