Inadequate needle and syringe coverage among people who inject psychoactive drugs across England and Wales

Aim: Needle and syringe (NS) provision is a proven intervention for reducing harms associated with injecting drug use, such as infections, but impact is coverage-dependent. We characterised people who injected drugs (PWID) in England and Wales who had insufficient NS in the past month to meet their injecting requirements.Methods: This study utilised 2017-2019 data from the annual Unlinked Anonymous Monitoring (UAM) Survey of PWID recruited through specialist services. Logistic regression was used to identify factors associated with inadequate NS coverage.Findings: Of 2,442 PWID surveyed who had injected in the past month, 34% reported inadequate NS coverage (or as high as 51% if including unsuccessful injections). Younger PWID (adjusted odds ratio: 2.18, 95% confidence interval: 1.35-3.52), those who began injecting in the past three years (1.46, 1.09-2.00), and those who reported sharing injecting equipment (1.46, 1.22-1.75) had greater odds of having inadequate NS coverage. PWID currently prescribed Opioid Substitution Treatment (OST) had lower odds of inadequate NS coverage (0.60, 0.49-0.73).Conclusion: Given the poor reported coverage of NS provision in England and Wales, there is urgent need to address inequity in accessing sufficient NS and increase coverage among this vulnerable group to reduce injecting-related harms.