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Needle and syringe programmes
Short Text
Introduction
This pathway covers recommendations on providing needle and syringe programmes (NSPs) for adults who inject illicit substances. Some of the recommendations are also relevant to adults who inject non-prescribed anabolic steroids and other performance and image-enhancing drugs (PIEDs).
While NSPs can help reduce the harm caused to people who inject drugs, the consequent reduction in the prevalence of blood-borne viruses benefits wider society.
All the recommendations are for those working in the NHS, local authorities and the wider public, voluntary and community who have a direct or indirect role in NSPs. This includes those working in drug (and alcohol) action teams (D[A]Ats) and pharmacies.
Source guidance
The NICE guidance that was used to create the pathway.
Needle and syringe programmes. NICE public health guidance 18 (2009).
Quality standards
Quality statements
Effective interventions library
Successful effective interventions library details
Implementation
Audit support
Audit support provides ready-to-use criteria, including exceptions, definitions, suggested data sources and a data collection tool.
Commissioning guides
Commissioning guides provide information on key clinical and service-related issues to consider during the commissioning process. Each guide contains a commissioning and benchmarking tool, which is a resource that can be used to estimate and inform the level of service needed locally as well as the cost of local commissioning decisions.
Costing support
Costing support includes national cost impact reports that summarise the national costs and savings and discuss the assumptions used; costing templates to assess the impact on local budgets; and costing statements when the impact is not significant or impossible to quantify at a national level.
Information resources and templates
These include key points for scrutiny or compliance assessment, signposting to resources, checklists and case studies. They are designed to offer practical help in putting NICE guidance into practice and the format depends on the specific topic.
Slide sets
Slide sets provide a framework for discussion and assist in local dissemination of the guidance. The slides contain the key messages from NICE guidance and can be tailored for local presentations.
Pathway information
Supporting information
Provide people who inject drugs with needles, syringes and other injecting equipment. The quantity dispensed should not be subject to an arbitrary limit but, rather, should meet their needs. Where possible, needles and syringes should be made available in a range of sizes.
Ensure people who use a needle and syringe programme (NSP) are provided with sharps bins and advice on how to dispose of needles and syringes safely. Provide a service for safe disposal of used equipment.
Ensure safer injecting advice and information are available when providing long needles and other equipment that could be used for more dangerous practices. (Long needles, for example, could be used for injecting into the groin.)
Provide other injecting equipment associated with illicit drug use and encourage people who inject drugs to switch to other methods of drug use. (At the time of publication, legally permitted equipment included filters, mixing containers and sterile water.)
Encourage people who inject drugs to mark their syringes and other injecting equipment or to use easily identifiable equipment to prevent mix-ups.
Encourage people who inject drugs to use services which aim to: reduce the harm associated with injecting drug use; encourage them to stop using drugs or to switch to non-injecting methods (for example, opioid substitution therapy); and address their other health needs. Advise them where they can access these services.
Glossary
Illicit (illegal) substances include opioids (for example, heroin) and stimulants (for example, cocaine) either separately or in combination (speedballing).
An integrated care pathway ensures all organisations and professionals involved in someone's care or treatment communicate with, and make referrals, to each other. They know when they should get involved – and when and how. It means people receive seamless care from the range of professionals and organisations required to meet their needs.
Needle and syringe programmes (NSPs) supply needles and syringes. In addition, they often supply other equipment used to prepare and take illicit drugs (for example, filters, mixing containers and sterile water). The majority of NSPs are run by pharmacies and drug services. A key aim is to reduce the transmission of blood-borne viruses (BBV) and other infections caused by sharing injecting equipment. Many NSPs also aim to reduce other harms caused by injecting drugs.
Services may include:
- advice on safer injecting practices
- advice on how to avoid an overdose
- information on safe disposal of injecting equipment
- access to blood-borne virus testing, vaccination and treatment services
- help to stop injecting drugs, including access to drug treatment (for example, opioid substitution therapy [OST]) and encouragement to switch to non-injecting methods of drug taking
- other health and welfare services (including condom provision).
- Level 2 services involve distribution of 'pick and mix' (bespoke) injecting equipment plus health promotion advice (including advice and information on how to reduce the harms caused by injecting drugs).
- Level 3 services involve level 2 plus provision of, or referral to, specialist services (for example, vaccinations, drug treatment and secondary care).
100 hour pharmacies must stay open for 100 hours a week (rather than the usual 40-45 hours).
Needle and syringe programmes
Needle and syringe programmes
Needle and syringe programmes
Needle and syringe programmes (NSPs) supply needles and syringes. In addition, they often supply other equipment used to prepare and take illicit drugs (for example, filters, mixing containers and sterile water). The majority of NSPs are run by pharmacies and drug services. A key aim is to reduce the transmission of blood-borne viruses (BBV) and other infections caused by sharing injecting equipment. Many NSPs also aim to reduce other harms caused by injecting drugs.
Services may include:
- advice on safer injecting practices
- advice on how to avoid an overdose
- information on safe disposal of injecting equipment
- access to blood-borne virus testing, vaccination and treatment services
- help to stop injecting drugs, including access to drug treatment (for example, opioid substitution therapy [OST]) and encouragement to switch to non-injecting methods of drug taking
- other health and welfare services (including condom provision).
Planners and commissioners
Planners and commissioners
Commissioning and coordinating needle and syringe programmes
Commissioning and coordinating needle and syringe programmes
Commissioning and coordinating needle and syringe programmes
Meeting local need
Commission a mix of generic and targeted needle and syringe programme (NSP) services to meet local need (see assessing local need and planning for NSPs). Targeted services should focus on specific groups (for example, homeless people and women who inject drugs). Services should aim to:
- increase the proportion of people who have over 100% 'coverage' (that is, the number who have more than one sterile needle and syringe available for every injection)
- increase the proportion of people from each group of injecting drug users who are in contact with NSPs
- ensure syringes and needles are available in a range of sizes and at a range of locations throughout the area
- offer advice and information on, and referrals to, services which aim to: reduce the harm associated with injecting drug use; encourage people to stop using drugs or to switch to non-injecting methods (for example, opioid substitution therapy); and address their other health needs.
Develop plans for needle and syringe disposal, in line with tackling drug-related litter.
Encourage identification schemes (involving, for example, the use of coloured syringes).
Commission integrated care pathways for people who inject drugs.
Audit and monitor services to ensure they meet the health needs of people who inject drugs and address the concerns of the local community.
Types of service
Use pharmacies, specialist NSPs and other healthcare settings to provide a balanced mix of the following levels of service:
- level 1: distribution of injecting equipment either loose or in packs, with written information on harm reduction (for example, on safer injecting or overdose prevention)
- level 2: distribution of 'pick and mix' (bespoke) injecting equipment plus health promotion advice (including advice and information on how to reduce the harms caused by injecting drugs)
- level 3: level 2 plus provision of, or referral to, specialist services (for example, vaccinations, drug treatment and secondary care).
Coordinate services to ensure injecting equipment is available throughout the local area for a significant time during any 24-hour period. As an example, commissioners of public health services could ensure that NSPs form part of the 'necessary enhanced services' offered by 100 hour pharmacies. Commissioners could also consider providing NSPs through community pharmacies that operate extended opening hours.
Ensure services offering opioid substitution therapy also make needles and syringes available to their clients, in line with the National Treatment Agency models of care.
Implementation tools
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/implementation-node-multipleSource guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodePublic health practitioners with a remit for substance misuse
Public health practitioners with a remit for substance misuse
Assessing local need and planning for needle and syringe programmes
Assessing local need and planning for needle and syringe programmes
Assessing local need and planning for needle and syringe programmes
With the help of the Health Protection Agency and public health observatories, collect and analyse local data to estimate the:
- prevalence and incidence of infections related to injecting drug use (for example, hepatitis C) and other problems caused by injecting drug use (for example, number of people overdosing)
- numbers, demographics, types of drugs used and other characteristics of injecting drug users (for example, the number of sex workers or homeless people who are crack and speedball injectors)
- number and percentage of injections 'covered' by sterile needles and syringes (that is, the number and percentage of occasions when sterile equipment was available to use)
- the number and percentage of individuals who had more sterile needles and syringes than they needed (over 100% coverage)
- number and percentage of people who inject drugs and who are in regular contact with a needle and syringe programme (NSP) (that is, at least once a month).
Use these data to ensure NSP services meet local need (for example, in terms of opening times and locations), taking the geography of the location into account (for example, whether it is in an urban or rural area).
Consult people who inject drugs to help assess the need for – and to plan – NSPs.
Consult local communities about how best to implement new or reconfigured NSPs. Promote the benefits of the service. For example, explain how it will help reduce drug-related litter by providing safe disposal facilities and sharps bins. Actively involve them in implementation.
For further recommendations see community engagement.
Implementation tools
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Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidance-nodeProviders of needle and syringe programmes
Providers of needle and syringe programmes
Community pharmacies
Community pharmacies
Community pharmacies
Provide people who inject drugs with needles, syringes and other injecting equipment. The quantity dispensed should not be subject to an arbitrary limit but, rather, should meet their needs. Where possible, needles and syringes should be made available in a range of sizes.
Ensure people who use a needle and syringe programme (NSP) are provided with sharps bins and advice on how to dispose of needles and syringes safely. Provide a service for safe disposal of used equipment.
Ensure safer injecting advice and information are available when providing long needles and other equipment that could be used for more dangerous practices. (Long needles, for example, could be used for injecting into the groin.)
Provide other injecting equipment associated with illicit drug use and encourage people who inject drugs to switch to other methods of drug use. (At the time of publication, legally permitted equipment included filters, mixing containers and sterile water.)
Encourage people who inject drugs to mark their syringes and other injecting equipment or to use easily identifiable equipment to prevent mix-ups.
Encourage people who inject drugs to use services which aim to: reduce the harm associated with injecting drug use; encourage them to stop using drugs or to switch to non-injecting methods (for example, opioid substitution therapy); and address their other health needs. Advise them where they can access these services.
Ensure staff who dispense needles and syringes receive appropriate training for the level of service they offer. As a minimum, this should include awareness training on the need for discretion and the need to respect the privacy of people who inject drugs. It should also include training on how to treat them in a non-stigmatising way.
Ensure staff providing level 2 and 3 services are trained to provide health promotion advice, in particular, advice on how to reduce the harm caused by injecting.
Ensure staff have health and safety training.
Ensure hepatitis B vaccination is available for staff.
Ensure staff can provide people who inject drugs with information about local agencies offering further support (this includes details about local opioid substitution therapy services).
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidanceSpecialist needle and syringe programmes
Specialist needle and syringe programmes
Specialist needle and syringe programmes
Specialist needle and syringe programmes are level 2 and 3 services.
Provide people who inject drugs with needles, syringes and other injecting equipment. The quantity dispensed should not be subject to an arbitrary limit but, rather, should meet their needs. Where possible, needles and syringes should be made available in a range of sizes.
Ensure people who use a needle and syringe programme (NSP) are provided with sharps bins and advice on how to dispose of needles and syringes safely. Provide a service for safe disposal of used equipment.
Ensure safer injecting advice and information are available when providing long needles and other equipment that could be used for more dangerous practices. (Long needles, for example, could be used for injecting into the groin.)
Provide other injecting equipment associated with illicit drug use and encourage people who inject drugs to switch to other methods of drug use. (At the time of publication, legally permitted equipment included filters, mixing containers and sterile water.)
Encourage people who inject drugs to mark their syringes and other injecting equipment or to use easily identifiable equipment to prevent mix-ups.
Encourage people who inject drugs to use services which aim to: reduce the harm associated with injecting drug use; encourage them to stop using drugs or to switch to non-injecting methods (for example, opioid substitution therapy); and address their other health needs. Advise them where they can access these services.
Ensure staff receive appropriate training for the level of service on offer.
Ensure a selection of individual needles, syringes and other injecting equipment is available.
Offer comprehensive harm-reduction services including advice on safer injecting practices, assessment of injection-site infections, advice on preventing overdoses and help to stop injecting drugs. Where appropriate, offer a referral to opioid substitution therapy services.
Offer (or help people to access):
- opioid substitution therapy
- treatment of injection-site infections
- vaccinations and boosters (including those offering protection from hepatitis A, hepatitis B and tetanus)
- testing (and counselling, where appropriate) for hepatitis B, hepatitis C and HIV
- psychosocial interventions
- primary care services (including condom provision and general sexual health services, dental care and general health promotion advice)
- secondary care services (for example, treatment for hepatitis C and HIV)
- welfare and advocacy services (for example, advice on housing and legal issues).
Source guidance
Failed to load fragment (default behaviour with no loader supplied): staticcontentfragments/source-guidancePaths in this pathway
Pathway created: December 2011 Last updated: December 2011
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