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Chapter 5: Needle exchange activity, 2004-05

Headlines from this chapter

• Thirty-six (out of 45) non-pharmacy services reported 82,389 transactions in 2004-05. The number of transactions ranged from 31 in one service in Grampian (Moray) to 11,739 in a service in Ayrshire & Arran.
• The ratio of male-to-female contacts reported by non-pharmacy services was 2.7:1.
• Twenty-three (out of 45) non-pharmacy services reported 756 contacts with under-18s.
• Pharmacy co-ordinators reported 169,117 transactions for 116 pharmacies in 2004-05. The number of transactions ranged from 0 in the two pharmacies in Orkney to 59,435 in the 26 pharmacies in Glasgow.
• Thirty-one (out of 45) non-pharmacy services had a total of 14,229 clients in 2004-05. The number of clients ranged from 10 in one service in Lanarkshire to 4,052 in a service in Lothian.
• Pharmacy co-ordinators (3 out of 10) reported 17,726 clients for 37 pharmacies in 2004-05. The number of clients ranged from 243 in the seven pharmacies in Highland to 15,974 in the 18 pharmacies in Lothian.
• Figures on the number of clients must be treated with caution because of the large number of non-responses to this question. Focus group participants mentioned the difficulties of accurately monitoring the number of clients accessing their services.
• At least 3.5 million syringes were distributed by needle exchange services across Scotland. However, these figures can only be taken as approximations. The actual totals are likely to be considerably higher.
• An approximately equal number of syringes were distributed by pharmacy and non-pharmacy services ( 1.8 million each). However, this statement masks enormous geographical variation. A very large number of syringes were given out by pharmacies in Glasgow. In most other areas of Scotland, it appeared that specialist services were distributing a larger number of syringes than pharmacy services. This finding was unexpected, given that pharmacy exchanges outnumber non-pharmacy exchanges across Scotland by 3 to 1.
• There were very wide geographical variations in the levels of syringe distribution per estimated injector - ranging from approximately one syringe per injector per day, to one syringe per injector every 6.4 days. These findings should be seen as a cause for concern.
• Data on needle / syringe returns was generally poor, due to the obvious difficulty of counting the contents of sealed sharps bins. However, at least 1.56 million syringes were reported to be returned to pharmacy and non-pharmacy services in 2004-05.

This chapter provides details of needle exchange activity in Scotland for the one-year period April 2004 - March 2005. Information will be presented on the number of "transactions" (or needle exchange contacts), the number of clients, the number of syringes distributed, and the number of used syringes returned in this one-year period. Information about paraphernalia distribution, and other harm reduction interventions offered by needle exchange services will be presented in the next chapter.

As mentioned earlier in this report (Chapter 2, page 13), there were some major discrepancies between the figures reported by DATs and those reported by service providers and pharmacy co-ordinators in relation to questions on needle exchange activity. The reported figures from all three surveys are shown in Appendix 3.

Table 5.1 below presents a summary of the best information available from the study on needle exchange activity. These findings are discussed in further detail below.

Table 5.1: Summary of findings on needle exchange activity for the period April 2004 - March 2005

Number of transactions

Information on needle exchange transactions has been taken from responses to the Services and Pharmacy Co-ordinator surveys.

Non-pharmacy services

Four-fifths of non-pharmacy services (36 out of 45) reported the number of transactions they had between April 2004 - March 2005. According to this data, these 36 services had a total of 82,389 transactions in this period. The number of transactions ranged from just 31 in one service in Grampian (Moray) to 11,739 by a service in Ayrshire & Arran. The median number of transactions per service was 1,054 and the mean was 2,289.

Non-pharmacy services were also asked if they recorded information about client age and gender. Only 29 out of 45 services were able to provide data on gender. These services reported a total of 45,007 transactions with males, and 16,578 transactions with females. This results in a male-to-female contact ratio of 2.7:1. It should be noted that the ratio of males to females in drug treatment services overall was reported to be 2.0:1 in the same period ( ISD 2005).

Only 23 out of 45 services were able to provide data on the number of transactions they had with under-18s. These services reported a total of 756 contacts with young people under the age of 18.

Pharmacy services

All 10 pharmacy co-ordinators provided information on needle exchange transactions in the pharmacies in their area, representing the activity of 116 pharmacies. According to this data, there were a total of 169,117 transactions for these 116 pharmacies in 2004-05. The number of transactions ranged from 0 in the two pharmacies in Orkney to 59,435 in the 26 pharmacies in Glasgow. The mean number of transactions was 1,458 per pharmacy. It was not possible to calculate the median because data on pharmacy transactions was reported as an aggregate figure for all the pharmacies in each NHS Board.

Number of clients

Information on the number of needle exchange clients has been taken from the responses to the Services and Pharmacy Co-ordinator questionnaires. There was a large number of non-responses to this question. Therefore, these figures must obviously be treated with caution. Focus group participants pointed out the difficulties of accurately monitoring the number of clients accessing their services since, in many cases, people access needle exchange services anonymously.

Non-pharmacy services

Thirty-one out of 45 non-pharmacy services reported the number of clients they had in 2004-05. These 31 services had a total of14,229 clients in this period. The number of clients ranged from 10 in one service in Lanarkshire to 4,052 in a service in Lothian. The median number of clients per service was 221; the mean was 491.

Pharmacy services

Pharmacy co-ordinators from only 3 NHS Board areas (representing 37 pharmacy services) were able to provide information on number of clients. These 37 pharmacies had a total of 17,726 clients. The number of clients ranged from 243 in the seven pharmacies in Highland to 15,974 in the 18 pharmacies in Lothian. The mean number of clients per pharmacy was 479. It was not possible to calculate the median because, again, data was not available at the level of individual pharmacies.

Number of syringes distributed

Findings from the DAT survey were used to calculate the number of syringes distributed across Scotland in the period 2004-05. As DATs are required to provide this data in their annual Corporate Action Plans, this information was reasonably complete. However, in some cases, it is obvious that the reported figures were estimates, as they were rounded to the nearest thousand - or even ten thousand.

All 19 of the DAT respondents provided data on the number of syringes distributed by non-pharmacy services in their area, and 18 out of 19 also provided data on the number of syringes distributed by pharmacy services. The findings indicate that at least 3,553,911 syringes were distributed by needle exchange services across Scotland. Table 5.2 shows that:

• Non-pharmacy services distributed a total of 1,807,490 syringes.
• Pharmacy services distributed a total of 1,746,421 syringes.

These figures can only be taken as approximations. The actual totals are likely to be considerably higher, since three DATs (Dumfries & Galloway, Edinburgh and Shetland) did not participate in the DAT survey, and therefore, their figures are not included. In addition, several DATs indicated in their responses that their figures were incomplete. ⁸

Table 5.2: Number of syringes distributed by needle exchange services, 2004-05

Bearing these caveats in mind, it is nevertheless interesting to note that the reported numbers of syringes distributed by specialist and pharmacy services across Scotland were very similar - about 1.8 million in each case. However, this statement masks wide geographical variation. See Tables 5.3 and 5.4 below. For example, the very large number of syringes given out in pharmacy exchanges in Glasgow (671,688) was about 381,000 greater than the next largest total (290,607 given out in Aberdeen City) for pharmacy services. The figures in these tables would seem to suggest that specialist needle exchange services were distributing a larger number of syringes than pharmacy services in most areas outside of Glasgow.

This finding is interesting given that pharmacy needle exchanges across Scotland outnumber non-pharmacy services by 3:1. Even if we removed all 29 Glasgow needle exchange services (26 pharmacy and 3 non-pharmacy services) from the total number of services in Scotland, there would still be five pharmacy exchanges for every two non-pharmacy exchanges.

Table 5.3: Reported no. of syringes distributed by non-pharmacy services, 2004-05, by DAT

Notes to table
The figures shown for Argyll & Clyde and Dundee City are incomplete. Orkney is not included in the table above, because the specialist service in Orkney does not collect data on numbers of needles and syringes distributed.

Table 5.4: Reported no. of syringes distributed by pharmacy services, 2004-05, by DAT

Notes to table
Western Isles is not included in the table above because there is no pharmacy needle exchange in the Western Isles. Data from Ayrshire & Arran was unavailable. The figure for Borders is estimated.

By using findings from the National Prevalence Study and the National Needle Exchange Survey and / or the annual Corporate Action Plan ( CAP) returns, it is possible to undertake a rough calculation of the total number of needles / syringes that were distributed per injector in each DAT area in the one year period April 2004 - March 2005. It must be remembered that the figures reported by some DATs for number of syringes distributed are clearly estimated. However, if the data provided by DATs are reasonably accurate, the results of this analysis indicate very wide geographical variations in levels of syringe distribution across Scotland. See Table 5.5 below.

Table 5.5: Injecting prevalence (2003) & the distribution of syringes, by DAT, 2004-05.

Notes to table
The one-year figures for syringe distribution shown for Dumfries & Galloway are estimated, based on figures for 9 months.
Accurate data on syringe distribution was unavailable for Edinburgh City, and data on injecting prevalence was unavailable for Western Isles, Orkney and Shetland. Therefore, these four DATs are not included in the table.
* Note that all the figures shown above for total syringe distribution are taken from the National Needle Exchange DAT Survey for 2004-05, except where the figures were unavailable or incomplete ( i.e., Dumfries & Galloway, Argyll & Clyde and Ayrshire & Arran). In these cases, figures from the annual CAP returns reported for 2004-05 have been used instead. A cursory comparison of CAP figures with figures from the Needle Exchange Survey indicates some discrepancies between the two. However, these discrepancies are not of such great magnitude that they drastically change the picture presented above.

The findings shown in Table 5.5 indicate that needle exchanges in Fife gave out the greatest number of syringes per client in the period 2004-05. Each of the estimated 1,124 injectors in Fife received, on average, 479 needles per year - that is, just slightly more than one needle per day per injector. Needle exchange services in Argyll & Clyde gave out the fewest syringes per injector in the same period. Each of the estimated 2,199 injectors in Argyll & Clyde received, on average, only 57 needles per year. That's one sterile needle every 6.4 days.

These very wide variations clearly cannot be accounted for in terms of rurality. Nor can they be explained in terms of the numbers of needle exchange services available in particular DATs (see again Table 3.1). The results suggest, rather, that some areas are simply getting more sterile syringes out to their clients than other areas. It should be emphasised that there may be problems with the data on syringe distribution from some areas. Nevertheless, these findings should be seen as a cause for concern.

Return of used syringes

DATs were asked whether needle exchange services in their area recorded the number of syringes returned. Five DAT respondents said their non-pharmacy services did not record this information, and four of these said their pharmacy services did not record the information either. One DAT respondent said it was only possible to give a rough estimate of the number of returns. These responses were somewhat unexpected as this information is required in the annual CAP returns. However, these messages were not altogether surprising.

The issue of returns was discussed at some length in the Scottish focus groups. Participants pointed out that it is not possible, using existing methods, to know how many needles are returned by clients. For obvious health and safety reasons, the disposal bins are not opened. The point was made that, as a performance monitoring measure, the use of return rates is largely meaningless.

With this in mind, Table 5.6 presents findings from the DAT survey on syringe returns. These findings indicated that in the one-year period from April 2004 - March 2005, at least 1,563,312 used syringes were returned to needle exchange services across Scotland.

• A total of 849,113 syringes were returned to non-pharmacy services (or 47.0% of syringes distributed by non-pharmacy services).
• A total of 714,199 syringes were returned to pharmacy services (or 40.9% of syringes reportedly distributed by pharmacy services)

These figures can only be taken as estimates. Again, the actual number of returns is likely to be considerably higher. And it is not clear from these responses how DATs have recorded data on syringes collected in sharps bins in hostels and public places.

Information on services' policies on returns will be presented in Chapter 7.

Table 5.6: Number of syringes returned to needle exchange services, 2004-05

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