Impact of the 2003 Impact of the 2003 ‘paraphernalia law’ change on ‘paraphernalia law’ change on UK needle exchange agenciesUK needle exchange agencies

Jenny ScottJenny ScottDept Pharmacy & PharmacologyDept Pharmacy & Pharmacology

University of BathUniversity of Bath

BackgroundBackground

‘‘Injecting paraphernalia’ is the collective term for Injecting paraphernalia’ is the collective term for equipment used to prepare drugs for IV use equipment used to prepare drugs for IV use e.g.e.g. spoons, spoons, water, acids, lighters, filters, swabs, needles and water, acids, lighters, filters, swabs, needles and syringes (N&S)syringes (N&S)

Background (2)Background (2)

In the UK it was illegal to supply items of paraphernalia In the UK it was illegal to supply items of paraphernalia except N&S before August 2003except N&S before August 2003

The law was changed in light of concerns about The law was changed in light of concerns about paraphernalia sharing and transmission of hepatitis Cparaphernalia sharing and transmission of hepatitis C

The law now permits doctors, pharmacists and drug The law now permits doctors, pharmacists and drug workers to supply certain items: swabs, sterile water, workers to supply certain items: swabs, sterile water, spoons/cups, filters and citric acid, for harm reduction spoons/cups, filters and citric acid, for harm reduction purposespurposes

(Misuse of Drugs Act s. 9A, SI No. 1653/2003; Misuse of Drugs Regulations (Misuse of Drugs Act s. 9A, SI No. 1653/2003; Misuse of Drugs Regulations (Northern Ireland) s.6A. SI No. 324/2003)(Northern Ireland) s.6A. SI No. 324/2003)

AimsAims

To measure the ‘before’ and ‘after’ extent of To measure the ‘before’ and ‘after’ extent of paraphernalia supply from UK needle exchange co-paraphernalia supply from UK needle exchange co-ordinatorsordinators

To identify factors that impact on paraphernalia supply To identify factors that impact on paraphernalia supply from UK NX schemesfrom UK NX schemes

To explore initial thoughts on response to impending To explore initial thoughts on response to impending Water for Injection reclassificationWater for Injection reclassification

MethodsMethods

A paper-based questionnaire sent to all identified UK A paper-based questionnaire sent to all identified UK needle exchange agency co-ordinators with 2 reminders needle exchange agency co-ordinators with 2 reminders then telephone follow-upthen telephone follow-up

‘‘Before’ version sent Spring 2003 and ‘After’ version set Before’ version sent Spring 2003 and ‘After’ version set Spring 2005Spring 2005

Before 225 co-ords identified, after 469 co-ords. Before Before 225 co-ords identified, after 469 co-ords. Before NAM only, After NAM plus online informationNAM only, After NAM plus online information

Ethics approval Scottish MREC (B) ref: 05/MRE10/1Ethics approval Scottish MREC (B) ref: 05/MRE10/1

ResultsResults

‘‘Before’ (2003)Before’ (2003) ‘‘After’ (2005)After’ (2005)

No. co-ords identifiedNo. co-ords identified 469469 225225

ResponseResponse 403 (86%)403 (86%) 193 (86%)193 (86%)

Provide NXProvide NX 240240 171171

Supply at least ONE Supply at least ONE item of paraphernaliaitem of paraphernalia 221 (92%)221 (92%) 147 (86%)147 (86%)

Number in 2005 who currently

DO supply(% of total n =240)

Number in 2005 who started supplying since law change

(% of no. supplying)

Number in 2003 who supplied

(% of total, n =171)

Swabs 200 (83%) Not asked 131 (89%)

Citric acid sterile sachets

155 (65%) 114 (74%) 39 (27%)

Citric acid loose powder

34 (14%) 9 (27%) 21 (14%)

Vitamin C sterile sachets

69 (29%) 53 (77%) 1 (0.5%)

Vitamin C loose powder

6 (2.5%) 3 (50%) 5 (5%)

Sterile water 52 (22%) 28 (54%) 39 (27%)

Filters 106 (44%) 49 (46%) 34 (23%)

Spoons 102 (43%) 82 (80%) 9 (6%)

Tourniquets 34 (14%) 6 (18%) 26 (18%)

Impact of the law changeImpact of the law change

Top reasons for not supplying paraphernalia: 2003: Top reasons for not supplying paraphernalia: 2003: ‘legal ‘legal restrictions’restrictions’ and 2005; and 2005; ‘lack of funding’‘lack of funding’

55 responders (23%) reported receiving more funding for 55 responders (23%) reported receiving more funding for paraphernalia since the law had changed and 126 (53%) paraphernalia since the law had changed and 126 (53%) said they had not [59 (24%) missed out this question]said they had not [59 (24%) missed out this question]

76 (32%) of responders said the law change had 76 (32%) of responders said the law change had impacted on their services in other ways, examples impacted on their services in other ways, examples given included given included ‘attracting more clients’, ‘more requests ‘attracting more clients’, ‘more requests for paraphernalia’ for paraphernalia’ and and ‘easier to source paraphernalia’‘easier to source paraphernalia’

106 (44%) said the law change had not impacted on 106 (44%) said the law change had not impacted on them in other ways [58 (24%) missed out this question]them in other ways [58 (24%) missed out this question]

Staff trainingStaff training

143 (60%) of respondents reported that their staff had 143 (60%) of respondents reported that their staff had undertaken training on paraphernalia supply, 22 (9%) undertaken training on paraphernalia supply, 22 (9%) said they had not and 8 (3%) did not know [67 (28%) said they had not and 8 (3%) did not know [67 (28%) missed out this question]missed out this question]

In-house training, various specific course providers and In-house training, various specific course providers and conferences were given as examples of trainingconferences were given as examples of training

Sterile water supplySterile water supply

13 of the 52 responders (25%) were already supplying sterile water 13 of the 52 responders (25%) were already supplying sterile water reported doing so under Patient Group Directive (PGD)reported doing so under Patient Group Directive (PGD)

One reported obtaining a prescription for each client, one reported a One reported obtaining a prescription for each client, one reported a ‘blanket’ prescription for all clients, 5 said they had another form of ‘blanket’ prescription for all clients, 5 said they had another form of arrangement e.g. written consent from the public health department, arrangement e.g. written consent from the public health department, and 29 said they and 29 said they ‘just supplied’‘just supplied’; 3 did not respond to this question; 3 did not respond to this question

Those who did not supply water (n=188) were asked how they Those who did not supply water (n=188) were asked how they thought the impending reclassification of Water for Injections to thought the impending reclassification of Water for Injections to allow supply by needle exchanges would impact on their serviceallow supply by needle exchanges would impact on their service– 92 (49%) said they would supply 92 (49%) said they would supply ifif they received additional funds they received additional funds– 49 (26%) said they would 49 (26%) said they would definitelydefinitely start to supply start to supply– 25 (13%) did not know25 (13%) did not know– 16 (9%) said they would 16 (9%) said they would notnot supply supply– Reasons given for choosing not to supply included Reasons given for choosing not to supply included ‘we have no demand ‘we have no demand

for water’for water’ and concerns about discarded equipment in the community and concerns about discarded equipment in the community– [6(3%) omitted this question][6(3%) omitted this question]

ConclusionsConclusions

The number of co-ords supplying paraphernalia The number of co-ords supplying paraphernalia has increased since the 2003 law changehas increased since the 2003 law change

Lack of funding remains a pertinent issueLack of funding remains a pertinent issue

The impending water for injection reclassification The impending water for injection reclassification needs to be planned for carefullyneeds to be planned for carefully

The need for research into the outcome of The need for research into the outcome of paraphernalia use remains –this work is ongoingparaphernalia use remains –this work is ongoing

AcknowledgementsAcknowledgements

Co-workers: Miss Emma Burton, Miss Leela Gill, Miss Co-workers: Miss Emma Burton, Miss Leela Gill, Miss Aimee Goodwin, Miss Emma Harrigan, Mrs Amanda Aimee Goodwin, Miss Emma Harrigan, Mrs Amanda Inkpen, Miss Yiki Mok, Miss Claire Oakshott and Miss Inkpen, Miss Yiki Mok, Miss Claire Oakshott and Miss Ubah YahieUbah Yahie

All the agency staff who took the time to respond, thank All the agency staff who took the time to respond, thank you!you!