Home > Profile of needle exchange services in Ireland.

Robinson, Janet and Gibney, Sarah and Keane, Martin and Long, Jean (2008) Profile of needle exchange services in Ireland. Drugnet Ireland, Issue 28, Winter 2008, pp. 16-17.

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Needle and syringe exchange services were first provided in Ireland in 1989, when five exchanges were established. There are now 34 exchanges in the country, operating three models of service: fixed-site exchanges, home visit exchanges, and exchanges in public locations. Peer-based, pharmacy, prison-based or vending machine exchange services are not available in Ireland.

 This article presents a profile of 31 needle and syringe exchange services operating between November 2007 and February 2008. A service-inventory questionnaire was used to collect the data. The questionnaire comprised six sections: administrative details, profile of target population, profile of staff and volunteers working in the service, activities, management issues and new phenomena in relation to drug use.1 The 31 services provided exchanges at fixed sites (28), on home visits (3) and in public locations (2); two services provided exchanges in two settings.
 Of the exchanges surveyed, 17 were operated by government, 11 by a partnership of government and non-government organisations, and three by non-government organisations. Two services provided social and medical care; six provided social care only and four provided medical care only. All provided services without charge to the client.
 Weekly opening times ranged from 24.75 hours over five days in one service to one hour on one day in three services. Twenty of the services were open on one day a week for 1-2.5 hours. One service was open on seven days a week for one hour each day; this was the only service that operated a weekend provision. Eight of the services were open after 5 pm on one night a week.
 Of the 31 services, 20 provided services in urban locations, 12 in inner city locations and three in rural locations; some services operated in more than one location. The majority reported a dispersed open drug scene and/or a hidden scene in their areas.
 Seven of the services had no formal data-collection procedures, and two services were not open for all of 2007. A total of 22 services reported 7,069 client attendances in 2007.
 Overall, between 10% and 30% of clients were female. The youngest clients were aged between 16 and 20 years. Twenty-five services were open to any person aged over 18; five of these also dealt with 16-18-year-olds. Two services catered for women and sex workers; two served residents only; and two operated specific services for ethnic minorities. Twenty-nine services reported that a significant minority of their clients were homeless.
 Twenty-nine services reported heroin as the drug most commonly used by clients; 18 services reported cocaine as the most common. As expected, injecting was the most common route of administration (reported by 19 services). Benzodiazepine injecting was reported as a common practice by 11 services. Nineteen services reported that clients attending their service injected steroids.
 Thirty services reported that the outreach workers had an academic (but not a professional) qualification. The remaining service reported that staff did not have formal qualifications. Thirty services were operated by two or more staff during a session; 15 had a general assistant present. Six services provided on-site access to health services, usually provided by a nurse; four provided on-site access to counsellors.
 All 31 services reported that staff received training on the assessment of clients' sexual risk practices and injecting practices, and on emergency responses such as overdose prevention techniques. Twenty-six services had a written document about staff training.
 A variety of policy and procedural documents have been developed to guide the operation of needle and syringe exchange services in Ireland. A written document for service providers in relation to health and safety issues was available in all services. A written document in relation to the health and safety of clients was available in 20 services. Thirty services offered staff vaccination against hepatitis A and B, and seven offered staff vaccination against tetanus.
All 31 services completed an assessment when a client accessed the service for the first time. The majority of services recorded clients' drug use, drug history and sexual health practices in the past year. The majority also recorded the blood-borne viral (BBV) infection status of their clients as well as their BBV test and treatment history. The amount of information recorded at the initial visit depended on how comfortable the client was in divulging this information. In some cases, service providers recorded basic client information (such as name, date of birth, drug of choice and mode of administration) at the initial visit and obtained additional details at subsequent visits. No service developed a written care plan for clients. However, 28 services reported reviewing clients' needs after a number of visits - in some services after every two visits and in others after every 10 visits.
 The majority of services recorded the following data at each return visit: date, used injecting equipment returned, sterile equipment received, client's sharing of injecting equipment (since last visit), drug(s) used (since last visit), condoms received, and length of visit.
 Information was recorded on client assessment forms in 30 services and on a computer system in 19 services; some services recorded the data in both ways. Of the services recording data on computer, 16 used the Drugs/Aids Information System (DAIS), two used Microsoft Excel and one used a specially designed client-information system.
 Services provided a range of sterile injecting equipment and materials. All 31 services provided different sizes and types of needle and syringe, as well as alcohol swabs and citric or acetic acid. All services also provided condoms. Thirty services provided stericups or cookers and sterile water; 28 provided non-toxic foil (for smoking heroin); eleven provided syringe identifiers; and seven provided tourniquets. No service provided single-use injecting packs, crack pipes or straws.
 All 31 services provided information on safer injecting practices, overdose prevention and blood-borne viruses; 29 provided information on safer sexual health. All services discussed with clients the importance of safely disposing of needles and syringes.
 All 31 services reported either providing social care and crisis counselling services on site or referring clients to other services that provided the necessary interventions. Accompanied referrals to either social care or health care services occurred infrequently in the majority of services. However, accompanied referrals to an emergency department were provided if a client presented to the service in a suicidal state.
 Some services provided facilities in addition to needle and syringe exchange: 11 had a drop-in, club, lounge or open-access service, of which five had tea and coffee making facilities, nine provided meals (a sandwich at minimum), seven had leisure facilities (games, television), nine had telephone facilities and three had internet facilities available to service users.
 Day-bed facilities were not provided by any service, though two provided night-bed facilities, with 17 and 20 beds available respectively. Lockers for personal belongings were available in two services. Eight services had personal hygiene facilities available to service users, of which seven had bath or shower facilities, seven had laundry facilities and four had clothes distribution facilities.
The authors are grateful for the help of exchange service managers and outreach workers in preparing this article.
1. Working Group on Data Collection within the Correlation Network (2008) Data collection protocol for specialist harm reduction agencies. Amsterdam: Foundation RegenboogAMOC.

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