Needle and syringe programmes

Needle exchanges aim to remove the need for people to share and re-use injecting equipment by: providing sterile equipment for injecting illicit drugs, including needles, syringes, water, and vitamin c; and disposing of used injecting equipment. These services are an important way of preventing injecting-related harms, the most urgent and high-profile of which are blood-borne viruses, such as HIV and hepatitis C. Because of this, needle exchanges exist in many countries where the underlying consumption of drugs is illegal.

The aim of needle exchanges is to distribute enough injecting equipment that there is no need for people to share or re-use. In 2014, the National Institute for Health and Care Excellence (NICE) called on commissioners to provide every person who injects drugs with more sterile injecting equipment than they need for every single injection – in other words, over 100% coverage.

Needle exchanges can be found in settings such as pharmacies, addiction treatment services, and sometimes mobile locations such as vans. To deliver these services, you need to establish contact with an organisation that will provide clean needles and take clinical waste away, as well as check with local commissioning groups about whether your premises is appropriate for needle exchange services, which will involve running needs assessments and risk assessments. It is very important that needle exchange services convey an understanding of the different uses of the products that are dispensed, and can offer harm reduction advice to people who use the service – both of which require appropriate training for staff.

The 2012 quality standards on needle and syringe programmes, published by NICE, refer to specific groups that may require special consideration in the planning and delivery of these services: homeless people; women; people who use anabolic steroids and other performance- and image-enhancing drugs; and the prison population.

In 2004, the World Health Organization concluded there is “compelling evidence” that needle and syringe programmes help to combat the spread of HIV, they are cost-effective, and there is “no convincing evidence of any major, unintended negative consequences”. However, as NICE found in 2008, “the distribution of sterile needles and syringes alone is not sufficient to reduce the transmission of [blood-borne viruses], among [people who inject drugs]”. This may require a broad range of harm reduction interventions.

A 2018 study found that removing needle and syringe programmes would lead to a large increase in the prevalence and incidence of hepatitis C by 2030. The scenario was modelled in three UK cities with varying levels of coverage of needle and syringe provision and rates of chronic hepatitis C: in Walsall, it was predicted that the number of incident infections would increase by 23% if high-coverage needle and syringe provision was removed; in Dundee, the number would increase by 64%; and in Bristol, the number would increase by 32%.

A 2019 study asked what would happen to rates of infection with hepatitis C if all the needle exchange programmes were closed down. In three UK municipalities, the answers were predicted to be more infections, lost low-cost opportunities to improve and save lives, and in two of the areas, greater health-related costs overall. The conclusion was that these services are among the best investments UK health services can make.

Women who inject drugs may face higher levels of injecting-related risk than men (1 2 3), but are less likely to access harm reduction programmes. A study in Sweden investigated barriers and facilitators to needle exchange use among women. Reasons given for not wanting or not being able to attend included fear of losing custody or visitation rights to children, male partner jealousy and violence, unwillingness to spend time in the waiting area, fear of receiving positive test results for HIV or hepatitis C, limited opening hours, and having too far to travel to the needle exchange. Most participants proposed some form of women-only access to the needle exchange to strengthen the feeling of it as a safe space.

In the UK, there are no prison-based needle and syringe programmes, despite injecting drug use taking place in prisons and needle exchange programmes being a cornerstone of harm reduction in the wider community. Across Europe, prison-based needle exchanges are only available in Spain, Germany and Luxembourg.

• Read about the history of needle sharing and needle and syringe programmes from Exchange Supplies, a unique social enterprise established to supply products, information, and services to improve and prolong the lives of people who use drugs.
• See summaries of two studies from the Drug and Alcohol Findings archive that examine the provision of lower-risk ‘low dead space’ syringes in needle exchanges. The first includes interviews with people who inject drugs and staff members about the acceptability of low dead space syringes, and the second looks at the potential protective effect of low dead space syringes among different groups of people who inject drugs.