The availability of injecting paraphernalia in the UK following the 2003 law change to permit supply

Methods: A postal questionnaire undertaken 18 months after the law change, sent to all identified UK drugs services. Those providing needle exchange were asked to respond. Co-ordinators of their schemes completed the questionnaires.

Findings: A total of 469 services were identified and contacted, 403 (86%) responded. Of these, 231 provided needle exchange (NX) from 1521 outlets. On average, they were responsible for 1.6 agency-based, 4.2 pharmacy, 0.7 outreach and 0.2 'other' NX outlets. Of those providing NX, 212 (92%) supplied one or more items of paraphernalia, most commonly swabs (n = 220, 87%), followed by citric acid sachets (n = 155, 67%), filters (n = 106, 46%), spoons (n = 102, 44%), vitamin C sachets (n = 69, 30%) and sterile water (n = 52, 23%). Other items supplied were citric acid loose powder (n = 34, 15%), tourniquets (n = 34, 15%) and vitamin C loose powder (n = 6, 3%). Only 4% (n = 10) said their services supplied all six items necessary in the injection process (sterile water, spoons, an acid, filters, tourniquets and swabs). Most commonly only two items were supplied, usually swabs and one acid and 63% (n = 144) supplied 3 or less items. Most commonly finances were said to limit supply. Sharing paraphernalia is associated with an increased risk of IDUs being hepatitis C (HCV) antibody positive. These data suggest that the range of paraphernalia supplied by needle exchanges could be extended from the majority of outlets, in the absence of information that can attribute risk to the sharing of specific items.

Conclusions: Although the majority of services supplied some form of paraphernalia, most did not supply the full range. Further research is needed to establish the impact of this supply on blood-borne virus and bacterial infections and whether increased supply is warranted.