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Needle exchange services are vital for the distribution of clean injecting equipment and disposal of equipment used for intravenous drug users. From the number of clean needles and syringes distributed and the estimated number of injecting drug users (IDUs), there may be insufficient use of needle exchange services. This highlighted the need to consider how services could be improved to encourage the use.A structured, short, anonymous questionnaire was distributed to IDUs through a wide range of agencies and services in North East Scotland. A form of snowball sampling was also used.A total of 370 individuals responded. Respondents noted the following in their two prioritized preferred options: ‘Provision of paraphernalia’ (citric acid, water and filters; 54%), ‘weekend opening hours’ (24%) and ‘antibiotic prescribing’ (23%). Other service developments noted were: ‘friendly, approachable staff’ (16%), ‘family planning’ (10.4%), ‘dressings for wounds/sores’ (9%), ‘leaflets on safer injecting’ (7.0%), ‘advice from staff on safer injecting’ (3.0%) and ‘evening opening hours’ (0.8%). Geographical gaps in current needle exchange services were identified. There was homogeneity of responses across demographic groups.IDUs were willing to participate and suggested more provision of paraphernalia.