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Chapter 4: Accessibility of needle exchange services

Headlines from this chapter

• Half of Scottish DATs said that all injectors living in their area had access to some form of needle exchange service within five miles of their place of residence.
• Not surprisingly, needle exchange was least accessible in the most remote and rural areas of Scotland.
• Injectors living in mixed rural / urban areas have access to the widest range of needle exchange services.

Chapter 3 showed the distribution of needle exchange services across Scotland. This chapter looks at the issue of needle exchange accessibility in more detail. The focus will be on the geographical proximity of services and their opening times. The findings are taken from responses to the DAT survey.

Geographical proximity

To measure the accessibility of needle exchange services, DATs were asked if all injecting drug users ( IDUs) in their area had access to some form of needle exchange facility within five miles of their home. At the same time, it was also recognised that in rural areas of Scotland, individuals may have to travel further than 5 miles to access any type of amenity (such as a shop, post office, GP surgery).

With this caveat in mind, half of DAT respondents (10 out of 19) reported that all IDUs in their area had access to some form of needle exchange within five miles of their place of residence. Those that did not were in Aberdeenshire, Argyll & Clyde, Borders, East Lothian, Highland, Lanarkshire, Moray, Orkney and the Western Isles.

It was expected that the rural nature of many areas in Scotland would have an impact on the accessibility of needle exchange. To explore these issues in more depth, DATs were grouped into one of six categories using a rurality classification scheme developed by the Scottish Executive (where 1 represents the most urban DATs and 6 represents the most rural). The classification takes into account both the size of settlements as well as their "remoteness", or distance from other larger settlements. See Table 4.1.

Table 4.1: Number of DATs by extent of rurality

Notes to table
As indicated in Chapter 2 above, three DATs did not participate in the survey. These were Dumfries & Galloway, Edinburgh and Shetland. These three DATs would be classified in the table above in categories 1, 5 and 6.

Not surprisingly, the findings showed that needle exchange was least accessible in the most remote and rural areas of Scotland. See Figure 4.1. None of the seven DATs in categories 5 and 6 had any form of needle exchange service that was available to all injectors within five miles of their place of residence. It is also not surprising that all three of the most urban DAT areas (category = 1) had pharmacy needle exchanges available to all service users within five miles of their home.

What is perhaps more interesting is that all five of the DATs in categories 3 and 4 had specialist services which were available to all injectors within five miles of their residence. Furthermore, in four of these DAT areas, there was also an outreach or mobile service available, and in three of these DAT areas, there was also a pharmacy needle exchange available to injectors within the same five-mile radius. It is also interesting to note that none of the four DATs in category 2 had pharmacy services and only two of the three DATs in category 1 had specialist services that were available to all injectors within five miles of their place of residence.

These findings suggest that "the rural factor" plays a big role in the accessibility of needle exchange services. However, rural / urban variations alone do not account for the accessibility or lack of accessibility of services. Living in an urban setting does not guarantee access to both specialist and pharmacy services. Injectors living in mixed rural - town settings appeared to have access to the widest range of needle exchange services.

Opening times

Non-pharmacy services Accessibility can also be measured in terms of opening times of services. The majority of non-pharmacy services in Scotland were open Monday to Friday, mornings and afternoons, although, as Figure 4.2 shows, services were more likely to be open in the afternoon than the morning. Just over a third of services offered evening opening hours, usually on Monday, Tuesday and Thursday evenings. Less than a quarter were open on Saturday or Sunday, and these were mainly based in hospitals or police custody suites. Most hospital and police custody suites were open 24 hours a day, seven days a week but, in general, these services saw very few clients. Indeed police custody suites are obviously only available to individuals taken into custody. The only other service in Scotland that was open 24:7 was the Glasgow Drug Crisis Centre.

Pharmacy services Responses from pharmacy co-ordinators indicated that, in general, "all" or "most" pharmacy needle exchange services in their areas were open six days a week, Monday to Saturday, mornings and afternoons. Glasgow had "a few" pharmacy services and Highland had one service (in Inverness) open until 9pm on weekdays. Edinburgh City had "a few" pharmacy services available seven days a week, from 9am - 9pm. Only Edinburgh, Aberdeen and Highland (again, the one service in Inverness) had pharmacy needle exchange service provision on Sundays.

Figure 4.1: Needle exchange coverage, by rurality

Note to figure
Because there is only one DAT in category 4, this DAT has been grouped together with those in category 3 for the purposes of this analysis.

Figure 4.2: Opening hours of non-pharmacy services

Note to figure
AM = morning; PM = afternoon; evening = up until 9pm; night = after 9pm.

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