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Author: Nigel Brunsdon

London Meeting (Oct 2005)

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This NNEF meeting was held on October 13th 2005 at the Victoria Park Plaza Hotel in London – the venue for the 2005 National Conference on Injecting Drug Use (which took place the following day).

The agenda featured presentations from Monique Tomlinson and Neil Hunt (‘Feedback from the UKHRA Consultation on Harm Reduction in the UK’), Jonathan Edwards (‘NHS Logistics National Agreement for Needle Exchange Packs in England’), and Wendy Rayner (‘Needle Exchange Waste Disposal’), as well as a regional round-up and open forum.

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London Meeting (Feb 2005)

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NNEF meeting held at Friend’s Meeting House in London on 25th February 2005.

Welcome and Introduction to the Day

Terry welcomed everyone and introduced Brenda Nash, Alan Neill and Pauline Rigby, who are involved in the Planning Group. He gave apologies from Jim Camp (chair), George Ellis (Healthy Options team), Julie Acton (Bridgend DAT), Rosemary Allgeier (National Public Health Service Wales). (Jenny Scott was later added to the list of apologies).
Terry thanked the sponsors for the day, Daniel’s Healthcare, Frontier Medical, and NHS Logistics.

Minutes of last meeting and updates:

Terry informed attendees that the production of water ampoules by Exchange Supplies, as mentioned at the previous meeting, was still awaiting legislative changes, but it was hoped that they would be available by summer.

Alan Neill reported back about the letter he had received from BD about the faulty needles that had been reported. BD has since closed down the factory where the faulty needles were being produced. A few people mentioned that they were still discovering faulty needles but it was agreed that these were probably from old stock.

Mari Ottridge reported that the DoH National Hepatitis C Action Plan was published last year. The plan outlines a very broad framework, with no extra resources identified. However, it does set out key responsibilities for named people, which is an achievement. She reported that those involved in the Action on Hepatitis C group feel that the group may have achieved its goals and may not continue in the same way in the future, but that she would keep the Forum informed about this.

Presentation: Needle Exchange Survey Research – Dawn Gordon and Ross Coomber NTA

Dawn Gordon from the NTA spoke about the audit of needle exchange services that the NTA will be undertaking between now and July. The aim of the audit is to determine the extent and nature of needle exchange provision in England, Scotland and Wales (with potentially some work in Northern Ireland also). Data will be collected both quantitatively (via questionnaires to DATs and pharmacy needle exchange co-ordinators), and also qualitatively through focus groups.

Ross Coomber discussed his part in this project, which is an in-depth case study that will be produced about an area in the South West. This will involve interviewing managers of services and pharmacy schemes, and DATs. The case study project will also involve interviewing service users and also intravenous drug users who are not currently using the service to determine what is working and what could be improved. It is hoped that this part of the project will add some depth to the rest of the service audit being undertaken.

View Presentation

Topics of interest and issues for next meeting

Alan Neill asked the attendees if there were any issues they wanted to discuss regarding the running of the Forum. There was a question about what the role of the Forum had been historically, and how things had changed in the last few years. Some of the long-serving members of the Planning Group explained that it began quite informally but has developed into a more formal body over the years as the field of harm reduction and drug treatment has changed.

Alan asked the group what role they felt the Forum should be undertaking now, and some people expressed a desire for the Forum to be a means of sharing information and good practice between members, through tools such as a website. Terry agreed that this was important and the issue of the website would be discussed as part of the AGM.
There was some discussion as to the Forum’s role in lobbying or in research, and a few members of the Planning Group expressed the view that the UKHRA was already doing a lot of this kind of work and wasn’t necessarily the role of the Forum, but that some closer working between the two bodies might be useful. A few people expressed the view that the Forum should have a bigger presence, particularly at events such as conferences etc. Pauline Rigby explained that the lack of resources has meant that this kind of work has been difficult to undertake.

Ross Coomber referred to the draft Terms of Reference and asked what the strategies were for meeting the aims as listed. Terry responded that these would be discussed as part of the AGM, but that the Forum needed to establish a core Planning Group which could then examine the desirability and feasibility of obtaining funding in order to meet the aims of the Forum.

One attendee thanked the Forum Planning Group who have worked on the Forum for a number of years, and explained that the Forum had been extremely useful for her when she started working in the field of needle exchange.

Issues that people would like to be discussed or presented at the next Forum meeting included:

  • Environmental issues, particularly around wastage and the transport of waste. There has been a lack of clarity around the procedures for disposal of waste from needle exchanges and this needs to be cleared up. Susan Waldron reported that she had been in touch with a lady from Greenwich council about waste policies. She said that this lady might be worth speaking to about presenting at the next meeting.
  • Neil Hunt reported that he is doing some research into the escalation of groin-injecting, which he might be able to present on at the next meeting
  • Steroid use – in particular the increase in steroid use and trends for different geographical areas, different reasons for use, what innovative ways services have developed to address this issue.

Mari Ottridge suggested that in order for the Forum to be sharing information it might be useful to share any information about service delivery or trends that emerges from the next Forum meeting with the NTA.

A potential date for the next meeting was set for 10th June, subject to the availability of a venue and the Planning Group, speakers etc.

Alan Neill asked people to please complete the questionnaires that they should have been sent by Jenny Scott.

Annual General Meeting

Following the morning meeting members who wished to attended the NNEF Annual General Meeting.

VIEW MEETING MINUTES

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2005 AGM

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2005 Annual General Meeting held in London on the 25th February following the NNEF All Day Meeting.

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Letter regarding faulty BD syringes

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In June 2004 following reports from our members of faulty 1ml BD microfine we contacted the makers Becton Dickinson via their Sales and Marketing Director Michael McGowan to pass on our concerns. Below is a copy of the letter and Michael’s reply.

Our initial letter with attached comments from members

 

18th June 2004

Dear Mr McGowan,

RE: Becton Dickenson 1ml Microfine Insulin Syringes

You will perhaps already know that a meeting of the National Needle Exchange Forum was held in London on the 1st of April 2004. The agenda included a discussion of the problems which have been experienced by needle exchanges with the above product since the latter part of 2003. More than one hundred members of the Forum from all parts of the country attended. Following the meeting, a number of members have written to us giving details of their own experiences.

Recently I received a copy of the letter in which you acknowledge “less than optimal needle point quality” as regards three specific lot numbers. I am now writing on behalf of the Forum in order to let you know the views which our members have expressed. I enclose a summary of the comments we have received. These make clear that the reliability of injecting equipment is a key issue for our members, when seeking to gain the trust of drug injectors and to promote safer injecting behaviour.

We are, of course, pleased to hear that you have now examined your manufacturing process with a view to improving quality control. However, we feel disappointed that it has taken several months to receive an acknowledgement of the reality of the problem. Members who spoke at the meeting recounted similar experiences of making approaches to your company, which they consider were not taken as seriously as they deserved to be. It was clear from the meeting that the same problems were being experienced by different agencies, but people were told that their complaint was an “isolated incident”. Our colleague Dr. Elliot Imbert of Apothicom in France was also present at the meeting, and reported that he had experienced the same difficulties.

Your product remains the brand leader in the field. We are therefore surprised that Becton Dickenson did not respond more quickly to protect the reputation of your company and product. We would like to be assured that your response would be more rapid if a similar problem should emerge in future. Needle exchanges account for a large part of the market for injecting equipment. As your insulin syringes currently cost approximately two pence each more than rival products, it seems reasonable for us to expect a higher level of quality and customer care from your company.

Yours faithfully,
Alan Neill
Member of NNEF Planning Group

c.c. Ralph Hilberath, BD France
c.c. Kim Jones, BD Oxford

 

 

Written comments were received from several agencies throughout England, as well as those expressed at the Forum Meeting held in London on 1st April 2004. The following extracts include comments from harm reduction agencies in Lincolnshire, Manchester, Sheffield, the Midlands, London, and Devon.

  • “During January we were getting complaints from our needle exchanges about 1ml BD needles being either blunt or barbed, or becoming detached from the barrels.”
  • “Our needle exchanges cannot be seen to be issuing faulty needles as our work mainly advocates safer injecting techniques…Clients may then be at risk of developing infected injecting sites due to faulty equipment.”
  • “It could drive clients to go back to sharing injecting equipment, which could then lead to an increase in blood-borne viruses.”
  • “Initially the company were unhelpful saying that no-one else had complained. After our initial package went to Ireland for analysis we heard nothing.”
  • “Clients were complaining of blunt, barbed and leaking needles, sometimes there being two needles coming from a barrel.”
  • “We saw the evidence from two clients who brought them in to show us of the needle becoming detached from the barrel.”
  • “There seems to have been a known problem for several months ….. and these batches have not been officially recalled.”
  • “Providing faulty goods will undo the hard work and effort we put in to gain our clients’ trust.”
  • “Provision of sub-standard goods will not encourage attendance for clean equipment.”
  • “I should also like to share with you some of their comments: Are they seconds? Have these needles been recycled?”
  • “The problems that were reported were as follows:
    • The needle is flimsy, not sturdy enough.
    • More than one needle on the end of the syringe.
    • The needle is bent.
    • The needle is already barbed (before being used).
    • It won’t draw up.
    • The plunger bounced.
    • The needle became detached from the syringe.”
  • “We all seem to be told that this is an isolated incident when we know this is not the case.”

 

The reply from Becton Dickinson

 

1st July 2004

Subject : BD Micro-Fine+ 1ml insulin syringes

Dear Mr Neill,

Thank you for your letter dated 18th June 2004. We note the comments from the members of the forum and thank them for their views and feedback.

As mentioned in your letter, with the co-operation of a number of needle exchange agencies, we have been able to identify three lots of syringes with less than optimal needle point quality. In April we took the voluntary decision to accept the return of products from these three lots and since that date we have had 84 cases returned. We are now monitoring the situation very closely and urge the members of the forum to inform us directly of any further complaints they may receive.

We acknowledge that during the initial period BD did not respond as quickly as customers would have wished and I apologise for this delay in resolving the issue. However, we feel it is also important to point out that a more rapid and conclusive investigation of the complaints was made more difficult for a number of reasons. Firstly, in the early stages the actual number of direct complaints received by BD was relatively few, even though we were aware of a significant level of discussion between agencies and on the market in general. Secondly, the low number of samples returned to BD for analysis made it difficult to assess the frequency and extent of the potential manufacturing issue. Several agencies assisted us greatly in our investigation and we thank them for their co-operation and patience. Direct communication, supported by clear descriptions of complaints and provision of representative samples is critical in helping us to identify and resolve manufacturing issues most effectively.

It is also important to mention at this point that syringes should not be returned directly to the BD Oxford office in the regular mail without notice or indication of content. We do have in place a procedure that is worth clarification to ensure rapid and safe analysis of potential complaints:

  • Telephone Gemma Bianchini (Tel 01865 781634), or Kim Jones (Tel 07818 004002) to report the complaint. We need lot number, expiry date and to know the precise quantity of products involved in the complaint.
  • If further investigation is required, we will instruct DHL to deliver a sharps container directly to the needle exchange agency for collection of the relevant samples. These will be taken for analysis directly to the manufacturing plant in Ireland.
  • Once the analysis of the plant is complete, we will communicate directly with the needle exchange agency and advise on the action we will take.

BD is aware that the quality of our product is an important part of the continued success of needle exchange programmes. With this in mind, we would welcome the opportunity to meet with representatives of the National Needle Exchange Forum to identify areas for improvement and development of our products.

Once again, thank you for your letter together with the comments of the members of the forum. We look forward to continued co-operation together with the joint objective of improving our products and services for the needle exchange programmes.

Yours sincerely,
Michael McGowan
Sales and Marketing Director

London Meeting (April 2004)

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Meeting held at: Meeting Room J, Regents College London on 1st April 2004.

Chair: Jim Camp

Welcome and Introduction to the Day:

Jim Camp welcomed everyone to the forum and Terry Shields thanked the sponsors.

Presentation: Injecting Paraphernalia – Andrew Preston (Exchange Supplies):

Andrew gave a presentation about the regulations surrounding distributing needle exchange paraphernalia, including citric acid, vitamin c, spoons, filters and water for injection. He referred to the fact that although distributing certain items of paraphernalia is illegal, many needle exchanges may be still doing it, because of a lack of alternative options. He explained that Exchange Supplies will be applying for a license from the MHRS to make water ampoules for injecting, and hope to release these by summer this year.

Presentation: Quality of BD Insulin Needles – Heather Gibson (KCW Pharmacy Needle Exchange Co-ordinator)

Heather spoke about the difficulties she has experienced in trying to get refunds from Beckton Dickenson of faulty “Microfine” 1ml syringes. She explained that particular batches had been faulty and she had been in negotiations with BD to get the situation remedied, but found they were not being very helpful. The faulty batch numbers are:

3132233
3132234
3191797 (Manchester)
3191796 (Vernon Carus)

Heather recommended that anyone who has experienced problems to contact Gemma Bianchini at Beckton Dickenson on 01865781634, or email gemma_bianchini@europe.bd.com. Heather also encouraged people to report any incidents of faulty needles to the MHRA, which can be done on the internet at mhra.gov.uk, by emailing ainsley.wickens@mhra.gsi.gov.uk , or by phoning 020 7972 8273.

Many other attendees also had experienced these faulty needles, with some people mentioning that there were other batches involved. Many people expressed their difficulties in getting the situation remedied. Nik Howes explained that he had been told the problems were due to camera alignment in the manufacturing process. He had also had difficulties in getting the situation resolved with BD.

Heather called for the forum’s support in sending a letter of complaint to BD to express concerns about their treatment of this issue. It was agreed that Mari Ottridge and Heather would put a letter together around this issue, based on the comments of forum members. Jim asked members to forward any incidents to Brenda Nash at DrugScope so that they could be included in the letter to BD.

There was a call for forum members to have closer links with each other, to enable communication about issues such as this.

Presentation: Mike Ashton – Drug and Alcohol Findings

Mike gave a presentation about the latest research findings on Hepatitis C. He talked about how prevalence levels of Hepatitis C are a good reflection of how well needle exchange is achieving harm reduction within the injecting community. Mike recommended that people read Drug and Alcohol Findings’ four-part series exploring research on the role and record of needle exchange in preventing the spread of Hepatitis C. The four parts are:

  • Part 1, issue 8 – The dimension of the challenge
  • Part 2, issue 9 – Case studies
  • Part 3, issue 10 – The British record
  • Part 4, issue 11 (forthcoming) – Conclusions and themes

The whole series can be obtained by subscribing to Drug and Alcohol Findings, via Alcohol Concern (telephone 020 7928 7377, email findings@drugandalcoholfindings.org, or visit findings.org.uk). Part three is available free from the website (for a limited time). Mike can be contacted personally at editor@drugandalcoholfindings.org.

This research showed that the current level of needle exchange is not sufficient to have an impact on the levels of Hepatitis C among injecting drug users, and has highlighted the need for a large increase in the number of needle exchange services available, to “flood the market, rather than drip-feed”. Mike also recommended that needle exchanges be less restrictive, in terms of one-for-one exchanges, opening hours, outreach etc.

Regional Roundup

Due to limited time, the chair asked for comments on specific topics, rather than a typical regional roundup. These topics were:

  • Needle exchange and Models of Care – implementation issues
  • CJIP pilot areas and needle exchange
  • Mari Ottridge commented that she has used various documents to help her reassess her organisation’s focus and strategies, to enable them to better meet the Models of Care framework. These documents included QuADS, DANOS, Drug Related Deaths, Hidden Harm, and Every Child Matters. She encouraged all attendees to take these documents into account when they are reviewing their service’s goals and strategies.
  • Jim Camp explained that he had been asked by the local CJIP team in his area to provide contact information for clients of the needle exchange, which was inappropriate. He asked the group to let him know if they have had similar experiences, because he is able to take this feedback to the relevant Home Office and NTA people and ensure that this kind of inappropriate request does not happen in the future. He provided his mobile phone number for people to contact about this issue – tel 07956346097.
  • A forum member from Yorkshire pointed out that clients of her needle exchange service had been expressing their unhappiness with the CJIP program, and that it did not seem to be meeting their needs. Another forum member commented that CJIP was placing further pressure on resources in services, as clients are being “pushed” into treatment when they may not be ready, and often do not attend treatment after having been forced to undergo an assessment.

Presentation: Professor Gerry Stimson (Dept of Social Sceince and Medicine, Imperial College) – “Trends in HCV and HIV infection – Implications of national and local harm reduction strategies”

Professor Stimson explained the main findings from his recent research into the prevalence and incidence of HIV and HCV among new injecting drug users in London.

This research was conducted with participants from a range of community settings and used a twelve-month follow up after the first interview to measure the levels of prevalence. The research indicates:

  • There is a higher prevalence of HCV than was expected
  • There is an extremely high HCV and HIV incidence, with an increase in transmission recently, and a very short window for prevention
  • 30% of participants who were infected with HCV were infected within 2 years of injecting
  • There were high levels of injecting risk behaviour
  • There was an increased risk of HCV with crack/cocaine injecting
  • The lack of coverage of needle exchange may not be sufficient to reduce transmission of HCV
  • There is a lack of targeted HIV/HCV prevention initatives
  • Health education, prevention of injection, increased accessibility of HCV testing, and treatment of those infected, are all urgently required.
  • Professor Stimson recommended that blood be tested rather than saliva, and commented that potentially fingerprick testing might be a way forward.

There was a question about how the participants were selected. Prof. Stimson reported that community networks were used to attract participants, and participants were required to have a home address (ie not be homeless), in order to be followed up after twelve months.

It is not yet known when this study will be published, or where it will be published.

Andrew Preston asked Prof. Stimson what he felt needed to be done in order to remedy the situation of high prevalence of HCV. He felt that there needed to be more needle exchange services, and that syringes needed to be provided to young people in much larger numbers. Jim Camp also raised the issue of using secondary distribution as a way of increasing the coverage of needle exchanges, which was generally supported by the group, but all expressed the difficulties they would have in actually doing this.

There was a feeling amongst attendees that needle exchange had slipped down the list of priorities of government, and that the whole issue needed to be revived and to be put “on the health agenda”, rather than being seen as a criminal justice issue. Professor Stimson encouraged attendees to watch out for the Department of Health’s Action Plans, and to liaise with local DH contacts in order to make sure needle exchange is included in these Action Plans. Jim also commented that partnerships and networking were very important factors, and that this needed to be highlighted to funders and commissioners.

Mari Ottridge – Action on Hepatitis C Update

Mari spoke about how Action on Hepatitis C has fought for a long time for a national strategy for Hepatitis C, but now that there is one, more needs to be done to implement it. There is currently no action plan, and Mari expressed a desire that everyone working in the harm reduction field needs to encourage and support the development of the plan, and monitor its implementation.

Mari announced the loss of the founder of Action on Hepatitis C, who was a huge supporter of needle exchange services. Nigel Hughes and Graham Foster have also left. Paul Wells has now accepted the role as chair.

The Action on Hepatitis C group has met twice since the last National Needle Exchange Forum meeting. The next meeting with be on 6th May in London, and Mari asked for feedback from forum attendees to take to this meeting.

Mari outlined a letter she had sent to Dr Vicky King from the Department of Health, asking for clarification about when the Action Plan for Hepatitis C would arrive. Dr King replied to her and outlined the government’s plans, but did not imply that Hepatitis C was high on the agenda.

Mari welcomed the “Shooting Up” report by the Health Protection Agency, which is available online.

She also informed attendees that the 8th International Hepatitis C conference will be held on 23-24th September in London at the Imperial College.

Amendment of NNEF Cheque Signatories

Jim Camp announced that himself and Terry Shields would be taking over the positions of National Needle Exchange Forum cheque signatories, unless there were any objections. There were no objections and so they were sworn in as the new signatories.

Deputy Chair and Treasurer’s Vacancy

The chair called for assistance in the above posts, and also for other assistance from forum members, to enable the National Needle Exchange Forum to run efficiently and to meet the needs of participants. He asked that people contact him directly either via telephone 0208 8807 780 or 07956 346 097, or by emailing him j.camp@addaction.org.uk or nxforum@drugscope.org.uk.

Close

The chair thanked attendees for coming to the forum meeting and announced that the next forum was likely to be held in the Midlands.