Needle exchange schemes for injecting drug users

The government proposes to continue supporting the provision of needle exchange schemes to reduce harms associated with injecting drug use.1 In particular, young injecting drug users (IDUs) have been found to be at higher risk of acquiring HIV infection.2 Injecting drug use and HIV are also common in prisons.2

Evidence of the possible benefits

There is good evidence that needle exchange schemes reduce transmission of HIV infection and thereby reduce drug-related deaths.2 Needle exchanges appear to have successfully prevented a major HIV epidemic among injecting drug users in the UK, where HIV rates are lower than those found in injecting drug users in other countries.3 However a recent ‘review of reviews’ described evidence for HIV prevention as ‘tentative’, partly due to discrepancies in findings from core reviews.4

Needle exchanges are effective at reducing self-reported injecting risk behaviour (such as sharing needles).4 Some studies have found unanticipated benefits e.g. higher treatment retention rates among users of needle exchanges.2 Needle exchanges might also provide a point of contact for other health and social interventions (such as opportunistic brief interventions).5

Evidence suggests that needle exchanges are a cost-effective way to reduce HIV infection.2 The cost-benefit ratio can be maximised by making them available in all communities that have high concentrations of injecting drug users.6

Evidence of the possible risks

There is insufficient evidence to conclude that needle exchanges are successful at preventing spread of other blood borne viruses such as hepatitis C but there is no evidence that they could facilitate further spread. It could be argued theoretically, however, that by minimising the health risks associated with intravenous drug use, the provision of needle exchange facilities may discourage people from stopping using drugs.

Any implications for health & well-being

The majority of users of needle exchanges continue to use drugs but do so with less risk to themselves and others 3, therefore reducing the morbidity and mortality associated with injecting drug use.

Author: Charlotte Warren-Gash MSc, MRC Clinical Research Training Fellow, Research Department of Infection & Population Health, UCL.

UK area affected: Health aspects of this policy are restricted to England only

NICE Guidance on this topic

National Institute for Health and Clinical Excellence (2007). ‘Drug misuse: psychosocial interventions’. http://www.nice.org.uk/nicemedia/pdf/CG51FullGuideline.pdf

References

1. Home Office, Drugs and Alcohol. http://www.homeoffice.gov.uk/drugs/drug-strategy-2010/

2. Wodak A & Cooney A .’Effectiveness of Sterile Needle and Syringe Programming in reducing HIV/AIDS among injecting drug users’. Evidence for action technical papers. WHO Geneva 2004

3. Reuter P & Stevens A ‘An analysis of UK drug policy: A monograph prepared for the UK drug policy commission’. April 2007

4. Palmateer N et al. ‘Evidence for the effectiveness of sterile injecting equipment provision in preventing hepatitis C and human immunodeficiency virus transmission among injecting drug users: a review of reviews’ in Addiction (2010)105: 844-859

5. ‘Drug misuse: psychosocial interventions’. Clinical guideline 51. National Institute for Health and Clinical Excellence. July 2007.

6. Harris, Z.K. ‘Efficient allocation of resources to prevent HIV infection among injection drug users: The Prevention Point Philadelphia (PPP) needle exchange program.’ Health Economics (2006). 15(2), 147–158.