This from the Scotsman (http://news.scotsman.com/health.cfm?id=854982006) :
Sat 10 Jun 2006
Many thousands of used syringes are not being returned to needle exchanges.
Picture: Julie Bull
Fears over million missing needles
UP TO one million dirty needles were dumped by heroin addicts in Scotland last year, sparking calls for a national review of strategies to curb the spread of hepatitis C.
New figures expose the alarming gap between the number of clean needles issued to heroin addicts and potentially infected drug-injecting equipment that is being handed back and safely destroyed.
Statistics released by the Scottish Executive show that more than 2.9 million clean needles were issued to drug users at around 200 clinics nationwide in 2004-5 - but only 1.9 million were returned.
The Executive advises drug workers to give addicts new needles in exchange for dirty ones to prevent them from sharing and spreading hepatitis C, while preventing dirty needles from being discarded in streets and parks.
In Greater Glasgow, 539,896 needles were issued and 327,381 returned, while in Lothian, more than 279,000 were give out but only 82,262 returned. Grampian gave out the second highest number of needles - 520,096 - and 357,991 were handed back.
The Scottish Executive insisted many dirty needles dumped in specially provided safe bins were not counted.
But Professor Neil McKeganey, director of the Centre for Drug Misuse, said thousands of needles were being thrown away and called for a clampdown on clinics which are too ready to give out clean needles.
"Giving ever more needles to drug users does not seem to me to be sensible and we've seen a massive increase in needles issued in the last ten years.
"There is growing concern that needle exchanges are adding to the level of discarded needles," he said.
"These figures necessitate a review of procedures in place in needle exchange clinics. It may be that a proportion of those not returned are safely disposed of in other ways but it would be foolish to think that is the case for all of them.
"We're not talking about hundreds but hundreds of thousands of needles - that is a worrying situation," Prof McKeganey said. "In many communities there is an increasing problem with discarded needles and syringes, creating a danger to people, particularly children, of catching hepatitis C. We mustn't contribute further to that."
Concern over addicts spreading disease by sharing needles meant that, in 2002, restrictions on the number of clean needles that could be given to them were lifted, with users allowed to receive up to 120 at a time, leading to a near-doubling of the number of needles issued.
But Prof McKeganey said the proportion of drug addicts sharing needles was constant, at about a third, and said "throwing more clean needles" at users was a misguided policy.
There are an estimated 51,000 heroin addicts in Scotland and 30,000 people with the highly infectious hepatitis C, a number which is growing every year.
Dr Richard Simpson, Scotland's former drugs minister, said the figures raised questions about needle exchange policies across the country.
Dr Simpson added: "The public need to ask questions as to what is happening and services need to demonstrate that they have procedures in place to prevent needles from ending up dumped on our streets."
Jim Shanley, manager of the harm reduction team at NHS Lothian, said: "Everyone who attends a needle exchange outlet is offered a needle and syringe in accordance with the Lord Advocate's guidelines.
"At every intervention they will also be offered a robust, kitemarked sin bin to encourage safe needle disposal."
A spokeswoman for the Scottish Executive said: "Needle exchanges are an essential part of strategies aimed at preventing spread of blood-borne viruses.
"Public safety is always of paramount importance. That's why guidance makes clear that there should be a requirement to return used equipment for safe disposal at exchanges before fresh equipment is issued.
"Drug workers do, however, need the flexibility to use their professional judgment when dealing with people with chaotic lifestyles," the spokeswoman said.
Our heroin legacy
HEROIN use in Scotland soared in the 1980s as opiates flooded the country from the "golden cresent" countries of Iran, Pakistan and Turkey.
This type of heroin was originally produced for smoking rather than injecting and its rise followed an increase in the number of Iranian refugees to the UK after the fall of the Shah in 1979. In subsequent years Afghanistan became the main supplier of heroin to Scotland.
Last year, the Scottish Drug Enforcement Agency warned that a 4,000-tonne opium crop in Afghanistan could result in more heroin becoming available in Scotland.
A recent study showed that the numbers of those using heroin had fallen, but the total number of users still remains at 50,000.
Addicts typically buy "tenner" bags which contain about 100mg of heroin. Some 225 people died from heroin overdoses in 2004, compared with 196 in 2000.
Fears over million missing needles