Secondary distribution of injecting equipment obtained from needle and syringe programmes by people injecting image and performance enhancing drugs: England and Wales, 2012-15.

•Secondary distribution of equipment from needle and syringe programs (NSPs) is common among IPED injectors.•Overall, 154 people collected equipment for 639–1,569 people injecting image and performance enhancing drugs (IPEDs).•Those also injecting psychoactive drugs were more likely to collect for others.•Many of those injecting IPEDs are likely not in direct contact with NSPs.•Innovative harm reduction approaches using online platforms and peers are needed.