1. Needle and syringe programmes Implementing NICE guidance 2009 NICE public health guidance 18

2. What this presentation covers • Background • Scope • Recommendations • Discussion • Find out more

3. Background • 115,000 - 200,000 injecting drug users (IDUs) in England • 23% of IDUs report recently sharing needles • Over 40% of IDUs are Hepatitis C positive • IDUs are ten times more likely to die prematurely than the rest of the population • In 2006, over 1400 deaths were linked to controlled drugs

4. Scope • The optimal provision of needle exchange and syringe programmes (NSPs) for people who injectillicit substances and non-prescribed anabolic steroids • Majority of NSPs are run by pharmacies and drug services • Some NSPs offer other services such as help to stoptaking drugs • This guidance refers to people of 18 years and older

5. Planning, needs assessment and community engagement LSPs, PCTs and D(A)ATS should collect and analyse localdata on: • problems/harms linked to injecting drug use e.g. infections • number and characteristics of people who inject • number of IDUs in regular contact an NSP • number who have sterile injecting equipment available

6. Planning, needs assessment and community engagement LSPs, PCTs and D(A)ATS should • Use data gathered to ensure services meet local need • Consult people who inject drugs when planning NSPs • Consult local communities • Use the information collated to ensure NSP services meet local need • During consultations with local communities:- promote the benefits of the service- actively involve communities

7. Meeting need LSPs, PCTs and D(A)ATS should commission generic and targeted services to: • increase the number of people who have more than one sterile syringe and needle available per injection • reach more people from specific groups who inject • offer advice, information and referral to harm reduction services

8. Meeting need LSPs, PCTs and D(A)ATS should • Develop needle and syringe disposal plans • Encourage needle and syringe identification schemes • Commission integrated care for people who inject drugs • Audit and monitor services

9. Types of service LSPs, PCTs and D(A)ATS should - use pharmacies, specialist NSPs and other settings to provide a balanced mix of services: • Level one - injecting equipment (loose or in packs) with written information on harm reduction • Level two - bespoke equipment plus harm reduction and health promotion advice • Level three - bespoke equipment, harmreduction advice plus specialist services

10. Types of service LSPs, PCTs and D(A)ATS should • Ensure injecting equipment is available for a significant time during any 24-hour period • Consider using community pharmacies that operate extended opening hours • Ensure opioid substitution services also offer needles and syringes

11. Equipment and advice • Needle and syringe programme providersshould provide people who inject drugs with • needles, syringes and other injecting equipment • at quantity based on need, not subject to arbitrary limit • where possible, in a range of sizes • including sharps bins and advice on safer disposal • safer injecting advice when providing long needles

12. Equipment and advice • Needle and syringe programme providers should • encourage people who inject drugs to: • use syringe identification methods • use harm reduction services • stop using drugs or to switch to non-injecting methods • address their other health needs • advise where these services can be accessed

13. Community pharmacy NSP • Provide sharps bins, advice on safer disposal • Provide a service for safe disposal of used equipment • Ensure Hepatitis B vaccination is available for staff • Ensure staff can provide signposting and referral to local agencies offering further support

14. Community pharmacy NSP Training • Staff should be trained for the level of service they offer • Staff should receive health and safety training • For level 2 or 3 services, staff should be trained to provide health promotion advice • Training should also incorporate how to treat controlled drug using clients in a non-stigmatising way

15. Specialist NSPs • Provide a selection of individual needles, syringes and other injecting equipment • Offer harm-reduction services including: - safer injecting and overdose prevention advice - help to stop injecting drugs - and referral to opioid substitution therapy (OST) • Offer (or refer to) specialist services including, OST, vaccinations, wound care and welfare and advocacy

16. Discussion • How can we engage NSP clients in service planning consultations? • What is the profile of our NSP clients? • Are we also meeting the needs of people who inject stimulants? • How are we dealing with drug-related litter? • How can we monitor the training and competencies of staff working for commissioned services?

17. Find out more • Visit www.nice.org.uk/PH18 for the: • guidance • quick reference guide • Costing statement and costing template • audit support • local authority planning checklist • factsheet for commissioners