Introducing retractable needles into needle and syringe programmes: a review of the issues

Needle and syringe programmes (NSPs) are widely regarded as an effective strategy for controlling the spread of HIV and other blood-borne viruses (BBVs) amongst injecting drug users (IDUs). However, there have been frequent public expressions of concern regarding inappropriate syringe disposal and the perceived risk to the wider community due to needlestick injury. Replacing the injecting equipment currently distributed by NSPs with retractable needles could reduce the risk of needlestick injuries in community settings. This paper reviews the likely impact of such an intervention on the rate of BBV infection amongst IDUs, and the level of inappropriate syringe disposal. To date there has been no trial involving IDUs that assess the acceptability and effectiveness of such a device. However, it does appear that increasing the number of retractable needles distributed relative to current practice, and ensuring acceptability by IDUs is essential to prevent an increase in BBV infections amongst IDUs, and may achieve a decrease. It is difficult to assess the likely impact on the level of inappropriate disposal, as little is known about the origins of currently discarded syringes. The possibility that the level of inappropriate syringe disposal will increase cannot be excluded. Importantly, the introduction of retractable needles into NSPs is unlikely to have any impact on the risk of BBV infection following needlestick injury, as the risk (outside of health settings) is already extremely low.