This blog is written by Felix Al-Talal, Peer Support Lead for Exeter & North Devon
Needle and Syringe Programs (NSPs) are a vital public health intervention designed to reduce injecting related harm for people who inject drugs. When needles are shared or reused, there is a high risk of transmitting blood-borne viruses (BBVs) such as hepatitis C (HCV), hepatitis B (HBV), HIV, and contracting bacterial infections like sepsis. Blood-borne viruses can remain undetected for years, slowly causing liver damage, leading to liver cirrhosis and cancer. Additionally, sepsis, a life-threatening condition caused by the body’s response to bacterial infections, has become an increasing concern, with emergency department admissions and deaths due to sepsis rising significantly in recent years. Awareness of sepsis and its risks is still inadequate despite its growing prevalence.[1]
In my work for the Hepatitis C Trust (HCT) as the Peer Support Lead in the South West of England, I have witnessed the devastating impact of untreated BBVs and other infections. This has highlighted the critical importance of NSPs to people who inject drugs. These programs not only reduce the transmission of BBVs and prevent bacterial infections, but help curb healthcare costs associated with treating chronic infections and complications. In so doing, NSP’s relieve pressure on the healthcare system as a whole.
However, NSPs encompass far more than just the distribution of needles and syringes. They provide sharps bins for the safe disposal of used needles, reducing the number of discarded needles in public spaces and minimizing the risk of needle-stick injuries for the general public. They offer sterile wipes and swabs to prevent infections at injection sites and specialized syringes that reduce the risk of BBV transmission even in cases of sharing, (although sharing is always strongly discouraged). NSPs also provide health education materials about safer injecting practices and distribute condoms and other harm-reduction tools to address broader health risks. This comprehensive approach ensures that NSPs serve as a foundation for harm reduction, both for individuals and their communities.
One of the most significant aspects of my work is building trust with individuals who use drugs. Many are marginalized and struggle to access healthcare due to experienced and anticipated stigma or fear of repercussions if they disclose their drug taking or dependency. By working closely with them, offering non-judgmental support, and providing one-on-one assistance, I can help clients access crucial testing and treatment for HCV, HIV, and health care for broader health issues. NSPs also create opportunities to educate individuals about ways to reduce their drug intake if they wish to do so. I often provide referrals to addiction counselling, support groups, and other health services, which many clients were previously unaware of. For those not ready, not wanting or able to stop using drugs, NSPs allow me to engage with them on safer injecting and how to use drugs more safely, reducing the immediate risks to their health.
A persistent challenge in my work is addressing the misconception that NSPs encourage drug use. This belief couldn’t be further from the truth. Rather than promoting drug use, NSPs focus on harm reduction by providing a safer environment for those who are already injecting drugs. By fostering trust and building relationships, NSPs often serve as a gateway for individuals to seek help and support when they are ready, ultimately leading to reduced or ceased drug use for many clients.
Unfortunately, despite their proven effectiveness, NSP coverage across England and Wales remains inadequate. A recent report from the UK Health Security Agency highlights significant gaps in NSP provision for people who inject psychoactive drugs. This lack of coverage not only increases the risk of BBV transmission, reducing the effectiveness of national HCV elimination efforts, but also contributes to much broader, and costly, public health challenges. Alternatively, expanding NSP access and recognising that they are much more than programmes for safer injecting, ensures that individuals who inject drugs have the tools and support they need to protect themselves and others. By addressing stigma and fostering trust, NSPs not only improve individual outcomes but also contribute to safer, healthier communities. Beyond this, NSPs also provide opportunities for meaningful engagement, health education, and support for individuals struggling with drug use.
National public health strategies should focus on enhancing awareness around the effectiveness of NSPs, improving their coverage and integrating services to provide holistic support are crucial steps toward reducing harm and saving lives. National strategies should also emphasize the importance of addressing bacterial infections like sepsis within NSP frameworks. To maximize their impact, expanding NSP coverage and addressing broader health risks such as sepsis are essential steps that policymakers and health services must prioritize. This will support the national HCV elimination plan, contribute to multiple other health prevention strategies, and ensure safer and healthier communities for all.
[1] ‘In the United Kingdom, there are at least 200,000 episodes of sepsis in adults each year and perhaps as many as 918,000 (Academy of Medical Royal Colleges 2022), with around 48,000 people dying as a result. Sepsis claims more lives than breast, bowel and prostate cancer put together.’ Taken from The Sepsis Manual. Available here: Sepsis-Manual-7th-Edition-2024-V1.0.pdf