Home > Needle exchange provision in Ireland in 2012.

Curtin, Margaret (2015) Needle exchange provision in Ireland in 2012. Drugnet Ireland , Issue 55, Autumn 2015 , pp. 22-24.

[img]
Preview
PDF (Drugnet Ireland 55)
3MB

The Health Service Executive (HSE) recently published a review of needle exchange provision in Ireland.1 The review was designed to assess the effectiveness of HSE-funded needle exchange services, using evidence from 2012. In particular, the study examined:

  • needle exchange activity nationally,
  • referral rates to health and social care,
  • data collection procedures and clinical governance, and
  • quality assurance and clinical governance.

Data for 2012 were collected between February and June 2013, using a questionnaire consisting of closed and open-ended questions. The data collection template was reviewed to ensure that it met the data-recording requirements of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). All six non-statutory needle exchange services and all HSE regional offices returned questionnaires. However, of the 63 pharmacies where needle exchange services were available, only 33 had reported transactions in 2012 and of these only 16 returned questionnaires.

 

Models of needle exchange in Ireland

The three models of needle exchange in use in Ireland in 2012 are documented in the review. These were:

  1. static – 24 sites mainly in Dublin City,
  2. outreach – 14 sites mainly in counties Dublin, Kildare, Laois, Offaly, Waterford and Wicklow, and
  3. pharmacy – 63 sites in regions outside Dublin, Kildare and Wicklow.

Access

Pharmacy needle exchange programmes provided the greatest level of accessibility, with pharmacies typically open six days a week and providing, on average, 48 hours of service weekly. On the other hand, 15 of the 24 static services opened for less than eight hours a week, and seven opened for 25–43 hours per week. Half (seven) of the outreach services opened for less than 25 hours a week, while five opened for 25–43 hours per week and two whenever needed.

 

Activity

The review indicates that 13,763 individuals used the needle exchange service during 2012, of which 7,359 (80%) were men and 1,862 (20%) were women. However, as there is no unique health identifier in Ireland, the authors urge caution in the use of these totals because individual service users may have been counted more than once.

 

A total of 65,099 needle exchange transactions are reported to have occurred during 2012, with the majority (84%) being provided through static or outreach services in either Dublin North-East or Dublin Mid-Leinster (see Figure 1). The differences in the level of use of each exchange type is a reflection of the number of services available in each area.

 

 

Paraphernalia distributed

Detailed information on the quantity of injecting equipment distributed at all sites was made available to the reviewers, with the exception of two static sites where only partial information was available. Individual items were distributed at the static and outreach services, whereas packs of equipment were distributed at the pharmacy-based exchanges.

 

Static and outreach services

In total, 156,575 syringes and 135,696 needles were distributed. Almost half of all syringes (49%) were fixed needle with a unit capacity of 1ml. In addition, the following items were distributed:

 

 

The review points to a discrepancy between the number of needles and quantity of other injecting equipment distributed. In particular, the fact that 67,928 more needles than vials of water were made available is highlighted. This, the authors state, may signal that some equipment was being used more than once, contrary to best practice.

 

Pharmacy-based needle exchanges

A total of 11,790 packs, each containing the equipment for 10 sterile injections, were distributed through pharmacy-based needle exchanges. Each pack contained 10 filter syringes (including needles), 10 stericups, 10 swabs, 10 citric acid packs, 10 vials with 5ml water for injection and one information leaflet (harm reduction and safer injecting advice).

 

Returns policy

All services reported that they encouraged the return of used equipment but that this was not a condition for accessing new equipment. All pharmacy-based needle exchanges kept a record of equipment returned, but across the static and outreach services the level of record-keeping varied.

 

Referrals and other services

The number of referrals reported to the review team are outlined in Figure 2. The authors state that this is an under-estimation of the level of referral from the static and outreach services. The review states that all services reported providing information on blood-borne viruses(BBVs) but that recording of the numbers referred for BBV testing or for hepatitis B vaccination was inconsistent in the static and outreach services. Referrals from the pharmacy-based services were recorded and reported systematically.

 

 

 

All services reported providing face-to-face advice on overdose and harm reduction as well as referrals to other treatment and counselling services. Other services included referral to general practitioners, A&E, outreach and social care services as well as wound care and injection site inspection.

 

Quality assurance and governance

The review details the quality assurance mechanisms in place in the various needle exchange services. Governance requirements for pharmacies are set out in the Pharmacy Act 2007, which gives the Pharmaceutical Society of Ireland powers of inspection, investigation and enforcement. All static and outreach needle exchange services work within the National Drug Rehabilitation Implementation Committee (NDRIC) framework, which is designed to ensure service providers offer individuals affected by drug misuse a range of integrated options tailored to meet their needs and create for each person an individual rehabilitation pathway. These services are reported as using a range of clinical governance approaches.

 

Recommendations

The review recommends a standardised electronic reporting mechanism for regular monitoring and reporting of all needle exchange transactions. It also points to the need for a unique identifier for each service user to remove the risk of individuals being reported more than once in a reporting year. The need for specific data on injecting of image- and performance-enhancing drugs is also highlighted. 

 

An examination of the potential barriers to BBV testing and vaccination is also recommended in order to improve uptake of this opportunity for testing and vaccination.

 

A number of recommendations are included with regard to the standards that need to be in place in order to enhance quality assurance and clinical governance.

 

Finally, the review recommends the provision of injecting equipment (e.g. stericups, filters and foil) in addition to needles and syringes, and points to the possibility of central purchasing of stock for all non-pharmacy needle exchange programme as a means of strengthening value for money.

 

1 Bingham T, Harnedy N, O'Driscoll D and Doyle J (2015) Review of needle exchange provision in Ireland. Dublin: Health Service Executive. https://www.drugsandalcohol.ie/23916/

 

Item Type:Article
Issue Title:Issue 55, Autumn 2015
Date:October 2015
Page Range:pp. 22-24
Publisher:Health Research Board
Volume:Issue 55, Autumn 2015
EndNote:View
Subjects:G Health and disease > Etiology > Disease transmission factor > Needle sharing
J Health care, prevention and rehabilitation > Substance use prevention > Substance use harm reduction
J Health care, prevention and rehabilitation > Health related prevention > Health information and education > Communicable disease control > Needle distribution and exchange
VA Geographic area > Europe > Ireland

Repository Staff Only: item control page