Northumberland Drug and Alcohol Action Team
A protocol for the provision of Needle Exchange in
Community Pharmacies
May 2010
CONTACTS:
HARM REDUCTION STAFF 01670 396360
NORTHUMBERLAND DRUG AND ALCOHOL ACTION TEAM (DAAT) Pharmacy Coordinator
Paul Chapple, 07949094929
ST GEORGE’S PARK PHARMACY ADMINISTRATOR:
Denise Richardson, 01670 501832
SORTED (Young people’s service): 01670 500150
INTRODUCTION
One of the ways for Blood Borne Viruses (BBV) to spread is through the practice of injecting drug users (IDU) sharing injecting equipment. BBV can be transmitted from sero-positive users to fellow injectors through shared equipment and to their sexual partners through unprotected sexual intercourse. In addition discarded infected needles and syringes pose a health risk to the rest of the population.
In order to reduce harm to the whole community as well as to drug users, a network of needle exchange schemes have been set up in Northumberland. These are based at community pharmacies in order to provide drug users local access to a harm reduction service. They provide a facility for the safe collection and disposal of used equipment together with harm reduction advice.
The Northumberland harm reduction service exists to monitor local needle exchange and other drug related intervention as well as training, information and advice for the whole county. The role of all harm reduction is to reduce the physical, psychological and societal risks associated with individuals and society’s continued use/misuse of drugs. The Community Pharmacy needle exchange schemes form the basis of harm reduction in Northumberland and are often the only agency a drug user may engage with.
In England 80% of needle exchange facilities are within Community Pharmacies. (NEX survey 2005 NTA)
The Harm Reduction Service in Northumberland is actively encouraging pharmacies to be more involved with IDU`s health and well being. The chaotic, often isolated and marginalised IDU has no contact with any other health service provider other than the staff in the pharmacy. The HRS team therefore plan to provide pharmacy staff with training and support to help fulfil this role.
The Drug and Alcohol Action Team (DAAT) Pharmacy Coordinator and HRS staff are available to help minimise any problems that may occur with the scheme. Needs assessment for service provision is continually reviewed and comments or suggestions from pharmacy staff are welcomed.
The scheme is geographically dispersed throughout Northumberland This ensures that IDU`s have access to clean injecting equipment and paraphernalia throughout the county. It is extensively documented that if access to clean equipment is not available for any reason an IDU will reuse or share equipment.
AIM
The Pharmacy needle exchange scheme will provide a service to reduce the level of harm associated with substance misuse and to minimise the spread of blood borne viruses amongst the drug using population of Northumberland. It is also envisaged that the scheme will attract and retain those IDU`s unable or unwilling to access the specialist Harm reduction team. The scheme will also reduce risks of BBV to the community. Services will operate in various pharmacies throughout Northumberland and will be supported by the Harm reduction service.
OBJECTIVES
Ø To provide access to a range of sterile injecting equipment and to be responsive to local service user’s needs for equipment required.
Ø To provide literature in the form of leaflets on safer injecting techniques reducing the risk of blood borne viruses and on safer sexual practices.
Ø To engage and offer support to service users not currently accessing the Harm reduction service.
Ø To reduce the public health risk from potentially contaminated injecting equipment, by ensuring safe disposal.
Ø To provide information and access to other services for injecting drug users in Northumberland including hepatitis B and C screening and vaccination where appropriate.
Ø To be a resource, in attracting service users into treatment services
Ø To engage with users to disseminate harm reduction advice
1. MANAGEMENT
The DAAT Pharmacy Coordinator will commission and coordinate the service
2. PUBLICITY
A sign will be displayed in the Pharmacy window, which is a nationally recognisable sign for injecting drug users that needle exchange is available at the pharmacy. Drug services will have information about all registered needle exchange pharmacies and service users provided with this via directories issued by the DAAT posters and leaflets.
3. EVALUATION OF SERVICE
The Pharmacy needle exchange service will be evaluated via a process of quantitative/qualitative analysis.
These statistics will include:
Ø Numbers of needles issued and returned.
Ø Number of new service users accessing the service for that period – male/female subtotal
Ø Number of transactions / individuals.
Ø Monthly record sheets should be sent to St. Georges Pharmacy
4. SERVICE PROVISION
The exchange service will be provided in a manner that is sensitive to the needs of the service user group and the local community. It will be non-judgemental, anonymous and aim to be service user led. Confidentiality will be adhered to at all times.
The main focus of activity will be to establish contact with injecting drug users, particularly those not in contact with any other agencies in order to:
Ø Provide free sterile injecting equipment to reduce the level of harm associated with injecting drug use.
Ø Provide facilities for the safe return and disposal of used needles and syringes.
Ø Provide information, support and when requested access to other services as appropriate.
Ø Service users with no access to harm reduction service exchange will have a flexible confidential service.
Ø Offers more choice for service users.
5. CONFIDENTIALITY
The level of confidentiality will adhere to professional guidelines and in practice will ensure the anonymity of the service user within the service and enable staff to work within the confidentiality guidelines. This level of confidentiality will only be breached if staff are subpoenaed by a court of law or there is a risk to life of the service user or another member of the public.
High levels of confidentiality need to be maintained for the following reasons: -
1). IDU’s are discriminated against and often labelled by society and would not wish to be identified to the local community due to fear of stigmatisation.
2). the possession of non-prescription drugs is illegal; a breach of confidentiality could result in arrest and prosecution.
3). Many IDU’s keep their drug use a secret from their friends and families and a breach could result in relationship and support breakdown.
In order to ensure confidentiality the service users name and address should not be recorded or information shared with other members of staff who are not trained in the needle exchange scheme. Only basic information is required for effective monitoring of the service.
Staff should not discuss service user’s details with other members of the public outside of the pharmacy. Exchange records should only be available to St Georges’s pharmacy, the DAAT Pharmacy Coordinator and HRS staff.
Registration sheets should be kept in a safe and confidential area within the pharmacy and only viewed by the staff trained in the scheme or those above.
Seeking advice or making a referral for a service user should only be done with their prior consent. If however there is a serious risk to life advice should be sought from the DAAT Pharmacy Coordinator or HRS staff.
6. WORKING WITH UNDER 16’S
The law is unclear about the issue of injecting equipment to those less than 16 years of age. Some exchanges use the Gillick ruling (1985) in their operational protocols to allow them to supply equipment to under 16’s.
The HRS in Northumberland does not knowingly supply equipment to those less than 16 years of age. In all cases we refer to Sorted! For their help and advice telephone their contact number.
7. CRITERIA FOR ISSUING INJECTING EQUIPMENT
Ø Evidence of injection sites
Ø Where necessary service user demonstrates some technical knowledge e.g. knows what to ask for / shows some familiarity of terms / can detail the procedure of preparing a drug for injection.
Ø The Pharmacy staff are confident that the equipment is to be used by someone who has injecting experience.
Ø There is evidence that without the service, the service user will come to harm.
8. SUPPLY AND EXCHANGE OF EQUIPMENT
Service user’s individual needs may vary considerably. On the first visit a user will be offered:
Ø Up to 10 needles and syringes
Ø A personal sharps container
Ø Sterets
Ø Water (5ml plastic ampoules are not covered by the medicines act therefore supply is currently not given).
Ø Citric acid/vitamin C
Ø Condoms
Ø Plaster
On subsequent visits the service user will be offered:
Ø Clean injecting equipment in return for used
It is vital that staff encourage service users to return used equipment. The continuation of the service depends upon the return and safe disposal of used equipment. If on subsequent visits the service user does not return equipment then a verbal warning should be issued to the service user to return on the next visit. The connection between the continued availability of the service and their co-operation in returning used equipment must be reiterated.
Ø In the event of the service user attending on two consecutive occasions to receive clean equipment without returning used, then the service user will be given 4 sets of clean injecting equipment as long as 4 is less than the usual number issued to the individual, if not 2 sets will be issued. If consequently the service user returns used equipment, the amount issued can be increased incrementally to the usual amount. A written comment should be made as to any action taken with any individual and passed to the HRS
Ø No less than 1 to be given regardless of returns since no provision of equipment would be against the harm reduction ethos. However it must be stressed to service users the survival of the service is dependent on return rates.
Ø Exclusion of a service user from the scheme would only be considered in exceptional circumstances such as lack of returned equipment. This would be at the discretion of the HRS and the DAAT Pharmacy Coordinator
Ø All issued and returned injecting equipment will be documented to each individual.
Ø Service users will be made aware of the overall return rate achieved by the service to engender interest and ownership. (after data analysis at the harm reduction service)
9. REGISTERING A NEW SERVICE USER.
1). Ask if the service user has ever used an exchange service before. This will help to determine how much information you will need to give them.
2). Show the service user which part of the pharmacy they need to use to access the exchange.
3). The client will be asked a few simple questions in order to register (see Appendix) and will be asked to give their initials and date of birth at each transaction. No identifying personal details are taken.
4). When registering a new service user it is recommended that a maximum of ten needles and syringes should be given. This will encourage the retention of the IDU and also to return used sharps.
5). It should be reinforced to the service user that the success of the scheme relies on the exchange of new equipment for his or her used equipment. It is unlikely that a service user will have any used equipment to dispose of at the first visit, hence the restricted number of syringes and needles issued.
10.TRANSACTIONS.
1). Ask the service user their initials and date of birth and enter these in to the monthly return sheet. The service user should be asked if they have any returns of used equipment. The used equipment should be disposed of in the agreed safe manner. (See appendix).
2). If the service user has no returns he or she should not be refused equipment. Although the scheme operates an exchange policy this is secondary to preventing the transmission of BBV and injecting injuries. The pharmacist should however use their judgement when issuing equipment to those consistently failing to return used equipment. Advice can be sought at anytime from HRS staff.
3). Depending on a number of variables; such as drug type, injection site and frequency, the service user may request different pieces of injecting equipment. Various items can be ordered to suit service users needs, please see the attached order sheet in the appendix.
4). Equipment returned and issued should be entered in the monthly returns sheet. This is forwarded to St. George’s pharmacy at the end of each month for payment. Sheets should still be sent even if there have been no transactions.
11. STAFF SAFETY.
Staff safety is of paramount importance as is that of the general public using your pharmacy. The pharmacist should use his or her own discretion in dealing with unacceptable behaviour. It is recommended that pharmacy staff dealing with used equipment should have a course of Hepatitis B and tetanus vaccines if they have not already done so. Please see the attached appendix of how to deal with sharps injuries.
APPENDIX
1). List of all pharmacies in the scheme
2). Registration form
3). Sharps injuries - action to be taken.
Appendix 1
Northumberland Needle Exchange Schemes
BOOTS UK (local) – 1 STATION ROAD, BEDLINGTON STATION. 01670 823251MONDAY
9.00am - 5.30pm / TUESDAY
9.00am - 5.30pm / WEDNESDAY
9.00am - 5.30pm / THURSDAY
9.00am - 5.30pm / FRIDAY
9.00am - 5.30pm / SATURDAY
9.00am - 4.00pm / SUNDAY
BOOTS UK (health & beauty) – 28/30 STATION ROAD, ASHINGTON. 01670 812142
MONDAY
9.30am - 5.00pm / TUESDAY
9.30am - 5.00pm / WEDNESDAY
9.30am - 5.00pm / THURSDAY
9.30am - 5.00pm / FRIDAY
9.30am - 5.00pm / SATURDAY
9.30am - 5.00pm / SUNDAY
LLOYDS PHARMACY – NORHAM ROAD, ASHINGTON. 01670 812035
MONDAY
8.45am - 6.00pm / TUESDAY
8.45am - 6.00pm / WEDNESDAY
8.45am - 6.00pm / THURSDAY
8.45am - 6.00pm / FRIDAY
9.00am - 6.00pm / SATURDAY
CLOSED / SUNDAY
LLOYDS PHARMACY – UNIT 9, BROCKWELL CENTRE, CRAMLINGTON. 01670 733981
MONDAY
9.00am - 6.00pm / TUESDAY
9.00am - 6.00pm / WEDNESDAY
9.00am - 6.00pm / THURSDAY
9.00am - 6.00pm / FRIDAY
9.00am - 6.00pm / SATURDAY
9.00am - 11am / SUNDAY
HAYDON BRIDGE PHARMACY – 6 CHURCH STREET, HAYDON BRIDGE, HEXHAM. 01434 684354
MONDAY
9.00am - 12.30pm
1.30pm - 6.00pm / TUESDAY
9.00am - 12.30pm
1.30pm - 6.00pm / WEDNESDAY
9.00am - 12.30pm
1.30pm - 6.00pm / THURSDAY
9.00am - 12.30pm
1.30pm - 6.00pm / FRIDAY
9.00am - 12.30pm
1.30pm - 6.00pm / SATURDAY
8.45am - 12.30pm / SUNDAY
BOOTS UK (health & beauty) – 7 FORE STREET, HEXHAM. 01434 602024
MONDAY
8.30am - 5.30pm / TUESDAY
8.30am - 5.30pm / WEDNESDAY
8.30am - 5.30pm / THURSDAY
8.30am - 5.30pm / FRIDAY
8.30am - 5.30pm / SATURDAY
8.30am - 5.30pm / SUNDAY
BOOTS UK (local) - 17 BERESFORD ROAD SEATON SLUICE 0191 2376880
MONDAY
9.00am - 5.00pm / TUESDAY
9.00am - 5.00pm / WEDNESDAY
9.00am - 5.00pm / THURSDAY
9.00am - 5.00pm / FRIDAY
9.00am - 5.00pm / SATURDAY
9.00am - 5.00pm / SUNDAY
BOOTS UK ( health & beauty) 60-68 MARYGATE, BERWICK 01289 306036
MONDAY
8.30am - 6.00pm / TUESDAY
8.30am - 6.00pm / WEDNESDAY
8.30am - 6.00pm / THURSDAY
8.30am - 6.00pm / FRIDAY
8.30am – 6.00m / SATURDAY
8.30m – 6.00m / SUNDAY
11.00am – 4.30pm
CRESCENT PHARMACY – 110 ALEXANDER ROAD, ASHINGTON 01670 858959
C
MONDAY
9.00am - 6.00pm / TUESDAY
9.00am - 6.00pm / WEDNESDAY
9.00am - 6.00pm / THURSDAY
9.00am - 6.00pm / FRIDAY
9.00am -8.00pm / SATURDAY
9.00am - 8.00pm / SUNDAY
10.00am – 8.00pm
Appendix 2