Needle and syringe programmes

Gaps in the evidence

The Public Health Advisory Committee (PHAC) identified a number of gaps in the evidence related to the programmes under examination, based on an assessment of the evidence. These gaps are set out below.

1. There is a lack of evidence about how many people inject drugs within different subgroups. This includes a lack of evidence about the number of young people who inject drugs and the number of people who inject image and performance enhancing drugs.

2. There is a lack of evidence about the injecting behaviours of different subgroups of young people and users of image and performance enhancing drugs. There is also a lack of evidence on how these groups use needle and syringe programmes and the effectiveness and cost effectiveness of providing needle and syringe programmes to these groups.

3. There is a lack of UK-based research on how best to target and tailor needle and syringe programmes to meet the needs of particular groups (such as young people who inject drugs, people who inject image- and performance-enhancing drugs and people who have recently started injecting drugs). For example, there is a lack of data on the effectiveness of using any of the following approaches with these groups: needle and syringe vending machines, specialist clinics, outreach or detached schemes.

4. There is a lack of evidence on how people who inject drugs perceive needle and syringe programmes and what encourages or discourages them from using the services. This may be particularly true for occasional users and use of image- and performance-enhancing drugs.

5. There is a lack of evidence on how to prevent people who are at high risk of injecting drugs (for example, those who smoke drugs) from moving from non-injecting to injecting drug use. This includes a lack of information about their needs and views.

6. There is a lack of evidence about the effectiveness (or otherwise) of providing needle and syringe programmes to children and very young people who are injecting drugs. This includes a lack of evidence about their specific needs.

7. There is a lack of evidence about the likelihood of children living with people who inject drugs becoming regular injectors themselves.

8. There is a lack of UK-based research on how the carers and families of people (including young people) who inject drugs and people who inject image and performance enhancing drugs view needle and syringe programmes. This includes a lack of evidence on how to get them involved with the programmes.

9. There is a lack of evidence about related behaviours that may occur among people who inject image and performance enhancing drugs, for example, poly-drug use or increased sexual activity.

10. There is a lack of UK-based research on the effectiveness and cost-effectiveness of prison-based needle and syringe programmes.

11. There is a lack of UK-based research into the potential unintended consequences of needle and syringe programmes. For example, there is a lack of evidence on whether or not they encourage people to inject more frequently.

12. There is a lack of standardised outcome measures for needle and syringe programmes in relation to safe injecting practices and the incidence and prevalence of blood-borne viruses, overdoses and wound infections. In particular, there is a lack of information regarding young people who inject drugs and people who inject image and performance enhancing drugs.

13. There is a lack of evidence on whether drug users who are referred to opioid substitution therapy programmes from needle and syringe programmes continue to attend after the first meeting.

14. There is a lack of evidence on the effectiveness of peer interventions that aim to prevent risky injecting practices and encourage people to use needle and syringe programmes.

15. There is a lack of evidence to determine whether secondary distribution increases risky injecting behaviour, and whether it increases or decreases the likelihood of people who inject coming into contact with a needle and syringe programme.

16. There is a lack of evidence on whether needle and syringe programmes encourage people to switch to safer injecting practices.

17. There is a lack of evidence about the impact that training needle and syringe programme staff can have on its effectiveness.

The Committee made 5 recommendations for research into areas that it believes will be a priority for developing future guidelines.