NICE endorses use of needle exchange scheme to minimise infection risk

BMJ 2009; 338 doi: (Published 23 February 2009) Cite this as: BMJ 2009;338:b771
  1. Andrew Cole
  1. 1London

    New guidance from the National Institute for Health and Clinical Excellence (NICE), to be published next week, endorses the use of the needle and syringe exchange scheme and could pave the way for its expansion.

    The programmes have been operating in the United Kingdom for the last 20 years with most run by pharmacies and other drug services. They offer sterile injecting equipment to people who inject illicit drugs as well as advice on safer injecting techniques and appropriate disposal.

    Around 200 000 people in England and Wales are estimated to inject illegal opiates and stimulants, said Professor Mike Kelly, director of NICE’s Public Health Excellence Centre. It was believed that around 25% shared their needles, which greatly increased their risk of contracting hepatitis B and C or HIV.

    The evidence indicated that needle and syringe programmes were not only effective in tackling bloodborne viruses among injecting drug users but also saved the NHS money. The cost to the NHS of caring for someone who injects drugs is around £35 000 (€39 575; $49 880) over their lifetime. Taking forward these programmes would “help keep in check the epidemic of hepatitis as well as the potential epidemic of HIV.”

    The NICE guidance recommends that primary care trusts and other planners review their needle and syringe programmes to ensure there are enough to meet local need, and that they are sufficiently accessible in terms of opening hours and location.

    All services should ensure that enough needles, syringes and other injecting equipment are available, it says. Users should also be advised on how to dispose of needles and syringes safely and how to identify their equipment to prevent mix-ups.

    Where possible they should be encouraged to stop using drugs altogether or to switch to non-injecting methods.

    The guidance coincides with a report by the Advisory Council on the Misuse of Drugs on preventing hepatitis C among injecting drug users, which indicates that around 240 000 people in England, Scotland, and Wales are believed to be infected with hepatitis C, mostly through injecting drugs.

    Matthew Hickman, chair of the council’s prevention working group, said prevalence was if anything increasing. The incidence of hepatitis C among people injecting for three years or less rose from 12% to 21% in the past decade.

    David Sloan, vice chair of the Public Health Interventions Advisory Committee, warned against complacency over HIV transmission. “Although HIV rates remain relatively low among injecting drug users, bad practice, such as the sharing of needles among multiple users, makes these individuals extremely vulnerable to any future outbreak.”

    It was also important that the local community was closely consulted over the planning of new or reconfigured needle and syringe programmes, he added. “People do have fears about having [these programmes] in their community. We believe these recommendations will protect communities, but they need to understand what the benefits to them might be.”


    Cite this as BMJ 2009;338:b771