Why are needle/syringe programmes (NSP) important?

One of the key elements of the harm reduction approach is NSP, the main aim of which is to prevent HIV and hepatitis infections. Through NSPs it is possible that injecting drug users exchange their already used injecting equipment (needles, syringes, filters, etc.) to sterile ones for free. However, it does not only mean the distribution of sterile paraphernalia but the collection and safe disposition of the used ones in order to prevent the transmission of viral infections. Besides needle exchange, NSPs often also distribute condoms and provide counselling and education on safer sexual behaviour and safe injecting practices. As a low-threshold service and a first link in the treatment chain NSP has an important role in connecting – otherwise hard to reach – injecting drug users to higher threshold services.

What kinds of NSPs exist in Hungary?

  • Fixed NSPs that are located at a specialist drugs agency in a building (e.g. outpatient drug counselling centre, low-threshold service provider, medical or social facilities targeting specifically IDUs). The term agency is hereby used in a wider sense.
  • Mobile-only NSPs which work exclusively from a mobile unit or through street outreach.
  • Syringe-vending machines

How is data collected on NSPs?

Each year the data is collected by the National Focal Point. NSP service providers supply turnover/client data relating to needle exchange through a web-based data collection site which is operated by the NFP. The aims of the site is to simplify data supply, improve the quality and accuracy of it, make it easier to handle collected data and make the data available on previous years for individual organisations on their own user sites.

How many needle and syringe programmes (NSPs) were operated in Hungary in 2015?

In 2015 30 organizations operated NSP in 21 cities in total which covers 14 counties and all 7 regions. In 2015 26 fixed-location programmes operated in the country, 13 organisations performed street outreach work, 3 organisations operated a mobile NSP, and in 4 cities IDUs could purchase syringes from syringe vending machines. 9 organisations operated two programme types, this in most of the cases was street outreach work linked to a fixed-location programme – this was the most characteristic combination.


Comparative European data – Fixed needle and syringe programmes

Comparative European data – Mobile needle and syringe programmes

Comparative European data – Geographical coverage

What was the number of distributed and collected syringes at needle and syringe programmes (NSPs)?

In 2015 Hungarian NSPs distributed 188,696 sterile syringes to the clients, the number of returned or collected used syringes was 150,565. In the last half of 2014, due to local governmental decisions the two largest NSPs in Budapest had to close down. The consequences of the closures can be found in the tendencies: in 2015 the number of distributed syringes dropped by 59%, while the number of returned syringes by 49%. Exchange rate significantly increased: from 64% to 80%. Some NSPs outside Budapest reported that syringe purchasing in pharmacies was probably increasing as more syringes were returned to their programmes than what they distributed.


Comparative European data


What was the number of needle and syringe program (NSP) clients over the past years? How frequently did they use NSPs?

In 2015, 3436 injecting drug users used NSP services on a total of 24.368 occasions. 1530 new clients were registered by the programmes in the course of the year. The impact of the closure of the two largest NSPs in the second half of 2014 could be measured: the number of clients decreased by 23% while the number of contacts by 41% compared to the previous year.


Comparative European data – Number of clients

Comparative European data – Number of contacts


How many syringes were distributed and collected per client and contact in 2015?

In 2015 the number of syringes distributed and collected per client significantly decreased compared to the previous year. On average 54 syringes were distributed and 44 returned per client. The mean number of contacts per client was 7 in the year in question, while it was 9 in 2014.



How many syringes were distributed per injecting drug user in 2015?

In 2015 the number of distributed syringes per IDU was 28, which means a significant decrease compared to previous years (2014: 81; 2013: 76; 2012: 74). It is important to note that a new IDU population size estimate for 2015 was carried out (for data and methodology see: 2016 National Report), on which the 2015 coverage estimate was based. Until 2014 the coverage was estimated based on the population size estimate carried out in 2010 (see: 2010 National Report).

Comparative European data


Why is the pharmacy-based needle and syringe programme important?

The wide availability of community-based pharmacies could highly improve the accessibility of sterile syringes due to the good geographical coverage and the round-the-clock opening hours of pharmacies on duty. Pharmacists could assume a crucial role in informing injecting drug users or referring them into the adequate testing or treatment programmes. (In Hungary, there is not any pharmacy-based needle programme currently available.)


Facts and figures about substitution therapy

What kinds of substitution treatment programmes are available in Hungary?

Methadone treatment was introduced in 1995 in Hungary. The product is financed by the National Health Insurance Fund since 2002. In 2007 the palette of substitution treatment programmes for opiate addicts was extended by buprenorphine-naloxone treatment. Since 2008 the preparation is also financed by the National Health Insurance Fund.


What regulates the content of substitution programmes?

The first methadone programmes started to operate in 1995. The first professional protocol was issued in 2002. Currently substitution treatment programmes operate according to the ‘Professional treatment protocol of the Ministry of Health for opiate use related problems’ and the ‘Methodological letter of the Ministry of Health on methadone treatment’.


How many treatment centres provide methadone and buprenorphine/naloxone treatment in Hungary?

In 2015 the number of treatment centres providing opiate substitution treatment in the country was 15. The therapy is typically provided in the scope of outpatient treatment, but there are some service providers who provide this pharmacologically assisted therapy in the scope of inpatient treatment (in a hospital or therapeutic community).

How many clients received opiate substitution treatment (OST) in 2015?

Service providers participating in the national data collection on substitution treatment reported a total of 669 clients, that covers around 80% of all the clients according to expert estimates.

95.2% (637 persons) of those receiving methadone or buprenorphine/naloxone treatment received their substitution drug as maintenance treatment and 4.8% (32 persons) received it for the purpose of detoxification. 79.7% of the clients in maintenance treatment were given methadone which is quasi equal to the previous years’ results. Buprenorphine/naloxone may be prescribed so that the medication is financed by the patient, which makes possible to treat clients who are willing to undertake the costs but otherwise would not obtain it due to the limited treatment capacities.


European comparative data on the number of clients in OST


What trends can be observed in the numbers of clients?

The number of those treated in OST was relatively stable over the studied years: there was a minor increase following 2008, which can be linked to the introduction of buprenorphine/naloxone (and the introduction of the possibility of self-financed treatment), then a development in methodology of data collection, which caused a decrease in 2011. The reason for the relatively stable availability is that the financed treatment capacity has not changed over the years. The last estimate on the number of heroin users in Hungary was made in 2013 with respect to 2010-2011. On the basis of this in 2010 those receiving substitution treatment represented 22% of the total number of heroin users.


Facts and figures about programmes providing party service

How many organizations provided harm reduction services in the recreational setting in 2015?

In 2015 a total of 23 organisations participated in the data collection, of which 13 operated harm reduction service in the recreational setting at city-level, 3 at micro-regional level, 3 at county level, 1 at regional level and 3 at national level.  They took part in a total of 583 events where they contacted 83.877 people. The mean number of contacts per event was 143 (the same figure was 66 in 2014, and 50 in 2013). The items most frequently provided by the organisations were water, condoms, leaflets, glucose tablets and effervescent tablets.