Access to needle and syringe programmes (NSPs) is a core component in sustaining the work done by the Hepatitis C Trust, the trust’s director of commÂunity services, Stuart Smith, told delegates in Birmingham. Reports from peers about the lack of access to NSPs were cause for alarm, he said. The Hep C Trust had fought hard for patients to have a voice in hepatitis treatment and there needed to be a grassroots movement to ask for accountability for harm reduction provision.
Peer accounts about the difficulties of obtaining needles were shared with the conference. ‘I’m diabetic, I get needles, as many as I want, and whenever I want them,’ said one. ‘This is not my experience of needle exchanges for drug users.’ Obtaining equipment from friends and having a very limited supply meant he reused needles many times, causing skin infections and vein damage. Sharing works had resulted in him contracting hepatitis C and B, he added.
With NSP provision dwindling in pharmacies, maintaining fresh supplies was a huge problem, said another peer. ‘The nearest pharmacy NSP is 25 minutes away by bus,’ she said. ‘When you get there, there is so much stigma – it’s mortifying and embarrassing.’
The other option was to access NSP based in a drug service, but there were concerns around this – people on a script could be denied access and mothers were very worried about social service interventions. Peers also spoke about the limited amount of kit that was provided – often only a couple of packs, and they needed to provide returns before they could receive fresh packs.
Peers also reported on a significant increase in cocaine injecting, with this growing population preferring to use blunt works or share needles than go to services. The situation needed to be considered and addressed urgently by drug treatment and harm reduction services (as also explained in the International Journal of Drug Policy).
Compiling these reports led the Hepatitis C Trust to begin a mapping exercise of NSP provision along with a mystery shopper campaign to establish the level of service provided by pharmacies offering NSP. It began with a freedom of information request to commissioners to find out where NSP was provided within their area. This was followed up by a telephone campaign to establish if provision was still available and to gain an understanding of the restrictions that were in place around numbers of packs provided and requirements for returns.
Alongside the campaign for increased NSP pharmacy provision, the conference also wanted to look at how drug services provided NSP – whether as a standalone service or within the service itself. BDP’s CEO Lydia Plant described providing NSP within their service to counter the dramatic reduction of pharmacies offering it within the Bristol area. The initiative included outreach provision among sex workers, engaging with steroid users, and providing a ‘grab and go’ option.
Several innovaÂtive approaches were showcased, including the ‘Spike on a Bike’ scheme in Wales – where packs were delivered directly to users – and Release’s Harm Reduction Hub which provided a safe, non-judgemental space for people to obtain harm reduction advice and supplies.
Providing packs to people when they needed them, easily accessible, and without stigma, was considered essential. Exchange Supplies’ NSPdirect service was designed to work alongside traditional needle and syringe exchange channels to offer a way for people who inject drugs to access equipment directly via a postal needle and syringe service.
Peer-to-peer supply was still one of the most common ways for people to obtain kit, and the Hepatitis C’s Cumbrian Are You Being Served project was set up to provide this. Peers with rucksacks distributed needle packs along with other harm reduction supplies, including naloxone, with the supplies provided to them by local services through a memorandum of understanding and a fair use policy. In return they gave data on the amount of equipment distributed, which could also be used to map against reinfection rates of hepatitis C. The project had provided an opportunity to build relationships and pilot other projects that incentivised returns and encouraged hepatitis testing, delegates heard.
The conference closed with a call to work together. ‘The coverage crisis is an emergency, but we’ve been here before, we know what to do,’ said Rachel Halford, CEO of the Hepatitis C Trust. ‘Let’s push for this to be a public health intervention.’