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Evidence into practice and
policy: needle and syringe
programmes - protecting people
and communities
Monday 19 May 2014, Birmingham
Evidence into practice and policy: needle and syringe
programmes - protecting people and communities
Chair’s welcome and overview
Dr Paul Cosford, Director for Health Protection and
Medical Director, Public Health England
Monday 19 May 2014, Birmingham
Welcome
• Here to support the implementation of an important evidence-based
intervention:
• Morning session:– the why and what
• Afternoon:– the how
In the 80s, 90s and 00s, government, services and
drug users responded to heroin and crack injecting
What do we face now? – A brief overview
3
Needle and syringe programmes - protecting people and communities, 19 May 2014
Significant achievements to maintain and build on
Rate of sharing
HBV vaccination rate
Anti-HCV prevalence
Anti-HIV prevalence
Anti-HBV prevalence
100%
80%
60%
40%
20%
0%
2002
4
2003
2004
2005
2006
2007
2008
2009
Needle and syringe programmes - protecting people and communities, 19 May 2014
2010
2011
2012
Evidence that IPED injection and
infection levels are increasing
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
The most commonly used image and
performance enhancing drugs are
anabolic steroids. These are typically
injected.
The 2012/13 Crime Survey estimated
that 59,000 people aged 16–59 years
had used anabolic steroids in the past
year, but emerging consensus that this
is an under-estimate.
Other drugs used include the tanning
agent melanotan.
1.5% are living with HIV
5.5% have been infected with hepatitis C
8.8% have been infected with hepatitis B
People who inject image and image and performance enhancing drugs are, in
some areas, the largest group making use of needle and syringe programmes.
Needle and syringe programmes - protecting people and communities, 19 May 2014
More challenges
Changes in psychoactive drug injection
New psychoactive substances and club drugs
• Evidence of mephedrone and ketamine injecting
• International lessons, e.g. injecting synthetic cathinones –
like mephedrone – associated with the recent HIV outbreak in Romania
Changing patterns of drug use among some men who have sex with men
• ‘Slamming’ (injecting drugs) often in the context of ‘sex parties’
• Injecting, often among HIV-positive gay men, heightening concern about
the transmission of blood-borne viruses and bacterial sexually transmitted
infections (particularly hepatitis C, HIV and Shigella)
6
Needle and syringe programmes - protecting people and communities, 19 May 2014
The operating landscape
Local authorities commission NSP from the PH grant
• Local decisions based on local need – evidence & assessment of need are
vital
PHE and NICE
• Evidence-based recommendations
• Implementation support, including: data standards; briefings for providers
and commissioners
• Case for investment and return on investment
• Relationship to other PHE and NICE work
• Hepatitis C treatment – access and pathways
• MSM sexual health and wellbeing
• Evidenced based commissioning and service provision
• Balanced recovery oriented treatment systems- balanced and integrated recovery
and impact on health harms and need.
• Evidence-based briefings on IPEDs, MSM, BBV transmission
7
Needle and syringe programmes - protecting people and communities, 19 May 2014
Evidence into practice and
policy: needle and syringe
programmes - protecting people
and communities
Monday 19 May 2014, Birmingham
Keynote address:
30 years of needle exchange
Lord Norman Fowler
Former Health Secretary
Evidence into practice and
policy: needle and syringe
programmes - protecting people
and communities
Monday 19 May 2014, Birmingham
Updating the NICE Needle and Syringe Programme
(NSP) Guidelines:
PH 52 - April 7th 2014
Professor Chris Packham, Core Member, Public Health Advisory Committee A
Centre for Public Health
Needle and Syringe Programmes
• Supporting existing NICE guidance
– PH9, PH4, CG52, CG51, several TAs
• NSPs protect individuals and communities from the effects of blood
borne viruses and other harms associated with injecting drugs
• NSP and Opioid Substitution Therapy (OST) hasn’t reduced
Hepatitis C prevalence – increased coverage may
• NSP is a gateway to wider prevention and treatment
• NSPs need to be available in many different settings / times and to
many different types of client group
• High coverage likely to be very important (>100%)
Six original recommendations (PH 18 2009)
1 PLANNING, NEEDS ASSESSMENT AND COMMUNITY ENGAGEMENT
2 MEETING NEED
3 TYPES OF SERVICE: 3 TIER MODEL OF NSP PROVISION
4 EQUIPMENT AND ADVICE
5 COMMUNITY PHARMACY-BASED NSPs
6 SPECIALIST NSPs: LEVEL THREE SERVICES
Plan
• Rationale for the update
• How the updated guidelines were developed
• Changes from the original guidelines
• Remaining gaps
Process
• Guideline PH18 published Feb 2009, review Apr 2012
• Expert group considered whether any new evidence or
significant changes in policy and practice would be likely
to lead to substantively different recommendations
• The proposal of the expert group was consulted on
publicly
• Findings
– There was no new evidence to contradict the current recommendations
– There was new evidence that could add to existing recommendations
– There was new evidence that could expand the previous work to more
fully meet the scope
New areas
• NICE decided to undertake an update of the existing
NSP guidelines
• Following the expert group and consultation, the update
focussed on:
– New evidence related to existing recommendations
• Vending machines, outreach, drop boxes.
– NSP provision to Image and Performance Enhancing
Drug (IPED) users
– NSP provision to under 18s
Preparing the review
Centre for Public Health commissioned reviews of the
evidence
–
Quantitative and qualitative review of evidence since 2008:
•
•
–
–
What level of coverage, type of NSP and alternative services are most effective and
cost-effective in reducing the prevalence of BBV, deaths and morbidity
qualitative evidence: what do users and professionals identify as suitable types of
NSPs, suitable level of coverage of equipment, views and perspectives on NSPs,
additional harm reduction services and OST delivered in parallel or alongside NSPs
–
Young persons (<18) use of services
Policy review and Consensus development using panel of 12
experts on optimal provision of services for <18s
Image and Performance Enhancing Drugs (IPEDs) review
–
Fieldwork results and summary of stakeholder comments
How the Public Health Advisory Committee
(PHAC) works
• Evidence searches determined by initial expert group
and public consultation
• PHAC then considered that evidence
– Core members (chair, systematic reviewer, public
health, psychology, statistics, economics, lay)
– Topic Experts
– Academic teams who produced the Evidence
– 2 meetings to produce then fieldwork / stakeholder
views on drafts
– Final meeting – production - consultation – publication
Deliberations
•
Wide range of facts and issues from initial evidence update and expert
comments:
–
–
–
–
–
Public perceptions of drop boxes
Aspects of improving data collection
Training issues in extending NSPs to under 18s
Switching from injecting not always a safer option
The heterogeneity of risk across different IPED user groups
Whats new?
• Original PH18 had six recommendations – PH 52 has 10
• Two completely new recommendations:
– Under 18s
– IPEDs
• Two expansions of existing recommendations
– Collation of data on drug use
– monitoring of services
Develop a policy for young people aged
under 18
•
•
•
•
Requires local areas to develop and implement a policy on providing NSP and related
services to young people aged under 18 (including young people under 16).
Asks how local services will achieve the right balance between the imperative to
provide young people with injecting equipment and the duty to safeguard them and
provide advice on harm reduction and other services. It includes:
– the young person’s capacity to consent
– the risks they face
– the benefits of them using services
– the likelihood that they would inject anyway, even if equipment was not provided.
Provide NSP as part of a package of care (esp to under 16s) where possible.
Offers some ideas about the things local areas will need to consider, for example
consent, parental involvement, specialist substance misuse services for YP, training
needs
Provide equipment and advice to people
who inject IPEDs
•
Ensure needle and syringe programmes:
– Are provided at times and in places that meet the needs of people who inject
IPED. (For example, outside normal working hours or outreach in gyms.)
– Provide the equipment, information and advice needed to support these users.
– Are provided by appropriately trained staff
•
Specialist NSPs with high numbers of IPED users should provide specialist services
for them. It includes:
– specialist advice about IPED and side effects
– advice on alternatives (for example, nutrition and physical training as an
alternative to Anabolic Steroids)
– information about, and referral to, sexual and mental health services and to
specialist IPED clinics, if these exist locally.
Notable additions
• “Not discourage secondary distribution”
• “Where possible, provide low dead space
syringes”
• Consider drop boxes (in consultation with police
and communities)
• Consider whether vending machines might be
appropriate
Considerations
• NSPs must be part of comprehensive strategies – vital ‘gateway’
role
• Non judgemental about providing NSPs
• Most research was USA-based
• High coverage (% injections covered by sterile needles) is key
• Vending machines for Out of hours or isolated geographical areas
but NOT as substitute
• Balance between safeguarding and provision for under 18s – good
practice to involve Local Safeguarding Board advice
• Some instability of the original heath economic model
• Lower marginal costs for extending NSPs to under 18s
• Lack of data for IPED modelling:
“insufficient evidence to determine whether it is cost effective to develop dedicated services for
this group”
Gaps and Research Recommendations
• Encouraging NSP use in specific groups
• Cost-effectiveness of NSPs for <18s and IPED users
• What behaviour-change interventions work apart from
‘clean works’
• What types of injecting equipment best reduce harm
• Do NSPs have unintended consequences?
– How do disposal facilities affect drug litter
– How do NSPs affect use long-term
– Do NSPs have negative effects on community perceptions of
crime
IMPLEMENTATION
• revised guidance published 9th April 2014
• Range of tools and support from PHE and NICE
[email protected]
Louisa Wall, Implementation Advisor
[email protected]
Costing statement
• The statement demonstrates that for a relatively small investment,
around £200 per annum for a person who injects drugs, there is the
potential to avoid significant future healthcare costs estimated to be
between £10,000 and £42,000 per individual, per annum. In addition
there may savings in wider societal costs, for example crime costing
an average of £26,074 is committed by an addicted person not in
treatment.
Evidence into practice and
policy: needle and syringe
programmes - protecting people
and communities
Monday 19 May 2014, Birmingham
Evidence into practice and policy:
The potential impact of needle and
syringe programme provision on people
and communities
Matt Hickman – & (Peter Vickerman, Norah Palmateer,
Sharon Hutchinson, Esther Aspinal, David Goldberg,
Matthew Barber, Angela Beattie, Georgie Macarthur,
Natasha Martin, Vivian Hope, Alec Miners, Lucy Platt)
Acknowledgements
• NIHR Health Protection Research Unit in Evaluation of Interventions
• NIHR School of Public Health Research
• Health Protection Scotland: HCV Action Plan
• NIHR Research for Patient Benefit (RfPB) Programme “Script in a day
trial” (PB-PG-0909-20007) & Bristol Drug Project
• European Commission Drug Prevention and Information Programme
(DIPP) “Treatment as Prevention in Europe: Model Projections of Impact
And Strengthening Evidence Base On Intervention Coverage and Effect”
• NIHR Health Services and Delivery Research (HS&DR) (12/3070/13) Assessing the impact and cost-effectiveness of needle/syringe provision
on hepatitis C transmission among people who inject drugs: an analysis
of pooled datasets and economic modelling.
• National Institute of Health and Care Excellence: Public Health Guidance
18
Summary
• NSP are effective
• Good/emerging evidence that reduce injecting risk and
BBV transmission
• NSP are cost-effective
• Strategies to increase high coverage NSP (as low cost)
likely to be cost-effective
• NSP gateway to other services
• Promote OST/ viral testing/ research
• NSP are a key component of “comprehensive programme of
interventions to reduce injecting risk/ drug related harm
Effectiveness:- Review of Reviews
NSP is effective in reducing self-reported
injecting risk behaviour
BUT weak/insufficient evidence on HCV (and
HIV) transmission
Palmateer et al Addiction 2010 105: 844-59
(http://www.hepcscotland.co.uk/action-plan.html
Pooling UK evidence on
intervention impact
Site
Year
Design
N
HCV+ve Incidence
Bristol
2006
RDS
299
59%
Leeds
2008
RDS
302
60%
Birmingham
2009
RDS
310
42%
Glasgow
2008-09
C'sectional
NSP
947
70%
Wales
2004-06 Follow-up 406/700
26%
London
2001-02 Follow-up 282/428
43%
Turner Addiction 2011 doi: 10.1111/j.13600443.2011.03515.x
40 per
100py
7.6 per
100py
5.2 per
100py
10.0 per
100py
5.6 per
100 py
42 per
100py
Seroconversions
14
2
2
6
17
49
OST/HIGH COVERAGE NSP (HC_NSP) EFFECTIVENESS
• Use recent pooled UK evidence for impact of harm reduction on
an individual’s risk of recent HCV infection1
Effect Estimates
AOR1
95% CI
HC_NSP
0.48
0.3
0.9
OST
0.41
0.2
0.8
OST and HC_NSP
0.21
0.1
0.5
1 adjusted for: gender, crack, homeless, injecting duration
HC_NSP is defined as exchanging more syringes than you inject
Turner K et al. Addiction 2011; 106:1978-88
Meta-analysis of studies showing impact of opiate substitution treatment in relation to HIV
transmission in people who inject drugs among all pooled studies and studies reporting only
adjusted effect estimates .
MacArthur G J et al. BMJ 2012;345:bmj.e5945
Results – Intervention to Increase Recruitment
(and extend duration) High Coverage NSP
Increase in
recruitment
Cost (£)
QALYs
ICER
20K*
30K*
Baseline
481,129,096
10,563
12.5%
481,248,303
10,566
£38,679
n/a
n/a
25%
481,251,065
10,569
£19,864
£1
£62
50%
481,243,248
10,574
£9,848
£118
£234
100%
481,318,473
10,583
£4,359
£321
£526
Decision Problem 2 - What additional cost would be
acceptable if it were possible to increase sterile syringe
coverage for IDUs attending NSPs?
I
NICE public health guidance 18 Needle and syringe
programmes: providing people who inject drugs with
injecting equipment
• Ensure services aim to be accessible and:
• Increase the proportion of people who have more than 100%
coverage (that is, the number who have more than one
sterile needle and syringe available for every injection)
HCV ACTION PLAN SCOTLAND:
HOW HAS INJECTING RISK
BEHAVIOUR CHANGED?
Slides on hcv action plan
• Unpublished data – please contact:• [email protected]
• [email protected]
Can we attribute changes in HCV and risk
behaviour to the Action Plan?
Provision/ uptake of
sterile injecting
equipment
Methadone
Drug market
factors
Frequency of
injecting
Drug use
trends
HCV testing/
knowledge of
HCV status
Sharing injecting
equipment
HCV transmission
Education
Cessation of
injecting/
death/
migration
Prevention: Evidence from international
studies
Intervention
Needle/syringe provision
(NSP)
Opiate substitution therapy
(OST), i.e. methadone
Outcome
Injecting risk
HCV
behaviour
transmission
NSP & OST combined
Paraphernalia provision
+ + + = compelling
+ = tentative
+++
+
+++
++
+++
+++
++
–
+ + = sound
– = insufficient
HCV PREVENTION –
COMBINED INTERVENTIONS
Estimated number of people infected
with HCV: E&W
~15,000 White; 11,000 (IPB)
Sweeting et al. Biostatistics 2008; De Angelis et al, Statistics
in Med Research 2009; Ross et al EJPH 2011
HCV prevalence
(baseline was 40% prevalence)
Impact of changing coverage of OST
and NSP from 50%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Without
NSP/OST
60%
70%
5 years
80%
60%
70%
80%
10 years
60%
70%
80%
20 years
Effect of scaling up both OST and NSP to 60%, 70% and 80%
coverage for different durations (baseline was 50% coverage)
Vickerman et al Addiction 2012
doi:10.1111/j.1360-0443.2012.03932.x
10 YEAR RELATIVE PREVALENCE REDUCTIONS WITH
COMBINING OST/NSP/HCV TREATMENT
40% chronic prevalence
• Dark red: modest (<20%)
impact, high HCV
• Orange: ~50% impact
• White: >80% impact
• HCV treatment scale-up
needed to achieve >40%
reduction in 10 years
Martin NK, Hickman M, Hutchinson SJ, Goldberg DJ, and Vickerman P. Combination
interventions to prevent HCV transmission among people who inject drugs: modelling the
impact of antiviral treatment, needle and syringe programmes, and opiate substitution therapy.
Clinical Infectious Diseases 2013
NSP – R&D
Script in a day (SCID)
• An un-blinded parallel-group feasibility RCT of
same day access to opioid substitution therapy
(OST) compared with standard care with 3
month follow-up.
• Injecting drug users presenting for needle
exchange at Bristol Drugs Project and not in
treatment for at least two weeks were invited to
take part.
Intervention vs Control
• SCID
• Drug worker makes appointment at trial GP surgery
for same day OST and arranges Peer Support
volunteer to accompany them to first and subsequent
appointments if wanted.
• Seen by GP on day 0, 7, 21 then transferred to
Shared Care Worker at their own GP surgery
• Treatment as Usual
• Case management/ MI
• Participant informed how to get OST and free phone
call to make own GP appointment.
SCID results - unpublished
• Please contact:• [email protected]
Summary
• No evidence of a difference in outcomes between the
two groups at 3 months
• Days use of opiate use decreased >70% in both groups
amongst those on OST
• Self-reported health utility improved during trial – but low
compared to general population (0.6 vs ~1) & no
evidence of a difference between intervention and
control
Conclusions
• Trial success
• good recruitment and excellent follow-up
• Proposed by users and workers/ PPI
• But insufficient evidence of an effect compared to
intensive case management.
• Qualitative study suggested that completing the baseline
questionnaires may help create or improve motivation for
treatment.
• Evaluate whether more intense case management (with
neutral health audit) could increase uptake of OST…
Future
• Systematic review of effectiveness of NSP & OST on
HCV
• Update & refine costing of NSP and CE evaluation
• Optimise combination of interventions to reduce HCV
• Develop & evaluate strategies to improve NSP delivery
and reduce drug related harm
Amsterdam Cohort Study – impact
of harm reduction
HIV seroconversion: Harm reduction vs. no harm reduction
HCV seroconversion: Harm reduction vs. no harm reduction
Van Den Berg et al..
Addiction 102 (9), 1454-1462
Evidence into practice and
policy: needle and syringe
programmes - protecting people
and communities
Monday 19 May 2014, Birmingham
Substance Misuse : Maintaining
Public Health Priorities in a time
of Diminishing Resources
Mind The Gap
Cllr Steve Bedser
Cabinet Member Health & Wellbeing
Health
Wellbeing
Mind&The
Gap
Significant change
Responsibility for Drug and Alcohol
funding moved to Local Authorities in
April 2013
Health
Wellbeing
Mind&The
Gap
Risk of Disinvestment
• Current severe financial pressures on Local
Authorities
• Realisation of cost efficiencies through integrated
commissioning and realising cross cutting
outcomes:
 Adult Substance Misuse and linkages with LAC
 Police and in cell intervention including substance misuse
/ mental health and health care
 Substance misuse detoxification combined with
rehabilitation
 Supporting People and substance misuse provision
Health
Wellbeing
Mind&The
Gap
HWB Priorities – Substance Misuse
Through early intervention / prevention
opportunities reducing:
• Numbers of LAC
• Homelessness
• Domestic Violence
Health
Wellbeing
Mind&The
Gap
The Reality – We Know
• Reducing the risk of neglect and abuse of
our children who have substance misusing
parents is a critical issue for many LA’s.
• A very high proportion of families with
children who are known to social care have
parents with substance misuse or mental
health problems
Health
Wellbeing
Mind&The
Gap
The way forward
• Use of new focused support mechanisms
• Use of new treatments and commissioning
different approaches
• Focus detailed, integrated, support for the
most vulnerable – timely interventions
• Continue our central battle through political
representation and advocacy
• Working across organisational boundaries
and at a local level
Health
Wellbeing
Mind&The
Gap
Local Government
• Still fairly new for Local Government and for
local politicians – a very large area of
expenditure
• Role of corporate and societal culture
• Hard choices on best use of public money –
not just what, but whom
PublicThe
Health
Mind
Gap
Key messages
• Needle & syringe programmes protect individuals & communities
• They were important when HIV threatened in the 80s – and are still
critical interventions.
• Opiate and crack use, and injecting, may be decreasing but
new/growing populations of injectors are emerging: image and
performance-enhancing drugs, and new psychoactive substances,
men who have sex with men, young people
• In some of these populations, BBVs are worryingly high
• NSP is also a gateway to treatment (drugs and HCV etc) and recovery
• NSP flexibility: both pharmacy and specialist, in gyms, 24-hours, etc
• Local authorities need to maintain investment in a context of
competing priorities. NSP provides value for money by protecting
individual and wider community public health and safety
Health
Wellbeing
Mind&The
Gap
An example from Birmingham
Audit & review: Needle Exchange Services
• Distributed without wrap round interventions
• Limited focus on harm minimisation
• Users are often not supported to access structured
treatment services
• Anecdotally gym owners sell on needles to steroid users
• Feedback from users: Needle exchange packs need
reviewing
• Expensive and outdated needle exchange packs
Action: Now being addressed as part of the recommissioning
of substance misuse services in Birmingham
Maintaining public health
priorities in a time of diminishing
resources
Martin Reeves, CEO, Coventry City Council
Evidence into practice and
policy: needle and syringe
programmes - protecting people
and communities
Monday 19 May 2014, Birmingham
Panel Discussion
Monday 19 May 2014, Birmingham
Evidence into practice and
policy: needle and syringe
programmes - protecting people
and communities
Monday 19 May 2014, Birmingham
NICE – supporting quality in health and social care
Chris Connell
Implementation Consultant
May 2014
Areas to cover
• Why use NICE guidance and quality
standards
• Support for implementation
• Finding what you need quickly and easily
So why use NICE guidance?
• Comprehensive evidence
base
• Expert input
• Patient and carer
involvement
• Independent advisory
committees
• Genuine consultation
• Regular review
• Open and transparent
process.
But there are tensions …
• Complexity
• Costs and funding
• Co-morbid conditions
• Demographic change
• Public expectations
• Professional interests
And in particular, from the NICE uptake
survey of PH18
•
•
•
•
•
Lack of data – esp. hard to reach groups
Difficulty in conducting needs assessment
Engagement of some key staff difficult
Knowledge gaps – e.g. comm. pharmacy staff.
Applying recommendations to young people –
half of respondent to survey had not applied the
recommendations to young people
• Insecure funding – evidencing the return on
investment
The NICE Implementation Strategy
• Developing a supportive environment
– Key partners
– Education initiatives
• Practical tools
• Evaluation
NICE guidance support
• Baseline assessment tool
• Costing tools
• Commissioning guide
• Shared learning case studies
• NICE MPC information for community pharmacists
• Collaboration with PHE to provide practical support
• Data Set – to be published
Shared learning case studies
Includes examples of:
• Community pharmacy based NSPs
• Blood borne virus screening and vaccination service
• Peer exchange scheme
Videos available from NICE website
Shared Learning
Lifeline Kirklees – Putting the
muscle into recovery
The Can Partnership PBNX
(pharmacy-based needle
exchange) programme for
community introduction
www.nice.org.uk/sharedlearning
NICE Field Team
• Implementation Consultants
• Team of 7 aligned to NHS
England regions
• 1 in Northern Ireland
• Each responsible for a
geographical area
• Provide local support
• Contact details on the map
Finding what you need quickly and
easily
Different ways of finding guidance on the
new website
NICE Pathways
NICE support for local government – on one page
www.nice.org.uk/localgovernment
How to find out more
• Website www.nice.org.uk
• Sign up to receive monthly NICE News
• Email: [email protected]
• Queries email [email protected]
• 25,000+ people now follow us on Twitter
for guidance updates @NICEcomms
Evidence into practice and
policy: needle and syringe
programmes - protecting people
and communities
Monday 19 May 2014, Birmingham
Panel discussion: NSP
implementation from different
perspectives
[email protected]
We believe individuals have a right to be able to
access high quality information about drugs and
using drugs to enable them to make informed
choices about which drugs they use, the positive
effects of drugs, the risks of using particular drugs
and practical information to enable them to use
more safely.
We also believe that anyone who feels they need
Drug Treatment should be able to access high
quality treatment that meets their individual needs.
We accept that this treatment may not be the same
for everyone and that an individual’s needs may
vary over time.
Norman E. Zinberg, M.D.
Drug, Set and Setting. The basis of controlled
intoxicant use.
Newhaven and London: Yale University Press,
1984
http://www.exchangesupplies.org/shopdisp_sharp_
needle_blunt_needle_card.php?page=pictures
Public Health England, Health Protection
Scotland, Public Health Wales and Public Health
Agency Northern Ireland.
Shooting Up: Infections among people who
inject drugs in the UK 2012 (update 2013)
London: Public Health England, November 2013
http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317140236856
Evidence into practice and
policy: needle and syringe
programmes - protecting people
and communities
Monday 19 May 2014, Birmingham
Workshop A
People who inject image and
performance-enhancing drugs
Monday 19 May 2014, Birmingham
EVIDENCE INTO PRACTICE AND POLICY:
NEEDLE AND SYRINGE PROGRAMMES –
PROTECTING PEOPLE AND COMMUNITIES
19/05/2014
People who inject
image & performance enhancing drugs
Anabolic steroids
Based on the (male) hormone testosterone
More accurately called:
Anabolic - muscle building
Androgenic - masculinising
Steroids
*a bit oestrogenic as well
What do we actually know about IPED
use in the UK?
Prevalence
Characteristics of users
Reasons/drivers for use
Drug efficacy & actions
Methods & regimes
Harms
Effective drug prevention
Effective harm reduction
Very little
Some
Partial
Limited
Good
Patchy
Minimal
Developing
+
++
++
+
+++
+
+
++
IPED
Psychoactive drugs
Used to change physical appearance
or improve performance / strength
Used to effect mood or perception.
Usually planned on/off cycles
Often uncontrolled and habitual
No evidence of drug driven crime but
some association with violence
Strong link with acquisitive crime
Ampoules of liquid or vial of powder
for reconstitution
Powders or tablets which need to be
prepared for injection
Mostly bought through the internet, in
gyms or imported
Acquired on the ‘street’
Injected IM or SC
Usually injected IV
Frequency of injection usually
between daily - weekly
Often multiple injections daily
Increasing numbers of users
Decreasing prevalence (heroin/crack)
IPED users – people who inject drugs
Vulnerable population – lifestyle including
other drug use, incarceration, sexual health
Changing practices and populations
The illicit market
16-59 year olds reporting use of anabolic steroids
1.2
1
“Have you ever taken anabolic steroids (steroids) (not
prescribed by a doctor) even if it was a long time ago?
0.8
0.6
last year
Ever
0.4
0.2
0
Drug (2012/13)
Last year
Ever
Anabolic steroids
59,000
271,000
Heroin
27,000
190,000
CSEW, 2013
Individuals attending agency-based NSP in
Cheshire & Merseyside (1991 – 2011)
LJMU, 2013
Percentage of NSP clients using IPEDs in the
North of England
Middlesbrough
Kirklees
Sheffield
Newcastle
Sunderland
Bradford
Halton
Liverpool
Sefton
St Helens
Warrington
Wirral
Manchester
Bolton
67%
60%
62%
52%
60%
41%
86%
83%
43%
34%
86%
77%
60%
52%
Data provided by NSP service providers/managers via [email protected]
Viral and bacterial infections amongst IPED
injectors
Prevalence
n
Anti-HIV positive
1.5%
(95%CI 0.56% to
3.3%)
6
Anti-HCV positive
5.5%
(95%CI 3.5% to
8.3%)
20
Anti-HBc positive
8.8%
(95%CI 6.3% to
12%)
26
Ever had redness at an injection site?
43%
168
Ever had an abscess/sore/open wound at injection site?
7%
27
Hope, McVeigh et al 2013 & 2014
Blood borne viruses
“No bodybuilders that I know share.
I mean you hear of what are called
druggies, people who use other
stuff. I don’t mix in those circles to
be honest”
Kimergård & McVeigh, 2014
Injected in previous year
Proportion
n
Anabolic Steroids
86%
340
Growth Hormone
32%
128
HCG
16%
62
Insulin
5.6%
22
Melanotan
8.6%
34
Other PIED (inc. EPO, IGF-1 and Nubain)
5.1%
20
Hope, McVeigh et al 2013
Prevalence of growth hormone use amongst
anabolic steroid users
The cost of growth hormone
Brand
Jintropin
Amount
100IU
Cost
£100
Cost per IU
£1.00
Hydrotropin
Ancemone
200IU
40IU
£350
£100
£1.75
£2.50
Norditropin
30IU
£140
£4.67
Genotropin
36IU
£225
£6.25
Humatrope
36IU
£300
£8.33
BNF £6 - £8 per IU
1997 illicit market prices
Evans-Brown & McVeigh, 2009
£10-20 per IU
The new stuff…
Pegylated Mecano Growth Factor
A long acting MGF similar to IGF-1
Growth Differentiation Factor 8
a myostatin inhibitor.
FST
Possibly Follistatin –myostatin inhibitor.
Sermorelin
Stimulates growth hormone release
The illicit market
“You can’t get anything pharmaceutical grade,
everything is ‘underground’”
(Steroid user, competing bodybuilder and gym owner aged 45)
“You wouldn’t know, but you do find out the
difference after you’ve finished your course and your
are not getting the results you should be getting. I
think that’s a risk you take, it comes in life, it comes
everywhere”
(Steroid user aged 27)
Kimergård & McVeigh, 2014
What’s in stock?
Substance
labelled
"Zenik"
Sustanon
Deca durabolin
Mastebolin
Parabolin
Testobolin
Nandrolone dec.
Test. Enanthate
Sustanon 250
Nandrolone
Decabol 250
DecaDurabolin
Omnadren
Substance Found
Test. & nandrolone
Nothing
Nothing
Drostanolone
Nothing
Testosterone
Testosterone
Testosterone
Testosterone
Nandrolone
Test. propionate
Boldenone
Nothing
Quantity and
Type
8 x 10ml Vials
2 x 1ml
2 x 1ml amps
10 x 1ml amps
5 x 1.5ml amps
1,000 amps
394 amps
10 x 1ml amps
10 x amps
1 x 2ml amps
2 x 10ml vials
1 x 2ml amps
1120 x amps
Price per
Ampoule/
Vial
£40.00
£4.00
£9.00
£8.00
£12.00
£7.00
£8.00
£7.00
£7.00
£8.00
£32.00
£15.00
£4.00
Total price
£320.00
£8.00
£18.00
£80.00
£60.00
£7,000.00
£3,152.00
£70.00
£70.00
£8.00
£64.00
£15.00
£4,480.00
Melanotan
.
The three most ‘popular’ internet
shops identified
A total of 73 vials of melanotan II
10mg were purchased
Melanotan II in vials ranged
between 4.32 to 8.84 mg
Contained impurities ranged from
4.1 to 5.9%
Kimergård, McVeigh et al, 2014
The strange case of GHRP-6…
“We aim for a high standard….”
Kimergård, McVeigh et al, 2014
CONTACT DETAILS
Jim McVeigh
Acting Director
Centre for Public Health
0151 231 4512
[email protected]
www.cph.org.uk
Twitter @mcveigh_jim
Overcoming Stigma and Barriers
in NSP for PIED users
Gary Beeny
Setting the scene - Manchester
• Year 2000 – 5% of 1750 – (80-85 clients)
• Year 2014 – 58% of 1700 - (approx 980 clients)
• Increase of ten fold
• Job Done?
Why not?
• Many more AAS users out there?
• Secondary supply
• Buying equipment on Internet
• 3 blokes in the car outside
• Loads of friends in the gym
Stigma? – Self perception
“Its not for drugs mate,
I'm a steroid user”
Stigma? – Service perception
“I feel like a
S****head now”
Barrier? – Perception of Drug Services
“I went to that other
Place (NSP) and it was
full of druggie’s!”
Barrier? – Client Confidentiality
“I didn’t tell you my real details
when I first came in,
I didn’t know I could trust you”
Solutions?
• Low threshold Service
• Anonymous attendance
• Limited assessment
• Liberal with equipment
• Specialist services
• Harm Reduction Philosophy
The Pump Clinic Manchester
• Needle Exchange with a Steroid Lead
• Free Biochemistry / Hormone Testing / BBV testing
• Easy to park
• Multi service venue
Gary Beeny
The Pump Clinic Manchester
0161 274 1652
[email protected]
Workshop B
People who inject NPS,
including men who have sex
with men
Monday 19 May 2014, Birmingham
Harm Reduction
Novel Psychoactive
Substance
Injecting
John McNeil – Recovery Worker/NPS Lead
Arundel Street Project Sheffield
So What
substances are
we talking about?
BRAND NAME, NICK NAME, CHEMICAL NAME, OR ACRONYM
2-DPMP 2CT-7 4-BD 4-MMC 6-APDB 7-UP A2 APB BATH SALTS BENZO
FURY BONSAI BONSAI SUPERSLEEP BUBBLE BZP CATHINONES
CHICKEN FEVER CHICKEN YELLOW CHING CHROMING COSMIC JELLY
D2PM DESOXYPIPRADRO DIMETHYLTRYPTAMINE 5-APDB D DMT DONKEY
DUST DOUBLE STACKED DR DEATH DRONE DUSTING ECLIPSE ECSESS
ENERGY-1 ESP FAST LANE FENAZEPAM FLASH FRENZY GBH GBL GHB
HAWK HERB HOLY SAGE IVORY WAVE JELLIES KILLER KIX K LEGAL E
LEGAL HIGHS 2CB LEGAL X LIGHTNING FLASH LINCTUS LIQUID GOLD
MCAT M1 MC MDPV MEOW MEOW MEPH MEPHEDRONE
METHOXETAMINE METHYLONE MEXICAN MAGIC MINT MEXXY MEXY
MIAOW MKET MXE NAPHYRONE NEMESIS NEW PSYCHOACTIVE
SUBSTANCES NORRIES NPS NRG-1 NRG-2 PAPER MUSHROOMS
PEBBLES PEP LOVE PEP STONED PEP TWISTED PHENAZEPAM
PIPERAZINES PLANT FOOD PMA PMMA PURPLE WAVE PYROVALERONE
6-APB RAPTURE RAVE RHINO KET ROCK HARD ROFLCOPTR ROOFIES
SALVIA SEVENTH HEAVEN SILVER BULLET 5-APB SPECIAL K SPICE
STARS SUPER K SYNTHETIC CANNABINOIDS T-7 THRUST TNT
TRIPSTACY ULTRAM VANILLA SKY VITAMIN K WHIPPETS WHITE MAGIC
WHITE PEARL X XTC YABA AMT DIMETHOCAINE PMAA MPA
ETHYLPHENIDATE 5-IAI 5-IT MDAI HAWAIIAN BABY WOODROSE KRATOM
DESOMORPHINE NAPTHYLPYROVALERONE
METHYLENEDIOXYPYROVALERONE IPHENYLMETHYLPYRROLIDINE PEP
What is commonly injected?
•
•
•
•
•
Mephedrone (m-cat, meow, bubble, dawg, kitty)
Methoxetamine (mexy, rhinoket)
Phenazepam, (fez, fenazepam)
Doxylam (AH-7921)
Crystal Meth ( methylmethamphetamine, Ice)
Combinations
• Heroin + Phenazepam
• Mephedrone + Heroin
• Mephedrone + Phenazepam
Mephedrone
The first ‘legal high’ to really hit the ‘big time’
4-Methylmethcathinone
A synthetic stimulant which produces feelings of euphoria,
empathy and a heightened state of alertness.
The most well known of a group of NPS’s derived from cathinone
Sold as a white/off white powder or capsules
Caustic leads to tissue damage
Possible unwanted side effects (palpitations, paranoia, fear,
anxiety, sweating, sleeplessness, vasoconstriction)
Effects felt immediately when injected creating an intense high
Plateaus within 15-30 minutes leading to compulsive re-dosing
Regular users injecting up to 20 times a day
Active dose is 75mg-150mg
Class B drug
Our biggest concerns…
•
•
•
•
•
•
•
•
•
•
•
Dosing problems
Authenticity
Potency
Tissue/Vein damage and other injecting injuries*
Increased risk of BBV transmission
Increased risk of STI’s
Compulsive re-dosing
New and existing cohorts
Hierarchy of use leading to non reporting
Very little known about most research chemicals
Death
Responding to NPS Injecting
•NSP are the frontline response
•Nothing has changed
•Harm reduction is the key and should continue to
underpin all interventions
•Key harm reduction messages still pertinent
•NSP workers need to constantly re-explore
substances being used
•Workers shouldn’t be afraid of terminology
•Symptomatic response
•NPS training useful to build confidence
I will be happy to try and answer any specific
questions around particular substances and the
risks and harm reduction messages that apply to
these during the question and answer session that
follows
Thank You
@davidastuart
@56deanstreet
“ChemSex”
CHAT with @Hot-Slammer
Hi. You’re hot.
Wot U into?
Wanna cum over?
15 mins?
I’ll bring Chems
Do you BareBack?
Do you Slam?
Sexualised
and
Injecting
Drug Use
by MSM
(Men who have Sex with Men)
@PHE_uk
@NICEcomms
@LGAcomms
@davidastuart
24 hour Saunas
@56deanstreet
Individuals/parties at homes
via online “sex apps”
@davidastuart
BRIEF HISTORY
@56deanstreet
2008 to present
Reports emerging of high risk behaviours,
increasing injecting use and poor injecting
awareness, amongst a population that
already exhibits high HIV/HCV infection
rates.
Of these services, Club Drug Clinic only one feeding data into
NDTMS
@davidastuart
56 Dean Street Response
@56deanstreet
Audit, Jan 2014; 144 MSM presentations at 56 Dean Street in 1 week
•9/144 MSM were asked about drug use (6%)
•9/9 admitted to previous club drug use (100%), and 8/9 had used in the last 3 months.
•1/9 clients was offered drug related support; 0/9 received any onward referral
GUM staff clearly needing guidance/support
• Full time Drugs Worker employed in clinic to address ChemSex
behaviours
• Staff trained; awareness; what to ask; how to effect a happy referral
to drug use support (usually to LGBT drug service/charity)
• Compulsory question for all MSM on Proformas Trust-wide; all MSM
asked routinely about fisting, injecting, barebacking, ChemSex.
• Care Plans/Treatment Outcome Profiles* tailored to ChemSex’ers
• Needle/Syringe provision available in clinic
• Partnership work (Antidote, GMFA, Hep C Trust, Turning Point,
@davidastuart
@56deanstreet
Simplifying access to treatment/rebranding
@davidastuart
@56deanstreet
Data
First
3
Months
300 MSM using (combinations of) Meth, Meph and GBL for sex consented to a brief
intervention for drug use support.
225 of 300 were not specifically seeking drug use support on presentation
•99% had never previously accessed drug use support.
•65% reported 4 or more partners per “bender” (highest being 30 partners)
•70% reported no memory of last sober sex encounter
•34% of those on ARV therapy reported poor adherence when high (typically, every
weekend), increasing infectiousness within the population
•46% were HIV +
•10% were currently on Hep C treatment (for 5 of these it was 2nd time infected); an
additional 15% had previously been cleared/previously been treated for Hep C
45% were IVDU’s (135 individuals). Of these;
•54% had never injected themselves/only ever been injected by sexual partners
•45% of those reported sharing
Stark contrast between what was disclosed to nurses, & what was disclosed to Drugs
Advisor; particularly in regard to injecting use, and ARV adherence.
@davidastuart
RECOMMENDATIONS
@56deanstreet
•NSP street outreach and traditional methods less effective for this population; most
prefer to buy online than to visit a drug service
•Needle/syringe provision within all GUM services
•Support/training for GUM services in identifying injecting use, communicating with
IVDU’s and facilitating onward referrals
•Improved dialogue between sexual Health & substance Misuse commissioning
teams
•Supported partnership work between drug services and their local GUM/HIV
services
•Improved partnership work between drug services, GUM/HIV and MSM Third
sector
•All MSM disclosing drug use be routinely tested for hepatitis C (regardless whether
HIV+ve or whether injecting drug use is disclosed)
•Drug services adapt to be more MSM-friendly; posters, separate targeted drop in’s,
language on assessments/Care Plans/TOP’s, staff champion trained in
equality/awareness/cultural competency
@davidastuart
@56deanstreet
@PHE_uk
[email protected]
@NICEcomms
@LGAcomms
147
Workshop C
Young people who inject
Monday 19 May 2014, Birmingham
NSP – Seminar
Young people
Kirsty Blenkins – Programme Manager (Young People)
Sam Cox – Programme Manager (Youth Justice)
Introduction
• Trends in drug use with young people
• NICE evidence
• Specialist substance misuse services –
data and feedback
• Developing and implementing young
people friendly NSP policies
• What’s different about this guidance
150
Nice NSP 19th May 2014
Background
• Limited published evidence and policy
documents on Needle and Syringe Programmes
(NSP) for under 18’s
• Systemic review of published and unpublished
literature by NICE – profile of risk behaviour
among YP who inject drugs
• New NICE public health guidance (PH 52) on
NSP published in April 2014 includes young
people under 18
Nice NSP 19th May 2014
There is a continuing decline in drug use amongst young people
although 1 in 6 young people reported ever having taken drugs in the
past year
Nice NSP 19th May 2014
NICE – Systemic review of the evidence
26 studies – Canada, USA, Ireland, Australia, Ukraine, Serbia,
Moldavia, Albania and Romania
•
Identified key differences between younger and older people who inject
drugs (PWID)
•
Large proportion of females – over a third in some studies (disclosing high
risk behaviours
•
33%+ are being injected by someone else
•
Sexually exploited
•
Experience of prison and arrest, and homelessness
•
High risk of sharing
•
Findings suggest that interventions are needed to target multiple risk
Nice NSP 19th May 2014
Needle and Syringe Programmes for YP
Specialist treatment services data (NDTMS):
• In 2011 /2012 416 under 18’s previously injected or currently
injecting - down from 663 in 2010 /2011
• 50% over 17
• 53% girls
• 75% opiates, 17% other, poly drug use
• Risk harm index indicates more likely to be self harming, offending,
LAC, NEET, and/or pregnant
• 78% access young people’s services, 19% adult services, 4% both
Nice NSP 19th May 2014
Girls data
Nice NSP 19th May 2014
Girls
• NICE - Girls more likely to be injected by someone else
and sharing equipment with sex partner
• Close links with sexual exploitation
• In 2012/13 34% of all young people in drug and/or
alcohol treatment and 32% of new presentations were
female - however 53% of injecting young people
• Girls in treatment present with a different range of
vulnerabilities to boys - more likely to present with selfharm issues, high alcohol and/or poly drug use and less
likely to present as offending or as NEET
Nice NSP 19th May 2014
Conclusions from evidence/research
• Fall in injecting drug use - heroin users are getting older
• Patterns of use are changing - so are injecting patterns
• Image and performance enhancing drugs are not new but there has been an increase in IPED users accessing
adult services
• New populations to be reached – men having sex with
men, young adults
• Young injectors tend to have multiple risks and
vulnerabilities – with particular issues for girls
Nice NSP 19th May 2014
PH 52 Recommendation 5
Develop a policy for young people who
inject drugs
Develop and implement a local, area-wide
policy on providing needle and syringe
programmes and related services to meet
needs of different groups of young people
aged under 18 (including under 16’s) who
inject drugs
158
Nice NSP 19th May 2014
Ensure policy details how local services
will achieve right balance between the
imperative to provide young people with
sterile injecting equipment and duty to
protect (safeguard) them and provide
advice on harm reduction and other
services.
159
Nice NSP 19th May 2014
Policy should take account of:
• the young person’s capacity to consent
(Gillick competence)
• the risks they face
• the benefits of using services
• the likelihood that they would inject
anyway, even if sterile needle and
syringes were not provided
160
Nice NSP 19th May 2014
• Make governance responsibilities of drug
services and safeguarding boards clear.
The LSCB should approve local policy.
• NSP should be part of a broader package
of care (where possible) – especially
important for under 16s
161
Nice NSP 19th May 2014
Ensure policy is responsive to the needs of
young people in the local area
• Provision of specialist young people’s substance misuse
services, including NSP
• How to encourage young people to ask for advice and
help from staff providing services (as well as providing
needles, syringes and injecting equipment)
• How to assess service users
• The skills and knowledge that staff need to deliver
services - including assessment of competence to
consent
162
Nice NSP 19th May 2014
Pharmacies
The potential for pharmacies to provide
young people with syringes and injecting
equipment, if they encourage the young
person to make contact with specialist
services.
Nice NSP 19th May 2014
Questions/themes for discussion
•
What experience do people have of providing NSP for YP?
•
What are the issues for implementation? Levers and/or barriers?
•
Making services more accessible for young IPED users and new NPS
•
Promoting development of young people friendly policies for IDUs?
•
Links with safeguarding?
•
Addressing the particular needs of young girls?
•
Opportunities for multi agency working?
•
Supporting pharmacy provision and/or provision in sexual health services?
– developing appropriate protocols and pathways
Nice NSP 19th May 2014
Workshop D
Monitoring needle and syringe
provision
Monday 19 May 2014, Birmingham
Assessing need for and
monitoring of needle and
syringe provision
Martin White, Programme Manager, Alcohol, Drugs and Tobacco
Division, Public Health England
Assessing need
• New NICE guidance PH52 recommends collation and analysis of data on
injecting drug use and provision of a mix of NSP services
• Assessing need across the range of people who inject drugs, e.g.:
o Opiate users
o Stimulant users
o NPS users
o IPED users
• Ensuring balance in the system for these groups and between types of
provision:
o Pharmacy-based provision
o Specialist NSP
167 Assessing need for and monitoring of needle and syringe provisions
Monitoring NSP services
• PH52 also recommends monitoring of services
•
Existing systems for monitoring:
• Needle Exchange Monitoring System (NEXMS) set up in 2007 as a nonmandatory web-based national data collection tool on NSP
• Wide variety of local systems (e.g. LAIKA)
•
PHE are working with NICE to develop a minimum set of data based on
PH52 which will be recommended for collection by local areas
•
Initially, this is encouraged to inform local monitoring but may enable
national monitoring in future
168 Assessing need for and monitoring of needle and syringe provisions
Recommended data collection
• The NICE guidance indicates that as a minimum data should be collected
on:
o Demographics and identification of those at increased risk
o Drug use and injecting practices
o Equipment supplied and returned
o Contact with other services (e.g. specialist drug treatment, CJS)
o Information and advice given
o Testing of blood-borne viruses
o Onward referrals
•
169
PHE would encourage broader data collection (e.g. data on overdose
prevention, naloxone provision)
our help, your change
The Health Shop
Harm Reduction Service
our help, your change
Why do we need to collect
data?
 Understand changes in service user
population
 Respond effectively to these
developments
 To identify needs and gaps
our help, your change
Data collection systems
 BOMIC
 Paper files/forms
 Service user involvement
 PHE and other local & national research
our help, your change
What do we do with this
information?
 Talk about it!
 Develop targeted interventions
informed by the data collected
 Identified gaps following data analysis and
anecdotal evidence
 Looked at how we could work in partnership to
meet the needs of this vulnerable service user
group
 Developed Joint Working Agreement, training
package and service user informed specialist
NSE packs
our help, your change
Returns Campaigns
 Data shows decline in return rates
 Posters/flyers/amnesty/discussions demonstrate
a significant increase in return rates
 Service users have a stake in their NSP and
how it is viewed locally
 DVD
Returns Campaign 1
If you don’t pick it up, someone else will . . .
Ref: Crimestoppers
Collect it, Use it, Bin it, Return it!
!
Returns
Campaign 2
Limitations and Forward
Planning





Qualitative Information
Can the system keep up?
NSP Pharmacies
Lost data
Local/National data
our help, your change
Thank you for listening!
Maria Storry
Harm Reduction Worker
The Health Shop
Substance Misuse Services – Specialist Services Directorate
Nottinghamshire Healthcare NHS Trust
Email: [email protected]
Tel:
0115 947 5414
Evidence into practice and
policy: needle and syringe
programmes - protecting people
and communities
Monday 19 May 2014, Birmingham
Evidence into practice and policy: needle and syringe
programmes - protecting people and communities
Parallel sessions feedback
Professor Mike Kelly, Head of Public Health, National
Institute for Health and Care Excellence
Monday 19 May 2014, Birmingham
People who inject IPEDs
•
•
IPED injecting growing but highly localised
Patterns of use different to people who inject psychoactive drugs:
intramuscular/subcutaneous, drugs in vials ready for injection, range of substances
used in cycles
•
•
•
•
•
•
•
•
•
182
Health and fitness, ‘not’ drug use’
Extensive secondary distribution, and injection by others is common
Non-injecting psychoactive drug use is common
Sexual and injecting risks
IPED injectors may need routes of access to NSP other than ‘traditional’
services: pharmacies may be useful but also, eg gym outreach
Tailor equipment offered to the needs of people injecting IPEDs
Give targeted advice on drugs, eg may be counterfeit and contaminated
Offer other services to engage users, eg metabolic testing and outreach
Address health needs, e.g. hepatitis B vaccination & sexual health
Needle and syringe programmes - protecting people and communities, 19 May 2014
People who inject NPS / MSM
183
•
Different populations: NPS-only and NPS with, on top of or instead of,
‘traditional’ injection drugs
•
Additional risks from frequent injecting with sometimes ‘corrosive’ or
unknown substances
•
As always, focus on the person, not the drug
•
Young people who inject NPS, and MSM, may be more likely to use health
services such as sexual health and these may be a suitable outlet for NSP
•
Sexual disinhibition
•
All NSP should offer access to BBV testing
•
NSP staff need to be culturally competent to work with MSM and other NPS
users
Needle and syringe programmes - protecting people and communities, 19 May 2014
Young people
184
•
Injecting among young people is rare
•
For many, it is part of a wider pattern of multiple risk and vulnerability,
requiring full assessment and safeguarding
•
Young people should be provided with sterile injecting equipment as part of
a broader package of care to meet their other needs, where possible
•
For some YP, especially those using IPEDs, there may not be the same
multiple concerns. However, there is growing concern about use of IPEDs
by young people and what opportunities there are to intervene
•
All areas should have a policy to ensure that age appropriate provision is in
place for those who need it
•
If pharmacies are to provide NSP to young people, they will need support to
develop pathways and links to YP treatment services
Needle and syringe programmes - protecting people and communities, 19 May 2014
Monitoring
185
•
Local data is essential to inform an assessment of need among every
injecting population, which in turn informs commissioning
•
Standardising this data will make benchmark comparisons between
services and areas easier, and will facilitate uploading to any future national
data system
•
Use to ensure accessible provision for all people who inject drugs, including
appropriate mix of NSP provision
Needle and syringe programmes - protecting people and communities, 19 May 2014
Evidence into practice and policy: needle and syringe
programmes - protecting people and communities
Closing
Professor Mike Kelly, Head of Public Health, National
Institute for Health and Care Excellence
Monday 19 May 2014, Birmingham
Summary
•
A continuing process of delivery
•
2009 and now 2014 guidance
•
NICE and PHE continue to support implementation, particularly from PHE
Centre teams at a local level.
•
New and growing populations for NSP and IPEDs but job remains the
same:
• Provide range of accessible provision according to local need
• Increase coverage
• Provide relevant and accurate advice and pathways to relevant services
Pledge cards and evaluations
Thank you and goodbye
187
Needle and syringe programmes - protecting people and communities, 19 May 2014
Evidence into practice and
policy: needle and syringe
programmes - protecting people
and communities
Monday 19 May 2014, Birmingham