DRUG USE: LIFE AT THE SHARP END

A Post investigation suggests tens of thousands of needles given to
Nottingham drug addicts through exchange programmes are not returned. Coun
Jon Collins, below, accuses health workers of handing the needles out "like
confetti". But health workers say it is unrealistic to expect every needle
to be returned. Health Correspondent CHARLES WALKER reports

The moment a discarded dirty needle pierced six-year-old Rebecca Unwin's
palm is etched into her mother's memory.

Because they want to put that rubbish in their veins they do not think about
others. Olga Unwin

"Seeing my daughter standing there with a needle and syringe sticking in her
I was scared for her life," said mum, Olga Unwin, who was terrified Rebecca
might have caught hepatitis.

And six weeks on, that fear has not gone away for Ms Unwin.

While her young daughter has almost forgotten the day she picked up the
needle and syringe, Ms Unwin is still anxiously awaiting the results of the
blood tests, due next month.

"I don't think she remembers it now," said Ms Unwin, of Coleby Avenue,
Lenton. "We do not mention it. She is just a child and should not have to
worry about these adult things. But it is a worry knowing the results could
be positive.

"It is in the back of your mind constantly."

Rebecca and her eight-year-old friend found the needle and syringe, which
contained blood and a brown substance that could have been heroin, when they
were playing on the grass in a public place a few yards from Rebecca's home
in March.

Despite exchange programmes, which enable drug addicts to bring back used
equipment in return for new, Nottingham City Council has been called out to
317 reports of discarded needles in the last year, compared with 146 reports
in the previous 12 months.

Council officers believe the increase may be due to the introduction of a
hotline telephone number through which to report discarded needles.

The exchange system provides one needle for each used one returned, but a
report from Nottingham City Primary Care Trust acknowledges that does not
happen.

A Post investigation suggests at least 20,000 given out last year did not
come back.

Coun Brian Grocock, the city council's cabinet member for street services,
said: "It is important people are extra vigilant and they keep their eyes
open and contact the local authority about any discarded needles. Parents in
particular have to keep an eye on their children and where they play.

"We know these needles are out there. People are reporting more now than
they were before and they have to be careful. These are extremely dangerous
pieces of equipment."

The fear is they could turn up where children play and that makes Olga
furious.

"It makes me mad," she said. "Some drug users just do not care who they
inflict their needles on when they just drop them.

"Just because they want to put that rubbish in their veins they do not think
about others."

Her anger is shared by leader of the city council, Coun Jon Collins, but he
points the finger at health workers, who he says should be stricter with
drug addicts.

"The difficulty is in a number of cases, drug users are not handing over
dirty needles," said Coun Collins.

"Some services appear to be handing out syringes and needles like confetti.
If that was not the case, why are they lying around the city?

"People are finding them on a regular basis. It is dangerous and unpleasant.
This is a serious, serious issue.

"Health workers need to be more responsible and if they are not getting all
the needles back they should not hand them out, but we are a mile away from
that. They should be one in, one out with no exceptions.

"There needs to be a much higher level of accountability of what is
happening through needle exchanges."

The Nottingham PCT report estimates:

More than 300,000 needles were distributed by the various exchange schemes
in Greater Nottingham from April 2003 to April 2004

The Health Shop, based in Hockley and run by Nottingham City PCT, supplied
almost 200,000 needles and staff estimate only six per cent - or 11,000 -
were not returned

Compass supplies more than 20,000 needles each year. The organisation does
not collect figures on return rates but staff estimate up to ten per cent
(2,000 needles) is not returned

The 16 pharmacies that operate a needle exchange scheme across Greater
Nottingham giving out 80,000 needles each year have no figures at all on
return rates.

Those handing out needles claim it is unrealistic to expect every single one
to be returned and they say they are doing a lot to ensure as many as
possible are accounted for and return rates have improved.

They say it is vital to provide clean needles to prevent the spread of
potentially lethal infections, such as HIV and Hepatitis B and C, in the
drug-using population and the wider community.

Tests on drug users visiting The Health Shop in the first six months of 2003
- - the latest available figures - show the number of infections increased
almost three-fold from 2002 and seven-fold from 2001.

A spokesman for Nottingham City Primary Care Trust, which runs the facility,
where staff claim a return rate of 94%, said the needles unaccounted for
would not necessarily turn up on the streets.

"The percentage figure of 94% for returned needles will be higher when
confiscations of needles off drug users by the police are taken into
account, as well as the figures for needles exchanged by Nottingham
community pharmacies," he said.

"Ideally the percentage figure would be 100% but we have to accept the
realities of life for some drug users, who may be leading highly chaotic
lives."

He said some needles would be left in flats and squats.

He added: "There are mechanisms in place whereby at the Health Shop every
client's return rate of used equipment is assessed at every visit. If a
client fails to return what has been recorded as given then supply is
reduced."

All the needle exchange programmes in Nottingham

now use new tubes for the return of needles and syringes, called "visibins",
which have a clear plastic strip to allow the healthworker to see what is
being handed in.

Prior to this there had been reports of addicts placing twigs inside tubes
to make it sound as though they were returning equipment in a bid to trick
health workers.

The visibins enable health workers to reduce the supply of needles if too
few are returned.

Jacqui Molnar, group manager in the East Midlands for Compass, said: "We are
taking clear steps. We have changed all the bins so we can monitor what
clients are bringing back."

Pharmacies are thought to face the biggest challenge in maintaining high
return rates, and they appear to be most vulnerable to Coun Collins'
criticism.

Gordon Ross, community pharmacy project manager at Gedling Primary Care
Trust, which manages the exchange scheme in pharmacies throughout Greater
Nottingham, accepts some needles go astray but said: "We are doing our
utmost to provide a public health service. We have been strict with our
return rates and we have lost pharmacy participants in our scheme because of
our strict policy of one-for-one."

However, he accepts they are probably not achieving a return rate as high as
the other organisations claim.

He said staff at The Health Shop and Compass can sit down with clients and
interview them when they bring their needles back so they have access
information about the individual they are dealing with.

But he added: "In a network of 16 pharmacies that are not linked by computer
to share information, it is harder to achieve the same level of returns."

He said there are occasions when staff at all needle exchanges will give out
equipment, even though the addict is not returning any.

If a drug user has recently come out of prison or custody, needles and
syringes will have been confiscated.

In these instances, pharmacists are more susceptible to being tricked into
giving out new equipment than drug workers because they tend to have less
time to spend with clients and do not have access to such detailed records,
which help to check the truth of an addict's claims.

The Notts Drug and Alcohol Action Team is currently developing a programme
to offer more support and training to pharmacists and it is hoped this will
lead to collecting information on the rate of returns in a consistent way so
it can be effectively monitored.

However, Mr Ross and other health workers vigorously defend the need to hand
give out equipment if it is believed an addict will otherwise use a dirty
needle and syringe.

Mr Ross said this may occur because of some users' "chaotic lifestyles"
where a desperate person buys drugs but has no equipment. They visit the
nearest pharmacy involved in the exchange programme in order to inject as
soon as possible.

He added: "If a person is desperate to use we have to provide a service to
minimise the risk they use old, contaminated equipment."

And he insists the whole community benefits because it helps to limit the
level of infectious diseases in Nottingham.

He said: "Needle exchanges are fulfilling an important public health role in
trying to stop the spread of infectious diseases. Infections do not just
affect the drug-using population, they are also a threat to the population
at large because the two groups mix with each other and have relationships."

And Mr Ross shares Olga Unwin's belief that ultimately most drug users are
responsible.

"The vast majority of the drug-using population fulfil their duty of care to
the rest of the population.

"Their habit does not impact on other people. But there is a minority who do
not take their responsibilities fully and this leads to discarded needles.

"It is down to the drug users. They are told and educated."

'Vital'

Drug users insist needle exchange services are vital to safeguard their
health.

A former heroin addict who used needle exchanges in Notts for up to five
years told the Post: "They are really, really important. A lot of society
thinks when you are using you are not bothered about your health, but you
are.

"People are very conscious of the risks of using dirty needles. And the last
thing you want as an addict is to be admitted to hospital because then you
cannot use."

The 32-year woman, who now works with the Notts Drug and Alcohol Action
Team, to help other people overcome their addiction, attended a drop-in
centre to drop off and pick up about ten needles at a time.

She said: "How many you exchange depends on how much money you have and how
much gear you can afford.

"I would say on average I would use at least three each day. I would go and
get two or three days' worth and take the same number back."

The woman, who did not want to be identified, is adamant the majority of
drug users are responsible.

"Everybody I used with always took their needles back because we knew if we
did not we would not get new ones in their place," she said. "It was very
strict."

However, she warned that if controls became too strict, people might feel
forced to use dirty needles.