Needle-exchange Programme - Operation

Operation

In addition to sterile needles, syringe-exchange programmes typically offer other services such as: HIV and Hepatitis C testing; alcohol swabs; bleach water and normal saline (often as rinse eye drops); aluminium "cookers"; citric acid powder (an imperative agent: enables heroin to dissolve in water); containers for needles and many other items. There was a survey conducted by Beth Israel Medical Center in New York city and the North American Syringe Exchange Network, which showed among the 126 SEPs surveyed, 77% provided to material abuse therapy, 72% provided voluntary counselling and HIV testing, and more than two-thirds provided supplies such as bleach, alcohol pads, and male and female condoms.

According to the Centers for Disease Control (CDC), in the United States around 1/5 of all new HIV infections and the vast majority of Hepatitis C infections are the result of injection drug use.

Needle-exchange programmes are supported by the CDC and the National Institute of Health. The NIH estimates that in the United States, between fifteen and twenty percent of injection drug users have HIV and at least seventy percent have hepatitis C.

Proponents of harm reduction argue that the provision of a needle exchange therefore provides a social benefit in reducing health costs and also provides a means to dispose of used needles in a safe manner. For example, in the United Kingdom, as the keystone prevention method, proponents of SEPs assert that, along with other programs, they have reduced the spread of HIV among intravenous drug users. The most extensive review of research into their effectiveness backs this claim. As a developed country, especially for medical care, the UK has been seen as a pioneer in establishing SEPs. These supposed benefits have led to an expansion of these programmes in most jurisdictions that have introduced them, aiming to increase geographical coverage, but also the availability of these services out of hours. Vending machines which automatically dispense injecting equipment "pack" have been successfully introduced in a number of locations.

Another advantage cited by supporters of these programmes are that SEPs can not only protect attenders themselves, but also provide a safe environment for their social network such as sexual partners, children or neighbours. If people among injecting drug users (IDU) did not attend SEP or share injection equipment with programme attenders, SEPs can also have an indirect influence to control transmission risks. In fact, in those SEPs, nurses are very important in terms of spreading knowledge about HIV among IDUs. These programmes not only provide physical protection from HIV, they also facilitate education by teaching IDUs about blood-borne pathogens as well as how to protect themselves and others.

Other promoted benefits of these programmes include being a first point of contact for drug treatment, access to health and counselling service referrals, the provision of up-to-date information about safe injecting practices, access to condoms, and as a means for data collection from injecting drug users about their behaviour and/or drug use patterns. SEP outlets in some settings offer basic primary health care. These are known as 'targeted primary health care outlet'- as these outlets primarily target people who inect drugs and/or 'low-threshold health care outlet'- as these reduce common barriers clients often face when they try to access health care from the conventional health care outlets,. For accessing sterile injecting equipment clients frequently visit SEP outlets, and these frequent visit are used opportunistically to offer much needed health care.

A clinical trial of needle exchange found that needle exchange did not cause an increase in drug injection These findings were endorsed by then United States Surgeon General Davis Satcher, then Director of the National Institutes of Health Harold Varmus, and then Secretary of the Department of Health and Human Services, Donna Shalala.

These services can take on a wide range of configurations:

• Primary needle and syringe programme ("stand alone" service)
• Secondary needle and syringe programme (such as incorporated within a pharmacy or health service)
• Mobile or on-call Service
• Dispensing machine distribution ("vending machine")
• Peer service: distribution networks
• Peer service: "flooding" or mass distribution
• Peer service: underground
• Prison-based facilities
• Distribution of bleach or other cleaning equipment (rather than needles and syringes)
• Ad hoc or informal distribution

Countries where these programmes exist include: Australia, Brazil, Canada, the Czech Republic, Netherlands, New Zealand, Norway, Portugal, Spain, Switzerland, United Kingdom, Ireland, Iran and the United States. In the United States such programmes may not receive federal funding, but this ban was briefly lifted in 2009 before being re-instated in 2010.