Millar, Seán ORCID: https://orcid.org/0000-0003-4453-8446
(2024)
Review of Pharmacy Needle Exchange Programme in Ireland.
Drugnet Ireland,
Issue 89, Autumn 2024,
pp. 47-49.
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Pharmacy needle exchange in Republic of Ireland
The current national drugs strategy (2017–2025) aims to reduce harms arising from substance misuse and to reduce the prevalence of blood-borne viruses among people who inject drugs (PWID) through the expansion of needle exchange provision to include community pharmacy-based programmes. In October 2011, the HSE rolled out the national Pharmacy Needle Exchange Programme, which is a partnership initiative between the Elton John AIDS Foundation, the Irish Pharmacy Union, and the HSE. Once pharmacies have signed a service level agreement with the HSE, their contact details are passed on to the relevant HSE services so they can promote access to sterile injecting equipment at the participating pharmacies and accept referrals for investigation and treatment. There are pharmacies providing needle exchange in each Regional Drugs and Alcohol Task Force (RDATF) area, apart from those covering Counties Dublin, Kildare, and Wicklow, which are served by a mix of static and outreach needle exchange programmes.
As no published review of the programme has occurred since 2015, a 2024 report aimed to provide an overview of the performance of the HSE Pharmacy Needle Exchange Programme.1
Specifically, the objectives of the study were to show patterns in terms of the following:
- The number of pharmacies enrolled and retained to provide a pharmacy needle exchange programme
- The number of people attending the programme
- The number of pharmacy needle exchange packs (containing needles, syringes, swabs, vials, citric acid packs, and water)
- The number of sterile needles provided each month and the average number of needles per person returned.
This article presents the main findings from this study.
Main findings
Number of participating pharmacies and number of attendees
The number of pharmacies providing the programme has declined since 2015 (see Table 1). The report noted that if this pattern continues, it is forecast that by 2027 the number of pharmacies will decline by a further 25% (n=68, CI: 59.78–76.13). In 2022, some 1,612 unique individuals per month used the programme.
The number of people using the programme increased by 15% from 2015 to 2019, followed by a decline of 19% from 2019 to 2022.
Table 1: Number of pharmacies providing needle exchange in Ireland, by RDATF area, 2013–2023
Source: Unpublished data from the HSE (2023)
Number of pharmacy needle exchange packs and number of sterile needles provided
In 2022, some 3,775 packs were provided per month, which represents an overall decline of 19% compared with 2015. There has also been a decline in the number of packs returned; the overall proportion of packs returned has declined from 23% in 2015 to 16% in 2022. This represents a 28% decline in the proportion of packs returned. There were 21,296 needles provided each month by the programme in 2022, with each person receiving 9.8 needles on average each month. There has been a 4.2% reduction in the average number of needles per individual since 2017.
Recommendations
The report authors suggest that further investigation into the reasons why the programme has declined in terms of the number of pharmacies participating and the level of usage is warranted, and that a survey of those pharmacies that have withdrawn from the programme may provide useful insights in this regard. Anecdotal evidence for Ireland suggests that negative experiences of providing sterile needles to people who use ‘crack’ cocaine may have contributed to the withdrawal of some pharmacies from the programme in 2019.
Prevalence studies in the 2020s have highlighted the increase in cocaine use in Ireland and identified the emergence of crack cocaine use among a marginalised population that may previously have used heroin.2
The provision of additional training for pharmacies may also encourage ongoing participation in the programme, particularly in terms of emerging trends such as the use of crack cocaine by people who inject drugs, as the needs of people who inject crack may present additional challenges.
1 Evans D and Keenan E (2024) Pharmacy Needle Exchange Programme: review of performance indicators. Dublin: Health Service Executive. Available from: https://www.drugsandalcohol.ie/40586/
2 HRB National Drugs Library (2024) Factsheet: Cocaine – the Irish situation. Dublin: Health Research Board. Available from: https://www.drugsandalcohol.ie/17308/
B Substances > Opioids (opiates)
G Health and disease > Disease by cause (Aetiology) > Needle (sharing / injecting)
J Health care, prevention, harm reduction and treatment > Harm reduction > Substance use harm reduction
J Health care, prevention, harm reduction and treatment > Health related issues > Health information and education > Communicable / infectious disease control > Needle syringe distribution and exchange
MA-ML Social science, culture and community > Community action > Community involvement > Task forces
T Demographic characteristics > Pharmacist
VA Geographic area > Europe > Ireland
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