Quality standard

Quality statement 1: Needle and syringe programmes

Quality statement 1: Needle and syringe programmes

Quality statement

People who inject drugs have access to needle and syringe programmes in accordance with NICE guidance.

Rationale

Needle and syringe programmes can reduce transmission of blood-borne viruses and other infections caused by sharing injecting equipment. High quality programmes may reduce other harm associated with drug misuse, for example by advising on safer injecting practices, access to drug treatment and testing, vaccination and treatment for blood-borne viruses.

Quality measure

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure people who inject drugs have access to needle and syringe programmes in accordance with NICE's guideline on needle and syringe programmes.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by pharmacies and drug services, for example from service specifications.

Outcome

a) Proportion of people who inject drugs who access needle and syringe programmes.

Numerator – the number of people who access needle and syringe programmes.

Denominator – the estimated prevalence of injecting drug users.

Data source: No routinely collected national data for this measure has been identified. Data for the numerator can be collected from information recorded locally by needle and syringe programme providers. Information on estimated prevalence of injecting drug users for the denominator can be found in the Office for Health Improvement and Disparities Alcohol and drug misuse and treatment statistics collection.

b) Incidence of blood-borne viruses among people who inject drugs.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally in healthcare records.

What the quality statement means for different audiences

Service providers ensure systems are in place for people who inject drugs to have access to needle and syringe programmes in accordance with NICE's guideline on needle and syringe programmes.

Needle and syringe programme staff ensure people who inject drugs have access to needle and syringe programmes in accordance with NICE's guideline on needle and syringe programmes.

Commissioners ensure they commission services for people who inject drugs to have access to needle and syringe programmes in accordance with NICE's guideline on needle and syringe programmes.

People who inject drugs have access to needle and syringe programmes that are nearby, have suitable opening hours and provide injecting equipment and advice on reducing the risk of harm.

Source guidance

Needle and syringe programmes. NICE guideline PH52 (2014), recommendations 1 to 4 and 6 to 9

Definitions of terms used in this quality statement

Needle and syringe programmes

Needle and syringe programmes supply needles and syringes for people who inject drugs. In addition, they often supply other equipment used to prepare and take drugs (for example, filters, mixing containers and sterile water). Most needle and syringe programmes are run by pharmacies and drug services. They may operate from fixed, mobile or outreach sites.

Needle and syringe programme services should meet local need. For example, they should take into account opening times, location and geography of the location (rural or urban), as well as the level of services needed.

Pharmacies, specialist needle and syringe programmes and other healthcare settings should be used to provide a balanced mix of the following services:

  • level 1: distribution of injecting equipment either loose or in packs with written information on harm reduction

  • level 2: distribution of 'pick and mix' injecting equipment plus health promotion advice

  • level 3: level 2 plus provision of, or referral to, specialist services.

Some level 2 services might also offer blood-borne virus testing and treatment for hepatitis B, hepatitis C and HIV. [NICE's guideline on needle and syringe programmes, recommendation 6 and glossary]

Equality and diversity considerations

A number of specific groups of injecting drug users may require special consideration. These groups include:

  • people experiencing homelessness, who are more likely to share needle and syringe equipment on a regular basis than others who inject drugs

  • women, whose drug use may be linked to specific behaviours and lifestyles that put them at an increased risk of HIV and hepatitis infections

  • users of anabolic steroids and other performance- and image-enhancing drugs

  • the prison population, which contains a higher than average number of injecting drug users.