Needle and syringe availability

Box 9: Making services more accessible

The term ‘low-threshold’ describes an implementation setting that aims to make it easier for drug users to get access to social and health services. To lower their threshold of access, agencies are placed in specific locations and have opening hours that are adapted to their clients’ needs, including late evening or night-time opening. Low-threshold agencies often also deliver their services through outreach workers. The use of the agencies’ services requires little bureaucracy and often no payment and is not linked to an obligation on the clients’ part to be or to become drug-free. Such agencies target current users who have never been in contact with other drugs and health services and those who have lost this contact. Their services are targeted towards the ‘hard-to-reach’ groups and specific high-risk groups of users and also experimental users (for example, through delivering their services in clubs and discos or other party settings). The low-threshold setting can apply to street agencies, drop-in day centres and field healthcare stations and also to emergency shelters. Within a comprehensive system of care, these agencies, because of their easy accessibility, have an important role in reaching out to the more ‘hidden’ or ‘difficult-to-reach’ populations of drug users. Besides motivating users to seek treatment and making referrals, they often deliver ‘survival-oriented’ services, including food, clothes, shelter, sterile injecting equipment and medical care. They are core settings for disseminating health promotion messages and increasing knowledge and skills regarding safe use among those who use drugs either experimentally or in a dependent or problematic way. Increasingly, they deliver treatment services too.

Needle and syringe programmes (NSPs) started in the European Union in the mid-1980s as an immediate response to the threat of an HIV epidemic among drug injectors and expanded rapidly over the course of the 1990s (Figure 18). In 1993, publicly funded programmes already existed in more than half of the current 25 EU Member States and in Norway. Today, NSPs are available in Bulgaria, Romania and Norway as well as in all EU countries, except Cyprus, where sterile equipment is, however, freely obtainable at pharmacies and an official NSP is under consideration (138). Once such programmes have been introduced to a country, the geographical coverage of outlets for NSPs generally increases continually. Many countries have now achieved full geographical coverage, with pharmacies being a crucial partner in several Member States. However, in Sweden, the two programmes started in 1986 in the south of the country remain the only ones; and in Greece, the number of NSPs is limited and they are only available in Athens (139).

NSPs are usually integrated firmly into the work of low-threshold drug counselling agencies (see box ‘Making services more accessible’), outreach work and the care for the homeless in the EU countries and Norway. As agencies that have a low threshold of access are successful in reaching hidden populations of active drug users, they can be an important starting point for contact, prevention, education and advice, as well as for referrals to treatment. It is also increasingly recognised that low-threshold services can be a vital platform for offering basic medical care, infectious disease screening and vaccination and viral treatment to members of the community who, for a variety of reasons, may find it difficult to access more formal healthcare services.

Needle and syringe programmes are described as a predominant approach to the prevention of infectious diseases among drug users in 16 EU Member States and Norway and a common approach in a further six; and it is considered a priority policy response to infectious diseases among drug users in two-thirds of EU countries (140).

Figure 18 Introduction of needle and syringe programmes in 23 EU countries, Norway and Bulgaria

(138) See Table NSP-2 in the 2005 statistical bulletin.

(139) See ‘Needle and syringe availability’ in the 2005 statistical bulletin.

(140) See the EMCDDA website for an overview of national responses to infectious diseases.