Needle Exchanges Give Good Value
posted: 20/02/2009
Providing free needles and syringes to people who inject heroin and cocaine is a cost-effective use of NHS money, the government's medicines watchdog said today. Free needles and syringes help prevent the transmission of HIV and hepatitis.
The National Institute for Health and Clinical Excellence (Nice) issued its first guidance on how harm reduction services for injecting drug users should be run throughout England, suggesting combining non-judgmental needle exchange schemes with treatment to help users come off drugs.
1 in 4 share injecting drug kit
Professor Mike Kelly, director of the institute's public health division, said there are about 200,000 injecting drug users in Britain. He estimated about 25% of users share needles, putting themselves at a greatly increased risk of being infected with Hepatitis C or HIV.
NW England focus
In NW England there are just over 100 people diagnosed with HIV who were infected through sharing drug injection kit. The actual number is probably closer to 140 because many people have not yet been diagnosed with HIV. Whatever the actual number is, only 2 in 100 people with HIV in NW England got HIV through sharing drug kit. Most people become infected with HIV through sex without condoms.
Around 40% of injecting drug users have hepatitis C and then the risk of death is 10 times higher than among the population at large. Having both HIV and hepatitis C is common.
Kelly said: "The cost to the NHS of caring for someone who injects drugs is around £35,000 over their lifetime. From a societal perspective, the average [lifetime] cost rises to an estimated £480,000 when you take into account the high cost of crime including criminal justice costs."
Needle exchanges help people consider treatment
If needle exchange schemes are run well, they can provide an effective conduit for doctors, nurses and pharmacists to gain direct contact with hard-to-reach groups – the first step towards encouraging them to seek treatment.
Providing injecting drug users with extra years of healthy life was cost-effective for taxpayers, said Nice.
Guidance supports HIV and hepatitis C prevention
Kelly added: "Keeping in check the epidemic of Hepatitis and maintaining HIV at its relatively low levels is an important aim that this guidance will serve."
Needle and syringe exchange schemes have been provided throughout England for more than 20 years. They provide injecting drug users with sterile equipment, needle disposal bins and advice on safer injecting practices. Primary care trusts (PCTs) have had discretion on how to run services to meet local needs.
Guidance for NHS
The Nice guidelines include advice on how PCTs should tailor the service to encourage injectors to seek treatment by offering more accessible opening times and locations.
Dr Mathew Hickman, chair of the Hepatitis C prevention working group at the Advisory Council for the Misuse of Drugs, said: "Needle and syringe programmes are a critical component of public health action to prevent Hepatitis C infections among injecting drug users.
"Evidence suggests that a combination of interventions is most effective. This means that staff need to use the opportunity they have with injectors actively to promote and refer people into treatment, such as opiate substitution programmes."
Dr David Sloan, vice-chair of the Public Health Interventions Advisory Committee, said: "Although HIV rates remain relatively low among injecting drug users in the UK, bad practice, such as the sharing of needles among multiple users, makes these individuals extremely vulnerable to any future outbreak."
The NICE guidance is now available for people using drugs, carers and the wider public. This includes professional guidance for healthcare staff, and the background papers and evidence for the new guidelines.
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