Impact of the 2003 ‘paraphernalia law’ change on UK needle exchange agencies

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

2. 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)

3. 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)

4. 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

5. 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

6. Results

8. 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]

9. 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

10. 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]

11. 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

12. 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!