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Dawn Griesbach, Dima Abdulrahim*, Dawn Gordon*, Karin Dowell**, Griesbach & Associates
*National Treatment Agency, **Scottish Executive

ISBN 0 7559 6108 0
This document is also available in pdf format (560k)

Contents

Executive Summary

Chapter 1: Background and context
Policy and research context
Aims of the study
Structure of the report

Chapter 2: Methods
Compiling a needle exchange directory
Analysis
Survey response rates
A note about data quality

FINDINGS - PART 1: NEEDLE EXCHANGE SERVICE DELIVERY AND ACTIVITY

Chapter 3: Mapping needle exchange provision

Chapter 4: Accessibility of needle exchange services
Geographical proximity and rurality
Opening times

Chapter 5: Needle exchange activity, 2004-05
Number of transactions
Number of clients
Number of syringes distributed
Return of used syringes

Chapter 6: Interventions provided by needle exchange services
Client assessment and review in non-pharmacy services
Interventions provided on-site by non-pharmacy services
Interventions provided by pharmacy needle exchanges
On-site interventions related to blood-borne viruses
Paraphernalia distribution
Pack syringe distribution vs pick-and-mix

Chapter 7: Needle exchange policies and procedures
Policies on the number of syringes distributed
Policies on returns of injecting equipment
Policies and practices on secondary / peer distribution
Policies on needle exchange for young people
Standard operating procedures for pharmacies
Getting the views of service users

Chapter 8: Comparisons between Scotland and England
Proportion of pharmacy and specialist exchanges
Opening times
Needle exchange activity
Interventions provided by needle exchange facilities
Needle exchange policies and procedures

FINDINGS - PART 2: PLANNING AND COMMISSIONING OF NEEDLE EXCHANGE

Chapter 9: Co-ordination, planning and commissioning issues
Co-ordination of needle exchange
Data collection and monitoring
Budgets and funding
Commissioning and purchasing needle exchange services
Making services more accessible
Targeting special populations

Chapter 10: Staff training and qualifications
Staff competency and qualifications in
non-pharmacy services
Training for pharmacy needle exchange staff

Chapter 11: Good practice

Chapter 12: Problems and impediments
Problems of funding and finance
Paraphernalia distribution
Negative public attitudes
Negative staff attitudes
Staff shortages
Other problems affecting needle exchange

Chapter 13: Discussion, conclusion and recommendations
Mapping needle exchange provision in Scotland
The nature of needle exchange provision in Scotland
How are services in Scotland doing in relation to
the Shooting Up recommendations?
Areas of good and innovative practice
Difficulties and impediments to good practice
Strategic issues in relation to needle exchange
Concluding remarks
Recommendations

References

Appendix 1: Survey responses
DAT survey respondents
Responses to the Services survey
Responses to the pharmacy co-ordinator questionnaire

Appendix 2: Participants in Scottish focus groups
DAT focus group attendees
Service provider focus group attendees
Pharmacist focus group attendees

Appendix 3: Tables

List of Tables
Table 2.1 Survey response rates
Table 3.1 Number of needle exchange services, by NHS Board and DAT
Table 4.1 Number of DATs by extent of rurality
Table 5.1 Summary of findings on needle exchange activity, 2004-05
Table 5.2 Number of syringes distributed by needle exchanges, 2004-05
Table 5.3 Reported number of syringes distributed by non-pharmacy services, 2004-05, by DAT
Table 5.4 Reported number of syringes distributed by pharmacy services, 2004-05, by DAT
Table 5.5 Injecting prevalence (2003) & the distribution of syringes, by DAT, 2004-05
Table 5.6 No. of syringes returned to needle exchange services, 2004-05
Table 6.1 No. of services covering specified issues in initial client assessment
Table 6.2 Interventions offered by pharmacy needle exchange schemes
Table 6.3 Number of non-pharmacy services that provide on-site interventions related to blood-borne viruses and tetanus
Table 6.4 Distribution of BBV interventions in services across Scotland, by NHS Board
Table 6.5 No. of services that distribute injecting paraphernalia free of charge
Table 6.6 Dist. of paraphernalia in non-pharmacy services, by NHS Board
Table 9.1 Arrangements for payments for pharmacy needle exchange
Table 9.2 Number of DATs targeting specific populations
Table 12.1 Problems affecting needle exchange provision in the last 12 months
Table A.3.1 Number of transactions, 2004-05: Comparison of DAT responses with Services and Pharmacy Co-ordinator responses
Table A.3.2 Number of clients, 2004-05: Comparison of DAT responses with Services and Pharmacy Co-ordinator responses
Table A.3.3 Number of syringes distributed, 2004-05: Comparison of DAT responses with Services and Pharmacy Co-ordinator responses

List of Figures
Figure 4.1 Needle exchange coverage, by rurality
Figure 4.2 Opening hours of non-pharmacy services
Figure 6.1 Number of non-pharmacy needle exchange services that provide the specified intervention on-site
Figure 8.1 Percentage of needle exchange facilities in Scotland and England delivered by pharmacy, specialist and other services
Figure 8.2 Percentage of non-pharmacy services in Scotland and England that provide BBV interventions on-site
Figure 8.3 Percentage of non-pharmacy services in Scotland and England that provide other harm reduction interventions on-site
Figure 8.4 Percentage of non-pharmacy services in Scotland and England that distribute items of injecting paraphernalia for free
Figure 8.5 Percentage of non-pharmacy services in Scotland and England that would distribute injecting equipment to young people
Figure 8.6 Percentage of non-pharmacy services in Scotland and England that have a written policy on needle exchange to young people, and percentage where policy has been agreed with area CPC
Figure 10.1 Number of Scottish services employing needle exchange staff with certain qualifications / training

List of Boxes
Box 6.1 Good practice - provision of citric acid
Box 10.1 Good practice in providing support to pharmacy needle exchange staff
Box 11.1 Good practice in reaching out to sex industry workers
Box 11.2 Good practice in working together with other agencies

Note regarding terminology

Throughout this report, the term "specialist needle exchange" is simply used as a short-hand to refer to all those services which are not pharmacy, police custody suite, or hospital A&E exchanges. Specialist services include those in both the statutory (usually NHS) and voluntary sectors.

Acknowledgements

We are grateful to James Egan at the Scottish Drugs Forum for his support and assistance in the early stages of this study.
We would particularly like to thank all the DAT officers, needle exchange co-ordinators, service managers and pharmacists who took the time to participate in a focus group discussion or complete a questionnaire - especially those needle exchange co-ordinators who filled in multiple (in some cases, 6, 7, 8…!) questionnaires. Their patience and good humour made this process much easier for us, and we know that the good return rate in the Scottish survey is largely due to them.

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