Transcript The Syringe in the Machine

The Syringe in the Machine
Jane Dodding & Matt Gaughwin.
Drug & Alcohol Unit, Royal Adelaide Hospital
Australian Journal of Public Health 1995 Vol 19 number 4.
• Vending machines likely to prevent some sharing.
• Vending machines be introduced to complement or
supplement existing services,but not as a
replacement strategy
Stark K, Leicht A, Muller R.
(1994) Characteristics of users of
syringe vending machines in Berlin.
Soz Praventivmed; 39(4):209-216
• Found that compared to other studies of
IDU in Berlin (conducted at syringe
exchange programs) the users of the
vending machines had significantly shorter
history of iv drug use.
Curtin University
The Fitpack study
Project Team
• Chief Investigator: Dr Simon Lenton
• Project
• Aims: To: (i) access drug injectors with little or no prior contact with drug
treatment agencies (ii) describe their characteristics, BBVI risk behaviours and
feedback on services and (iii) challenge some stereotypes about citizens who
inject drugs.
Findings:
• Most respondents wanted to see sterile water (75.7%) and swabs (65.6%) sold
with Fitpacks, and 79.7% wanted Fitpacks available in vending machines.
•
The most common problems buying Fitpacks were the negative attitudes of
pharmacy staff and unavailability e.g.. after hours. Conclusions: The study
successfully accessed a diverse group of drug injectors not typically seen in
agency and peer recruited research. They provided useful feedback about how
harm reduction strategies to reduce BBVI transmission among injectors can be
improved. However, they also reported higher rates of injecting and sharing
than previously found in traditionally recruited samples of injectors which
suggests there is no room for complacency.
International Journal of Drug Policy 11(4):285-297.
“Syringe Vending Machines for
Injection Drug Users in
Marseille, France”
Obadia, Yolande; Feroni, Isabelle; Perrin, Vincent;
et al.
American Journal of Public Health (12/99) Vol. 89, No. 12, P. 1852;
• These individuals were more likely to be under the age of
30, to report no history of drug maintenance treatment, and
to report no sharing of drug injection equipment. The
researchers concluded that vending machines may help
provide access to syringes for younger drug users, who
have typically avoided needle exchange programs and
pharmacies.
Needle and Syringe Vending
Machine Trial Evaluation Report
2: Albury (Sept 1995)
• There was no increase in inappropriate disposal and the
disposal bin located nearby was well used.
• There were no reports of vandalism and the police said that
there had been no complaints made to them about the
machine.
• Staff at the hospital were provided with in-service training
prior to installation of the machine to allay their concerns
regarding safety, dealing with IDU and encouraging drug
use by providing needle and syringes. There were no
reports of problems encountered by hospital staff in
relation to dispensing machine clients.
New Zealand Needle and Syringe Exchange
Programme Review: Final Report. Aitken
C. The Centre for Harm Reduction (circa
2003)
• Three electronic dispensers provide after hours access to
injection equipment in NZ. Two of the machines are colocated with needle exchange services. These two
machines are responsible for approximately 15% of total
needle and syringe distribution at each exchange.
• Over one third of respondents to a survey of needle
exchange users about service delivery issues selected “outof-hours fit vending machines” (36.7%) as their preferred
method of improving NE services. A further 23.7%
selected “longer opening hours” indicating that users see
increased availability of equipment as important.
• The review recommends that the use of electronic
dispensers be expanded to provide greater after-hours
service.
Moatti JP, Vlahov D, Feroni I, Perrin V,
Obadia Y (2001). Multiple access to sterile
syringes for injection drug users: vending
machines, needle exchange programs and
legal pharmacy sales in Marseille, France.
Eur Addict Res; 7(1):40-45.
• Compared to NEP users, vending machine users
were younger and less likely to be enrolled in a
methadone program or to report being HIV
positive. They also had lower financial resources
(vending machines exchange a used syringe for a
new one at no cost) and were less likely to be
heroin injectors than both pharmacy and NEP
users.
Evaluation of the Fitpack®
Vending machine at Kalgoorlie
Hospital
Adrianne Moloney
Northern Goldfields Health Services, Public & Community Health
• Fewer people entering the hospital at night
increased security for staff.
• Public and Community Health unit experiencing
an increase in Fitpacks® distributed.
Evaluation of the Fitpack®
Vending machine at Kalgoorlie
Hospital
 In terms of disposal of Needle & Syringes there does
not appear to be any significant difference since the
introduction of the Fitpack vending machine.
 Clients satisfied, with the convenience of after hours
access and anonymity.
 Overall the trial of the Fitpack® vending machine has
been successful.
Report on the Harm Reduction Needs
of Aboriginal People Who Inject Drugs
(National Drug Research Institute, 2002
Recommends:
• Vending machines with 24 hour access
in both metropolitan and rural locations
(specific locations should be determined
on the basis of identified need and in
consultation with local communities).
More Needle Provisions Called
for in Ireland
Birchard, Karen
Lancet (www.thelancet.com) (03/04/00) Vol. 355,
No. 9206, P. 818
In their Feb 21 report Making Contact: An
Evaluation of a Needle Exchange, the
Merchant's Quay Project, Dublin, recommend:
syringe-vending machines to provide 24-hour
needle supplies; pharmacy involvement in
distribution of syringes; and mobile needle
exchanges.
THE STATE OF NEEDLE &
SYRINGE SUPPLY MEASURES
IN AUSTRALIA
Dave Burrows,
http://users.xcel.net.au/drugarm/research/burrows_full.htm
IDU Policy Officer, Australian Federation of AIDS Organisations
Several respondents called for more vending machines
to increase access to equipment. AFAO supports the use
of these machines, as long as peer education and other
types of education (eg, of residents' groups, community
groups, health workers) are maintained or expanded.
A Rapid Situation Assessment of
injecting drug use
and blood-borne viruses in the Eastern
Metropolitan Region
RECOMMENDATIONS
• (depending on possible policy changes) the installation of syringe
vending machines to provide anonymous out-of-hours service,
especially in outer areas
• increasing safe injecting equipment disposal options across the EMR
• Conducted by
The Epidemiology and Social Research Program
Macfarlane Burnet Institute for Medical Research and Public Health
SUPPORT STATEMENTS
Peter Parkes, Manager
Canberra Alliance for Harm Minimisation and Advocacy.
• Whilst CAHMA is conscious of the ongoing need for
delivery of quality education and intervention in Needle
and Syringe Programs (NSPs), and for an increase in
Peer Based models of NSP delivery, we feel that it is
equally important that further outlets for injecting
equipment become available. As such, CAHMA fully
supports the integration of vending machines
(providing sterile injecting equipment) into current and
newly established Needle and Syringe Programs in
Australia.
SUPPORT STATEMENTS
Stuart Loveday, Executive Officer
Hepatitis C Council of NSW
"The Hepatitis C Council of NSW fully supports
any initiative that facilitates access to sterile
injecting equipment by people who inject drugs.
Australia is a world leader in having prevented
high levels of HIV infection among those people
who inject. As a result, HIV rates in the broader,
heterosexual Australian community have
remained exceptionally low. This major public
health success has been achieved through the
provision of sterile injecting equipment,
information and education through Australia's
needle and syringe program. (continued)
SUPPORT STATEMENTS
Stuart Loveday, Executive Officer
Hepatitis C Council of NSW
Vending machines are an easy, convenient and safe
way to dispense sterile injecting equipment, and we
support their use. Of course they need to be used in
conjunction with the existing education services
provided by primary and secondary NSP services,
and we would not support budget cuts to staffed
NSP services in order to fund any exclusive
expansion in vending equipment. In other words,
we see them as complementing, not replacing,
staffed needle and syringe programs.
• They are an essential health service, and vending
machines play a very important role in providing
access to sterile equipment - particularly out of
hours, when other health services are closed."
SUPPORT STATEMENTS
Charles Roberts, Convenor
Top End Users' Forum Inc.
• TUF supports the expansion of NSPs to
include a range of outlet types including
mobile NSPs and vending machines. This
must be done in conjunction with peer
education programs to ensure that people
who inject drugs are properly informed about
viruses such as hepatitis C."
SUPPORT STATEMENTS
Nicky Bath, Policy Officer
Australian Injecting and Illicit Drug Users League
• "The Australian Injecting and Illicit Drug Users League, (AIVL)
supports the provision of sterile injecting equipment via
static needle vending machines. International research shows
that such machines play an important role in increasing the
accessibility of injecting equipment to injecting drug users
thus further contributing to the minimising of the
transmission of blood borne viruses and other injecting
related health issues. AIVL believes however, that only with a
coordinated approach that has the key involvement of peers
and includes broad based education and awareness raising
will such an initiative be most effective and fully endorsed by
AIVL."
SUPPORT STATEMENTS
JEAN WYLDBORE
The Centre for Harm Reduction, Melbourne
Re: Needle Vending Machines (NVM). I am delighted to say that
expansion is warranted, and that here in Victoria, we eagerly
await government's decision to initiate their programmed
installation, especially in rural areas. NVM appear to have
complemented other forms of IDU-related harm reduction,
and they are a valuable asset in public health.
• I am delighted to support the provision and use of these
machines, but would add that this should happen in tandem
with peer/user education and other types of education (eg of
residents' groups, community groups, health workers, local
government), and that - if possible - these education
programs should in fact be expanded.
SUPPORT STATEMENTS
Shelley Cogger, Peer Education and Support Worker
DUNES Inc
• Drug User's Network Education and Support
(DUNES Inc) fully supports any initiative that
facilitates IDU access to sterile injecting
equipment. While acknowledging the unique
value of Peer Education models, limiting the
transmission of Blood Borne Viruses is a
priority that may be met by the implementation
of vending machines in discreet locations.
Main Points
• Pharmacists report no noticeable impact on the
number of Fitpacks they distributed.
• No increase in discarded equipment.
• No negative impact on local free distribution
(reports of increased distribution).
• In terms of security, there had been no
incidents reported.
• Clients reached that will not use other services.