For people who inject drugs, needle and syringe programmes (NSP) are a life-changing – and even life-saving – intervention.
Being able to access clean injecting equipment, advice, and harm reduction interventions massively reduces people’s vulnerability to hepatitis C, HIV, bacterial infections and a range of other harms.
While we know that NSPs are an effective way to reduce harm to people who inject drugs, we also know there are factors that are holding these programmes back from their full potential. In particular, we face a crisis in coverage that is preventing people from accessing the support that they need to stay safe.
Here at Change Grow Live, we’ve been exploring new ways to break down these barriers and ensure that NSP is available to the people who need it, whenever they need it – and we want to bring voices from across the sector together to achieve this.
Coverage crisis
In 2014, the National Institute for Health and Care Excellence (NICE) retained its target of achieving 100 per cent NSP coverage (see box, below) for the UK. Their evidence showed that even if we achieve 100 per cent coverage for 60 per cent of the population, this would be enough to dramatically slow the spread of blood-borne-viruses and infections among people who inject.
Unfortunately, the UK is falling far behind these targets. There is currently no national approach to measuring the UK’s level of NSP coverage, but informed estimates place it at around just 30-35 per cent. The government’s most recent Shooting up report suggests that the number of people sharing and reusing injecting equipment is still high, with a third of people who inject drugs saying they don’t have enough clean equipment.
Every increase we can make to the UK’s coverage rate can reduce people’s risk of harm and help to save lives – and Change Grow Live is working with the UK Health Security Agency (UKHSA) as part of a national working group to develop a standardised approach to measuring NSP coverage.
Safer injecting
There’s no single, catch-all solution to this issue, but there are ways we can begin to tackle the challenge of expanding our NSP coverage – and at Change Grow Live we’ve already begun to explore what those responses might look like.
One of the major challenges is the question of how we reach people who are not in regular contact with drug and alcohol services, or face difficulty in – or have reluctance to – accessing a service in person. The introduction of integrated recovery services, replacing the tiered models of care approach, has made many people reluctant to engage with NSP services. The one-stop shop approach of integrated care is welcome in many ways, but feedback shows that many people who inject drugs miss the discreet, anonymous approach to NSP provided by open-access tier 2 services.
People want to access NSP in a way that is simple and discreet, and with a degree of separation from conversations they may be having around their substitute prescribing treatment. To support with this, we’re working with the harm reduction social enterprise Exchange Supplies to provide people with the service NSP Direct – an online ordering system that allows people to have safer injecting supplies delivered to their home address.
Our NSP Direct offer began as a way of helping people maintain their safer injecting supply during the pandemic, but it’s proven to be a well-received intervention that we believe has a role to play in expanding NSP coverage more broadly. By supporting people to access NSP in a simple, discreet way that works for them, we can help to break down barriers and reduce harm.
Model for success
We also need to ensure that the issue remains at the forefront of debate and of performance targets for the drug and alcohol sector. If we recognise the crisis, we can plan the response accordingly. This response will be strongest if we work together, as demonstrated by the successful achievements already made as part of the UK’s hepatitis C elimination strategy.
Hepatitis C is the most common bloodborne virus affecting people who inject drugs, so we’ve welcomed the massive investment in testing and treatment the strategy has ushered in. We’ve also welcomed the commitment to partnership working that we’ve seen, as providers come together to share learnings, resources, and expertise.
Nowhere is this commitment better demonstrated than in the award-winning work of the Hep C Provider Forum, of which Change Grow Live is proud to be a member. Together, the forum shares knowledge, expertise and resources to collectively work towards the NHS’s hepatitis elimination goals.
Never before have providers worked so well together to get this far, and the results are clear to see. Between April 2022 and March 2023, more than 35,000 people were tested in our services for hepatitis C and other blood-borne viruses, with more than 1,400 of those people going on to access treatment. In that same period, six of our services and two of our hubs achieved the milestone of hepatitis C micro-elimination. This is a major achievement, but we can only maintain this success with improved, robust harm reduction provision for people who inject drugs.
We want to build on these successes, to ensure that the gains we have made are sustainable, and that more people than ever are able to reduce their risk of harm via NSP. Crucially, we want to do this with your support.
Stronger together
The time is right for a renewed focus on improving our coverage rate. We are at a crossroads moment for our sector, with major changes already underway and a general election on the horizon. This gives us the opportunity to reimagine the future and plan our new direction.
The sector must come together to tackle the NSP coverage crisis, taking inspiration from the success of the Hep C Provider Forum. We can look to how different voices came together and galvanised change, and use this example to make sure that safer injecting equipment and harm reduction guidance are available to everyone who needs them.
If you’d like to work with us to ensure more people can access the life-saving interventions they need, we’d love to hear from you – please get in touch at Peter.Furlong@cgl.org.uk to find out more about what we can achieve together.