Transcript 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
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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
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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)
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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.
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NEX activity
Non-pharmacy services
Pharmacy services
Number of transactions
82,389
(36 services)
169,117
in 10 schemes
(116 pharmacies)
Number of clients
14,229
(31 services)
17,726
in 3 schemes
(37 pharmacies)
Number of syringes
distributed
1.81 million
1.75 million
Number of syringes
returned
849,113
714,119
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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
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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.
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Interventions offered by NEXes
Face-to-face HR advice
List of other NEXes in area
Referral to structured treatment
Motivational interviewing
Keyworking
Structured counselling
Care for minor infections
Complementary therapies
OD prevention training
Nutrition advice
Housing / social / legal advice
Well-woman clinic
GP/primary care sessions
Steroid clinic
Other
0
5
10
15
20
25
30
Number of services (out of 45)
35
40
45
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On-site interventions - comparison with England
Face-to-face HR advice
List of other NEXes in area
Referral to structured treatment
Scotland
Motivational interviewing
England
Key working
Structured counselling
Care for minor infections
Complementary therapies
OD prevention training
Nutrition advice
Housing / social / legal advice
Well-woman clinic
GP / primary care sessions
Steroid clinic
0%
10%
20%
30%
40%
50%
60%
70%
Percentage of services
80%
90% 100%
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On-site BBV interventions
25
20
15
10
5
0
HIV pre / post HCV pre / post HCV testing
test
test
counselling
counselling
HBV testing
HBV immun
HIV testing
HAV immun
Tetanus
immun
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On-site BBV interventions - comparison with England
60%
Scotland
England
Percentage of services
50%
40%
30%
20%
10%
0%
HIV pre / Hep C pre /
post-test
post-test
counselling counselling
Hep C
testing
Hep B
testing
Hep B
immun
HIV testing
Hep A
immun
Tetanus
immun
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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 cutbacks on paraphernalia that they had previously
been distributing for free.
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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.
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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.
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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?)
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Conclusion
Variation, variation, variation…
Is this variation acceptable?
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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.
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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
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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.
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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.
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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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