Needle and syringe programmes

Involve the following when assessing the need for, and when planning, expanding or improving, a needle and syringe programme:

Consult local communities about how best to implement new or reconfigured needle and syringe programmes. Promote the benefits of the service. For example, explain how these programmes have helped prevent an HIV epidemic in the UK and that they provide a route into drug treatment. Also explain that they may help reduce drug-related litter, by providing safe disposal facilities such as drop boxes and sharps bins.

Regularly collate and analyse data from a range of sources (including data from Public Health England) to build reliable local estimates of the:

Map other services that are commonly used by people who inject drugs, for example, opioid substitution therapy services, homeless services and custody centres.

Ensure the results of consultation and data analysis (in recommendations 1 and 2) inform the local joint strategic needs assessment.

Commission a range of generic and targeted needle and syringe programmes to meet local need, based on these results. For example, ensure services are offered at a range of times and in a number of different locations. Take the geography and demographics of the area into account (for example, whether it is an urban or rural area). Targeted services should focus on the specific groups identified.

Ensure services aim to be accessible and:

If applicable, commission outreach or detached services for areas where there are high levels of drug use or populations that do not use existing needle and syringe programmes.

Promote needle and syringe programmes to groups that may be under-represented among those who use them, for example, club-drug injectors and people who inject image- and performance-enhancing drugs.

Develop plans for needle and syringe disposal, in line with the Department for Environment, Food and Rural Affairs tackling drug-related litter: Guidance and good practice. Include the provision and disposal of sharps boxes for the safe disposal of needles. Consider providing public sharps bins (drop boxes) in areas where drug-related litter is common. Work with members of the local community, people who inject drugs and the local police service to agree the location for drop boxes.

Commission integrated care pathways for people who inject drugs so that they can move seamlessly between the full range of services, including treatment services.

Collect data on service usage as follows:

Ensure a local mechanism is in place to aggregate and analyse the data collected on at least an annual basis. Aim to build up a picture of injecting practices in the local area and how this may be changing over time. This data should be used as part of the collecting and analysing data process (see recommendation 2).

Ensure local service use data are available, in anonymised form, for relevant national bodies and research units (for example, Public Health England).

Develop and implement a local, area-wide policy on providing needle and syringe programmes and related services to meet the needs of different groups of young people aged under 18 (including young people under 16) who inject drugs.

Ensure the policy details how local services will achieve the right balance between the imperative to provide young people with sterile injecting equipment and the duty to protect (safeguard) them and provide advice on harm reduction and other services. It should take account of:

Make the governance responsibilities of drug services and safeguarding boards clear. The safeguarding board should approve the local policy.

Ensure the policy emphasises the need to provide young people with sterile injecting equipment. This should be provided as part of a broader package of care to meet their other health and social care needs, where possible. This is especially important for under-16s.

Ensure the policy is responsive to the needs of young people in the local area. The developers of the policy should take into account:

Ensure needle and syringe programmes aimed at young people who inject drugs implement all the recommendations in this guidance, not just those for young people.

Regularly review the policy.

Use pharmacies, specialist needle and syringe programmes and other settings and approaches to provide geographical and demographic coverage. Examples of other settings and approaches that could be used include: custody centres, sexual health services, outreach and detached services. Provide a mix of the following levels of service to meet local needs:

Establish links and referral pathways between the different levels of service to promote integration and to share learning and expertise.

Coordinate services to ensure testing for hepatitis B and C and other blood-borne viruses is readily available to everyone who uses a needle and syringe programme (see NICE's guideline on hepatitis B and C).

Coordinate services to ensure injecting equipment is available at times, and in places, that meet the needs of people who inject drugs. For example, it may be appropriate to provide out-of-hours vending machines for groups that would not otherwise have access to services – or not at the time that they need them. (The location of these machines would need to be considered carefully and their use would need to be regularly monitored.) Another example would be to encourage pharmacies with longer opening hours to provide needles, syringes and other injecting equipment.

Ensure services offering opioid substitution therapy also make needles and syringes available to their service users.

Provide people who inject drugs with needles, syringes and other injecting equipment. The quantity provided should not be subject to a limit but, rather, should meet their needs.

Not discourage people from taking equipment for others (secondary distribution), but rather, ask them to encourage those people to use the service themselves.

Ensure people who use the programmes are provided with sharps bins and advice on how to dispose of needles and syringes safely. In addition, provide a means for safe disposal of used bins and equipment.

Provide advice relevant to the type of drug and injecting practices, especially higher risk practices such as injecting in the groin or neck.

Encourage people who inject drugs to mark their syringes and other injecting equipment, or to use easily identifiable equipment, to reduce the risk of accidental sharing.

Encourage people who inject drugs to use other services as well. This includes services that aim to: reduce the harm associated with this practice; encourage them to switch to safer methods, if these are available (for example, opioid substitution therapy), or to stop using drugs; and address their other health needs. Tell them where to find these services and refer them as needed.

Ensure staff who distribute needles and syringes are competent to deliver the level of service they offer. As a minimum, this should include awareness of the need for discretion and the need to respect the privacy and confidentiality of people who inject drugs. It should also include an understanding of how to treat people in a non-judgmental way.

Ensure staff providing level 2 or 3 services (see recommendation 6) are competent to provide advice about the full range of drugs that people may be using. In particular, they should be able to advise on how to reduce the harm caused by injecting and how to prevent and manage an overdose.

Ensure staff have received health and safety training, for example, in relation to blood-borne viruses, needlestick injuries and the safe disposal of needles, syringes and other injecting equipment.

Ensure hepatitis B vaccination is available for staff directly involved in the needle and syringe programme.

Ensure staff are aware of, encourage and can refer people to, other healthcare services including drug treatment services.

Ensure pharmacy staff offer wider health promotion advice, as relevant, to individuals.

Ensure a selection of individual needles, syringes and other injecting equipment is available.

Provide sharps bins and advice on how to dispose of needles and syringes safely. In addition, provide a service for safe disposal of used equipment.

Ensure staff are competent to deliver the service on offer. As a minimum, this should include awareness training on the need for discretion and the need to respect the privacy and confidentiality of people who inject drugs. It should also include training on how to treat people in a non-judgmental way.

Ensure staff are competent to provide advice about the full range of drugs that people may be using, how to reduce the harm caused by injecting and how to prevent and manage an overdose.

Ensure hepatitis B vaccination is available for staff directly involved in the needle and syringe programme.

Offer comprehensive harm-reduction services. This includes: advice on safer injecting practices, assessment of injection-site infections, advice on preventing overdoses and help to stop injecting drugs.

Offer (or help people to access):

Ensure needle and syringe programmes:

Ensure those level 2 and 3 programmes used by a high proportion of people who take image- and performance-enhancing drugs provide specialist services for this group. This is in addition to routine services set out in recommendations 6 to 9. It includes: