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 inject illicit 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 stop taking 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 local data 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. 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 Planning, needs assessment and community engagement

7. 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 Meeting need

8. 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 Meeting need

9. 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, harm reduction advice plus specialist services Types of service

10. 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 Types of service

11. Equipment and advice Needle and syringe programme providers should 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. 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 Community pharmacy NSP

14. 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 Community pharmacy NSP Training

15. 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 Specialist NSPs

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:www.nice.org.uk/PH18 guidance quick reference guide Costing statement and costing template audit support local authority planning checklist factsheet for commissioners