Findings of a survey of needle exchanges in England Lead author: Dima Abdulrahim, NTA

1. Findings of a survey of needle exchanges in England Lead author:Dima Abdulrahim, NTA National Needle Exchange Forum 7th July 2006 Marion Walker, Pharmacist – Clinical Team, NTA

2. Paying the Price • “Hepatitis C infection is the underlying certified cause of death in around 100 people each year. It also contributes to some of the 5,000 deaths each year from the complications of liver disease……..” Hepatitis C Action Plan for England July 2004

3. Needle Exchange survey • Background and aims • Methods • Key findings • Pharmacy needle exchanges and “Best Practice guidance”

4. Background and aims • In response to Hepatitis C action plan Looking at: • NEX provision • Interventions to reduce drug related harm • Data reporting systems • Delivery, commissioning, planning

5. Key findings • Most DATs had a mixture of (NEX) pharmacy and specialist services – maximises availability • 80% of NEX were pharmacies • Median activity per DAT p.a. • 8,000 visits • 700 clients • 149,950 syringes

6. Key findings (2) • Many specialist NEX did not provide or address BBV testing, Hep B immunisation, injecting hygiene, safer injecting • Lack of uniformity of nature and adequacy of NEX provision in England • Pharmacies generally only provide a limited range of interventions • Pharmacy NEX must be complementary to specialist NEX – not instead of.

7. Key Findings (3) • At DAT level often: • Poor data collection • Poor management of needle exchange activity • DATs often could not provide: • Data on numbers of visits • Number of clients • Quantities of equipment supplied/ returned

8. Good Practice • Many examples of good practice in needle exchange and wider harm reduction • User survey of nearly 4000 clients showed % who “Strongly agree” or “agree” with statement that clients are treated with respect by: • Key workers: 97% • Reception staff: 95% • Pharmacy staff: 84% • Other users: 82%

9. But……. • Many areas and groups of injectors were being denied interventions in line with MoC • User survey: • 25.7% said they had received advice about safer injecting • 20.7% had used a needle exchange • Not possible to work out where people had received “safer injecting advice”

10. Pharmacy NEX • “Best Practice guidance for commissioners and providers of pharmaceutical services for drug users” Feb 2006 • Jointly published by NTA, RPSGB, PSNC and PharMAG • 14 million face to face client contacts p.a. • New pharmacy contract • Difficulties for commissioners to engage with community pharmacies

11. What’s included • Pharmacy based needle exchange: • Detailed sample service specification • PSNC / DoH enhanced service contract information • How community pharmacies are paid • What else pharmacists can do! Plus, supervised consumption , non-medical prescribing, clarifying current and future pharmacy roles (community, PCT and hospital), pharmacy contract, crushing Subutex, Home office part instalments

12. Better Treatment • Role of scheme coordinator is crucial • “More treatment” also means ensuring sufficient capacity in the system – aim for 25% of community pharmacies providing NEX • Make best use of pharmacists and staff; • systems can be set up to ensure PNEX complements the specialist NEX. • Pharmacies can provide advice, information signposting to all drug users they come into contact with (not just NEX clients).