BRIGHTON & HOVE
NEEDLE EXCHANGE SCHEME
HANDBOOK
CONTACT:
- Amanda Marshall, NHS Brighton & Hove, Tel: 01273 545358
Email:
or
- Chris Saunders, CRI, Harm Reduction & Needle Exchange Service, Tel: 01273 607575
Email:
Published Date: March 2009
Review Date: March 2011
NEEDLE EXCHANGE
Contents
/Page No.
Aim
/3
Objectives
/3
Concept
/3
Service Provision
/3
Client profile
/4
Young People
/4
Performance-enhancing drugs (aka steroids)
/4
Insulin and other non-illicit substances
/4
Disposal of sharps waste service
/4
Confidentiality
/5
Ordering and delivery information
/5
Pack contents
/5
Return of used equipment by client
/6
Collection of used equipment from the pharmacy
/6
Payment information
/7
Training
/7
Step-by-step procedure for needle exchange
/8
BBV Vaccinations and Testing for injecting drug users
/9
Hepatitis B Vaccinations for staff
/9
Leaflets
/9
Publicity and logo
/9
Needle stick injuries procedure
/10
Activity sheet
/11
Brighton & Hove needle exchange list
/12
NEEDLE EXCHANGE
A free & confidential service for all injecting drug users (IDUs)
AIM
To reduce the transmission of blood-borne viruses and other infections associated with injecting drug use, through the provision of sterile injecting equipment and sharps disposal facilities.
OBJECTIVES
To make sterile injecting equipment freely and easily available to injecting drug users.
To encourage and facilitate the safe disposal of used equipment.
To provide a friendly and non-judgmental service.
To reduce associated harm to communities through the provision of sharps disposal.
To offer advice, information and sign-posting to other services as appropriate.
CONCEPT
The philosophy of needle exchange is one of Harm Reduction, which is crucial to the successful delivery of the service. The aim is to reduce the harm associated with injecting drug use without moralising or judging the injecting drug user in any way. Importantly, harm reduction does not attach the requirement of abstinence but instead emphasises safe practice. Needle Exchanges are seen as an important public health measure and as such are backed by the National Treatment Agency, a special health authority, and the Royal Pharmaceutical Society of Great Britain.
SERVICE PROVISION
The service is available to all adult drug injectors - notably heroin, amphetamines, cocaine, crack and injectable methadone. Equipment can also be supplied to carers and for secondary distribution.
In order to successfully attract injecting drug users the service needs to be run in an extremely confidential and non-judgmental way. There should be as few restrictions as possible and therefore the service should be available throughout opening hours. The pharmacist does not need to be on the premises in order for an exchange to take place. Clients do not need to provide names, addresses or GP details in order to make use of the service.
Once entered into contract with NHS Brighton & Hove the service is continuous until further notice. Either party may decide to discontinue the service with 3 months’ notice.
Whilst the service was originally set up as a 1-4-1 exchange (ie one pack given out in exchange for a used bin being returned) this is now seen to be counterproductive. Consequently it is NOT necessary for a client to return used equipment in order that they may receive sterile equipment.
The service is funded by NHS Brighton & Hove and managed by Amanda Marshall, Community Pharmacy Development Manager. CRI, the local Harm Reduction and Needle Exchange Service, support the service.
Contact information for CRI:
11 St George’s Place
Brighton
BN1 4GB
Tel: 01273 607575
Opening Hours:Monday, Tuesday and Thursday 9am – 5pm
Wednesday 9am – 8pm
Friday 9am – 4pm
Saturday 10am – 1pm
NB: USERS ARE ABLE TO ACCESS CRI SERVICES FROM 10AM MONDAY – SATURDAY.
CLIENT PROFILE
Adult Injectors – 18yrs and over
The Needle Exchange is primarily targeted at adult injectors, over the age of 18.
The government deems that younger injectors are better suited to Young People’s Services where they can be given specialist attention. So young people should be referred to CRI, who will liaise with the Young People’s Services to ensure appropriate support is available.
Performance-enhancing drugs
Performance-enhancing drug (PED) users (including anabolic steroids and growth hormones) are encouraged to use needle exchange services. Research indicates that this group is at an increased risk of blood-borne virus transmission requiring similar harm reduction interventions as intravenous drug users (PED users are intramuscular injectors). PED users should be referred to CRI.
Insulin and other non-illicit substances
Diabetic customers should not be using the needle exchange as there are alternative provisions in place for their particular needs. Diabetic customers should contact South Downs Health to request a sharps collection, when their used equipment will be collected. Contact details are as follows:
Disposal Service: South Downs Health – tel: 01273 242077
However, small and infrequent returns of diabetic needles should not be refused if the patient is unlikely to dispose of equipment appropriately. Please indicate on the activity sheet that the client was returning diabetic sharps.
CONFIDENTIALITY
DO NOT advise prescribers of attendance at the needle exchange, nor anyone else, without the client’s permission. Due to the confidential nature of the service, all personal information should be stored accordingly. Data is collected with anonymised information such as initials or nickname, but this is not essential if a client prefers not to provide such/any information. All transactions should be conducted in such a way as to protect the dignity of the clients.
ORDERING AND DELIVERY OF PACKS
Packs can be ordered direct from Frontier Medical Products. The contact details are:
Margaret Boyes
Medipack Solutions
Unit 22, Calow Brook Drive
Hasland, Chesterfield
Derbyshire, S41 0DR
Tel: 01246 274190
Email:
Please allow 3- 4 working days for delivery. In order for a successful service to be maintained it is essential that you never run out of packs.
EQUIPMENT/PACKS (update)
There are a number of different packs that are ready-prepared for convenient storage. The packs contain:
PACK NAMECONTENTS
1ML PACK20 X INSULIN NEEDLES/SYRINGES
(RED)20 X SWABS
20 X VITC SACHETS
20 X STERILE SPOONS
1 X SHARPS BIN
1ML PACK20 X 1 ML BARRELS
(YELLOW)20 X LONG ORANGE NEEDLES
20 X SWABS
20 X VIT C SACHETS
20 X STERILE SPOONS
1 X SHARPS BIN
2ML PACK20 X 2ML BARRELS
(BLUE)20 X LONG BLUE (1 ¼”) NEEDLES
20 X SWABS
20 X VIT C SACHETS
20 X STERILE SPOONS
1 X SHARPS BIN
1ML NEVER SHARE PACK20 X 1MLNEVER SHARE NEEDLESSYRINGES
(GREEN)20 X SWABS
20 X VIT C SACHETS
20 X STERILE SPOONS
1 X SHARPS BIN
Water – if any Clients request water please note that this can be ordered separately from Frontier to be given out as required.
Citric acid – if any Clients request citric acid please note that this can also be ordered separately from Frontier to be given out as requested.
Clients are allowed to take as many packs as they require as they may be injecting 2-4 times daily or more depending on the substance. Consequently it is unlikely that anybody would request more than 3 packs in one go. If they do this might be because they are collecting for another person, which is equally acceptable. For statistical purposes and service development/planning, it is useful to know if a person is distributing to other injectors so please record this on your return sheet.
RETURN OF USED EQUIPMENT
Whilst the service is set up to allow easy access to sterile injecting equipment, the facility for sharps disposal should also be encouraged. Reports are made monthly as to the amount of equipment distributed and disposed of and pharmacies should be aiming for at least 50% of their equipment being returned. Pharmacies that have the highest return rates tend to keep their needle exchange bin in a convenient location, which is also the safest option, allowing clients to put their sharps in the bin themselves. Clients should always put their sharps in the bin; staff should not collected returned sharps and put them in to the bin. However, should a client continually neglect to return equipment the service should NOT be withdrawn. Keep encouraging the person to return their equipment and enquire if there is a particular problem that makes it difficult for them to return (for example, lack of transport or fear of police).
Clients should ideally return used equipment in the individual sharpsbin provided in the pack. If a client returns loose sharps or sharps in a carrier bag or other container, ask the client to put the items directly into the needle exchange bin and seal the lid immediately. Whilst we don’t encourage clients to return equipment in this manner, it is still preferable that they return items to the pharmacy rather than elsewhere. Please inform CRI if you are aware of a local ‘trouble-spot’ for discarded equipment.
COLLECTION OF USED EQUIPMENT
(NON-HAZARDOUS WASTE)
South Downs NHS Trust is the contracted clinical waste company for the needle exchange waste collection. This is a separate contract to any other items (such as returned medicines) and therefore it is necessary for a separate needle exchange bin to be used for this purpose only. CHECK Choose between a 30-ltr or a 60-ltr bin from the driver, who will attend approximately every 4 weeks. Mark the bin with NX to make sure that no other waste is collected. If you require an additional collection please telephone the Waste Supervisor (tel: 01273 696011 x3388) who will make suitable arrangements. Equipment wrappers, cotton wool etc can also be placed in the clinical waste bin but general household waste is not appropriate, nor are diabetic sharps or epipens etc. A representative from South Downswill call you on a regular basis to see if you need a collection.
PAYMENT
Payment for providing the service is £360 annual retainer fee plus £0.90p for every pack given out. Payment is made monthly and paid via Prescription Pricing Division payments. This is calculated from the client sheets and therefore care should be taken to ensure they are completed accurately and legibly.
TRAINING
Community pharmacists based at a pharmacy providing the service should have the appropriate Harmonisation of Accreditation Group (HAG) certificate. The HAG training means that the pharmacist must complete the CPPE pack on Substance Use and Misuse within six months of starting to provide the service.
In addition, free local training is provided for all participating pharmacists, their locums and their staff teams. It is a contractual requirement that all pharmacies participating in the scheme attend at least one training session per year. These sessions will also act as a discussion forum to review the scheme. Please feed back any suggestions, compliments or complaints to Amanda Marshall or the group at the training session.
On-site training for pharmacists and their staff is available, arranged at flexible hours to suit the individual pharmacy – please contact either Amanda Marshall, at the NHS Brighton & Hove, or Chris Saunders at CRI.
You may also wish to access the Sussed Professionals website The website is designed for anyone who comes into contact with clients who are misusing or affected by drugs and alcohol. It is a one stop resource for access to: local and national documents, news teaching resources and a member’s forum.
STEP-BY-STEP PROCEDURE FOR NEEDLE EXCHANGE
** ALWAYS KEEP SUFFICIENT STOCK & NEEDLE EXCHANGE WASTE BIN EASILY ACCESSIBLE **
HIV, HEPATITIS A, B AND C TESTING FOR CLIENTS
The Health Protection Agency (HPA) 2006 report “Shooting Up” suggested that blood-borne viruses for Injecting Drug Users (IDU) are:
- HIV is found in 1:25 IDUs in London, 1:50 in Brighton
- Hepatitis C is found in nearly 1:2 IDUs in Brighton
- Hepatitis B is found in over 1:5 IDUs nationally, but with geographical variation, in 1: 3 IDUs in Brighton.
It is a government recommendation that IDUs are tested for HBV and HCV and vaccinated against Hepatitis B. CRI provide a Hepatitis B vaccination service or people can be referred to the Claude Nichol Clinic (GUM) at Brighton & Sussex University Hospital Trust (BSUH), Eastern Road, Brighton tel: 07090 419 888.
HEPATITIS B VACCINATIONS - STAFF
The Department of Health recommends that staff participating in needle exchanges have a course of Hepatitis B Vaccine. General practitioners can vaccinate people in high-risk categories free of charge. This is optional but it is important that you are aware of the recommendations. Any person wishing to be vaccinated will be reimbursed if a cost is incurred for having the course of vaccine. A single booster dose is considered necessary every 5 years.
The risk of blood-borne virus transmission for a needle stick injury when the donor is known to be infected with the virus is as follows:
- Human innunodeficiency virus (HIV)1:300
- Hepatitis C (HCV)1:30
- Hepatitis B (HBV)1:3
Taken from Hawker et al (2005) 2nd Edition, Communicable Disease Control Handbook, Blackwell Publishing: Oxford.
LITERATURE AND LEAFLETS
There are many safer-injecting leaflets and information regarding the risks of injecting. These are freely available from CRI or the Health Promotion Library @ BSUH. The Health Promotion Library contact details are:
Sarah Hay, Health Promotion Librarian,
Library Services, AudreyEmertonBuilding
Brighton & Sussex University Hospitals NHS Trust
Eastern Road, Brighton, BN2 5BE
Tel: 01273 523312
Email:
PUBLICITY AND LOGO
The needle exchange scheme will be widely publicised with posters and leaflets. Therefore, please display the logo in the door or window of premises.
Acknowledgement: Many thanks to Vicky Fenwick, West Sussex PCT, for sharing her documents and expertise.
Activity Sheet – needle exchange
Pharmacy: / Month:Please complete and return to the PCT at the end of each month with your invoice.
Date / Initials / DoB / Male / Female / Packs issued / Bins returnedTotals:
Return to: Amanda Marshall, BHCPCT, Prestamex House, 171-173 Preston Road, London, BN1 6AG or fax: 01273 545475
Needle Exchange Pharmacies
KAMSONS PHARMACY: Alistaire Twigge
50 The Highway, Moulescoombe, Brighton, BN2 4GB
Tel: 01273 686853
BOOTS PHARMACY: Zhen Tan
119-120 Lond Road, Brighton, BN1 4JH
Tel: 01273 603621
STEPHEN BOWER PHARMACY: Stephen Bower
109 St James Street, Brighton, BN2 1TH
Tel: 01273 681715
ALLIANCE PHARMACY
1 Rock Street, KempTown, Brighton, BN2 1NF
Tel: 01273 682618
DAY LEWIS PHARMACY: Emhran Aghamin
108 Western Road, Brighton, BN1 2AA
Tel: 01273 734227
WESTONS PHARMACY: Tracy Gray
6-7 Coombe Terrace, Lewes Road, Brighton, BN2 4AD
Tel: 01273 605354
DAY LEWIS / BLAKES PHARMACY: Ivan Stansill
91 Blatchington Road, Hove, BN3 3YG
Tel: 01273 735108
BOOTS PHARMACY:
67-68 Boundary Road, Hove, BN3 5TD
Tel: 01273 412080
ALLIANCE PHARMACY: Violet Phillips
4 The Parade, Hangleton, BN3 7LU
Tel: 01273 733718
DAY LEWIS PHARMACY: Rex or Sarah
12 Hollingbury Place, Hollingbury, BN1 7GE
Tel: 01273 505817
BOOTS THE CHEMIST: Charlotte Bates
57-61 George Street, Hove, BN3 3YD
Tel: 01273 731591
SAINSBURYS PHARMACY
361-367 Old Shoreham Road, Hove, BN3 7GD
Tel: 01273 439257
ASDA PHARMACY: Katie Duke
The Marina, Brighton, BN2 5UT
Tel: 01273 811210
LLOYDS PHARMACY: Sally Sullivan
105 Church Road, Hove, BN3 2AF
Tel: 01273 732216
SUPERDRUG PHARMACY: Shilpa Patel
78 Western Road, Brighton, BN1 2HA
Tel: 01273 327402
WATTS & CO: Lisa Knox
110 Dyke Road, Brighton, BN1 3TE
Tel: 01273 327640
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