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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Call to Obama on HIV and Drugs

posted: 04/02/2009

A rift between the EU and US over how to deal with global trafficking of illicit drugs is undermining international efforts to agree a new UN strategy.

The EU wants a pragmatic international drugs policy for the next ten years with harm reduction at its heart. Harm reduction measures to limit the spread of HIV and hepatitis among injecting drug users have been opposed by the USA under former president Bush.

The confrontation has been heightened because of suggestions that the US negotiating team is pushing the hardline, Bush administration "war on drugs", in contrast to the EU position which supports "harm reduction" measures such as needle exchanges.

Talks are said to be at breaking point in Vienna where representatives have gathered to hammer out a new UN declaration in time for a signing ceremony at a drugs summit in mid-March. Negotiations, which have been going on for three months, are due to resume today with no indication of a breakthrough.

New 10 year UN drugs declaration

At the heart of the dispute is whether a commitment to "harm reduction" should be included in the UN declaration of intent, which is published every 10 years. In 1998 the declaration was "a drug-free world - we can do it".

Need for harm reduction to tackle HIV and addiction

EU countries, backed by Brazil and other Latin American countries, Australia and New Zealand, say even with the best of intentions the world will not be drug-free in 10 years and some commitment to tackling HIV and addiction through needle exchange programmes and methadone and other drugs should be included.

The US position, as maintained throughout the Bush years, is that harm reduction sends the wrong message and must be resisted. President Obama has already lifted the ban on federal funding for needle exchanges and is known to have a more liberal approach to the issue, but the US negotiating team is opposed to varying the "drug-free" strategies of the past. The US is backed by Russia and Japan.

Governments at the talks acknowledge that no consensus has been reached. "Negotiations are currently complex but we are hopeful that a satisfactory conclusion can be achieved," a Home Office spokesman said.

Harm reduction works

Drugs policy experts expressed concern at the stalemate. "It is troubling that, despite clear global evidence of the effectiveness of harm reduction in reducing HIV and its acceptance in every other UN body, that the US is still resisting its inclusion," said Mike Trace, chair of the International Drug Policy Consortium and former UK deputy drugs tsar. "We are sure the incoming administration will take a different view but they will have to move fast or this will be the position for the next 10 years."

Obama and US drugs policy change

Danny Kushlick of Transform, the British drugs reform charity, said talks were at a crucial stage. "The race is now on to change the instructions from US officials before the ink dries on the previous administration's line," he said. "The implications of changing the political line is enormous for those who have suffered under the US administration's refusal to support basic harm reduction measures."
 

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