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Removed arguments FOR needle exchange from the arguments anti-NEP section and added some
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===Anti-Needle Exchange Arguments===
===Anti-Needle Exchange Arguments===


*The research regarding Needle Exchange programs has failed to demonstrate a demonstrable preventative effect with blood-borne diseases HIV and Hepatitis C (HCV) when this is the very rationale for their implementation.<ref>Drug Free Australia {{cite web|url=http://www.drugfree.org.au/index.php?id=81&tx_ttnews[tt_news]=72&no_cache=1 |title=LATEST NEEDLE EXCHANGE REVIEW FINDS NO PROVEN EFFECTIVENESS ON HEP C TRANMISSION |accessdate=2013-07-01}}</ref>
*Popularity of Needle Exchange programs has grown over time, more than quadrupling in six years from 1993-1999.<ref>{{cite journal | author = Vlahov D., Des Jarlais D., Goosby E., Hollinger P., Lurie P., Shriver M., Strathdee S. | year = 2001 | title = Needle exchange programs for the prevention of human immunodeficiency virus infection: Epidemiology and policy | url = | journal = American Journal of Epidemiology | volume = 154 | issue = 12| pages = 70–77 }}</ref>
*The HCV rates in countries with very significant government spending on, and commitment to, needle exchange is no different to rates of HCV in countries with no or little numbers of NEPs. If NEPs show no strong preventative effect with HCV it is evident that large percentages (65-70%) of drug users in these countries are still sharing needles despite free availability of clean needles.<ref>Drug Free Australia {{cite web|url=http://www.drugfree.org.au/index.php?id=81&tx_ttnews[tt_news]=72&no_cache=1 |title=LATEST NEEDLE EXCHANGE REVIEW FINDS NO PROVEN EFFECTIVENESS ON HEP C TRANMISSION |accessdate=2013-07-01}}</ref>
⚫
**Despite discussions for federal funding of Needle Exchange Programs since President [[Bill Clinton]]’s administration, the U.S. has yet to implement a permanent change in its federal policy.
*"Drug use in America, especially among children, increased dramatically under the Clinton-Gore Administration, and needle exchange programs signal nothing but abdication, that these dangers are here to stay. Children deserve a clear, unmixed message that there are right choices in life and wrong choices in life, that we are responsible for our actions, and that using drugs will destroy your life." - George W. Bush
*In 2011, there were up to 221 sterile NEP sites in the United States. An estimated annual budget was approximately $169,000 for just one site to operate. The estimated total for all sites in the United States was roughly $37.5 million.<ref>http://www.statehealthfacts.org/comparetable.jsp?ind=566&cat=11</ref>
⚫
*Despite discussions for federal funding of Needle Exchange Programs since President [[Bill Clinton]]’s administration, the U.S. has yet to implement a permanent change in its federal policy.
*Democrats in the House of Representatives repealed a 21 year long ban on federal funding for needle exchange program in 2009. The repeal made federal grants available to local NEPs.<ref>{{cite news| url=http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/12/17/MNKM1B5S7L.DTL | work=The San Francisco Chronicle | title=U.S. repeals funding ban for needle exchanges}}</ref><ref>{{cite journal |author=Green TC, Martin E, Bowman S, Mann M, Beletsky, L |title=Life After the Ban: An Assessment of US Syringe Exchange Programs’ Attitudes About and Early Experiences with Federal Funding|journal=Am. J. Pub. Health |url= http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2011.300595?journalCode=ajph |accessdate=2012-07-05 |volume=102 |issue=5 |pages=e9-e16 |year=2012 |doi=10.2105/AJPH.2011.300595}}</ref>
*As part of a large spending bill passed to get the federal government through the 2012 fiscal year, federal funding for NEPs was banned again just two years after Obama repealed the original ban.<ref>http://www.kaiserhealthnews.org/stories/2011/december/21/needle-exchange-federal-funding.aspx</ref>
*Democrats in the House of Representatives repealed a 21 year long ban on federal funding for needle exchange program in 2009. The repeal made federal grants available to local NEPs.<ref>{{cite news| url=http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/12/17/MNKM1B5S7L.DTL | work=The San Francisco Chronicle | title=U.S. repeals funding ban for needle exchanges}}</ref><ref>{{cite journal |author=Green TC, Martin E, Bowman S, Mann M, Beletsky, L |title=Life After the Ban: An Assessment of US Syringe Exchange Programs’ Attitudes About and Early Experiences with Federal Funding|journal=Am. J. Pub. Health |url= http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2011.300595?journalCode=ajph |accessdate=2012-07-05 |volume=102 |issue=5 |pages=e9-e16 |year=2012 |doi=10.2105/AJPH.2011.300595}}</ref> But as part of a large spending bill passed to get the federal government through the 2012 fiscal year, federal funding for NEPs was banned again just two years after Obama repealed the original ban.<ref>http://www.kaiserhealthnews.org/stories/2011/december/21/needle-exchange-federal-funding.aspx</ref>


==Opposition==
==Opposition==

Revision as of 01:42, 4 July 2013

Contents of a needle-exchange kit

A needle & syringe programme (NSP) or syringe-exchange programme (SEP) is a social policy based on the philosophy of harm reduction where injecting drug users (IDUs) can obtain hypodermic needles and associated injection equipment at little or no cost. Many programmes are called "exchanges" because some require exchanging used needles for an equal number of new needles, in order to discourage the incorrect discarding of used equipment. Other programmes do not have this requirement.[1] The aim of these services is to reduce the damage associated with using unsterile or contaminated injecting equipment.

A comprehensive study by the World Health Organization (WHO) in 2004 stated that there is a "compelling case that NSPs substantially and cost effectively reduce the spread of HIV among IDUs and do so without evidence of exacerbating injecting drug use at either the individual or societal level."[2] The WHO's findings have also been supported by the American Medical Association (AMA), which in 2000 adopted a position strongly supporting NSPs when combined with addiction counseling.[3][4] Contradicting the above study, the most extensive review to date of journal studies on the effectiveness of NSPs by the Institute of Medicine, comprising 24 scientists, medical practitioners and reviewers, found that the evidence for the effectiveness of NSPs in preventing HIV was 'inconclusive' and that 'multiple studies show that NSEs do not reduce transmission of HCV(Hepatitis C)."[5] Two 2010 reviews of reviews by a team originally led by Norah Palmateer which examined systematic reviews and meta-analyses on the topic concluded that there is insufficient evidence that NSP prevents transmission of the Hepatitis C virus, tentative evidence that it prevents transmission of HIV and sufficient evidence that it reduces self-reported injecting risk behaviour.[6] The Palmateer reviews of reviews, though, have drawn some criticism.[7]

History and development

"Sharps" container (for safe disposal of hypodermic needles)

Needle-exchange programmes can be traced back to informal activities undertaken during the 1970s, however the idea is likely to have been discovered a number of times in different locations. The first government-approved initiative was undertaken in the early to mid-1980s, with other initiatives following closely. While the initial Dutch programme was motivated by concerns regarding an outbreak of hepatitis B, the AIDS pandemic motivated the rapid adoption of these programmes around the world.[8] This reflects the pragmatic response to the pandemic undertaken by some governments, and encapsulated in the harm reduction / minimization philosophy.

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.[9] 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.[10]

Needle-exchange programmes are supported by the CDC and the National Institute of Health.[10][11] 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.[11]

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.[12] 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.[13][14][15]

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,[16] 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,.[17][18] For accessing sterile injecting equipment clients frequently visit SEP outlets, and these frequent visit are used opportunistically to offer much needed health care.[19][20]

A clinical trial of needle exchange found that needle exchange did not cause an increase in drug injection [21] 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.[22][23]

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.[24]

The Melbourne, Australia inner-city suburbs of Richmond and Abbotsford are locations in which the use and dealing of heroin has been concentrated for a protracted time period. Research organisation the Burnet Institute completed the 2013 'North Richmond Public Injecting Impact Study' in collaboration with the Yarra Drug and Health Forum, City of Yarra and North Richmond Community Health Centre and recommended 24-hour access to sterile injecting equipment due to the ongoing "widespread, frequent and highly visible" nature of illicit drug use in the areas. During the period between 2010 and 2012 a four-fold increase in the levels of inappropriately discarded injecting equipment was documented for the two suburbs. In the local government area the City of Yarra, of which Richmond and Abbotsford are parts of, 1550 syringes were collected each month from public syringe disposal bins in 2012. Burnet Institute's Professor Paul Dietze stated, "We have tried different measures and the problem persists, so it's time to change our approach" in response to the ongoing risk of disease transmission in the areas.[25]

On 28 May 2013, the Burnet Institute stated in the media that it recommends 24-hour access to sterile injecting equipment in the Melbourne suburb of Footscray after the area's drug culture continues to grow after more than ten years of intense law enforcement efforts. The Institute's research concluded that public injecting behaviour is frequent in the area and inappropriately discarding injecting paraphernalia has been found in carparks, parks, footpaths and drives. Furthermore, people who inject drugs have broken open syringe disposal bins to reuse discarded injecting equipment.[26]

Research

Two 2010 ‘reviews of reviews’ by a team originally led by Norah Palmateer which examined systematic reviews and meta-analyses on the topic concluded that there is insufficient evidence that NSP prevents transmission of the Hepatitis C virus, tentative evidence that it prevents transmission of HIV and sufficient evidence that it reduces self-reported injecting risk behaviour.[6] In a comment Palmateer warned politicians not to use her team's review of reviews as a justification to close existing programs or to hinder the introduction of new needle-exchange schemes. The weak evidence on the programs' effectiveness in preventing disease is rather due to inherent limitations in the designs of the reviewed primary studies and should not be interpreted as the programs lacking preventative effects.[27]

The second of the Palmateer team 'review of reviews' scrutinised 10 previous formal reviews of needle exchange studies and after critical appraisal only four reviews were considered rigorous enough to meet the inclusion criteria, those done by the teams of Gibson (2001), Wodak and Cooney (2004), Tilson (2007) and Käll (2007).[28] Regarding the Gibson et al. review, the Palmateer team judged that their conclusion in favour of NSP effectiveness was not consistent with the results from the HIV studies they reviewed. The 2007 Tilson et al. (the US Institute of Medicine) review, with its panel of 24 scientists, medical practitioners and reviewers,[29] was judged to be the most rigorous of these studies, with its review determining, in contrast to the Palmateer team review of reviews, that the evidence was ‘inconclusive’ concerning the effectiveness of needle exchange programmes in preventing HIV.[30]

The Wodak and Cooney review had, from 11 studies of what they determined as demonstrating acceptable rigour, found 6 that were positive regarding the effectiveness of NSPs in preventing HIV, 3 that were negative and 2 inconclusive.[31] However the Käll et al. review[32] detailed errors in the Wodak and Cooney review which, when corrected, would change the studies on NSP effectiveness to 3 positive, 3 negative and 5 inconclusive. The US Institute of Medicine review operative in 2005 and 2006 and reported in 2007 in the journal article by Tilson et al., heard the conflicting evidence of both Drs Wodak[33] and Käll[34] in their Geneva session[35] before giving their deliberation of inconclusive evidence.

All but one of the studies regarded as positive by the four reviews reviewed by the Palmateer team were ecological studies, which the US Institute of Medicine asserted were unable to establish any causal link between NSPs and HIV prevention because they monitor populations, and not individuals.[36] The IOM study also states that, “another limitation is that the study designs generally do not allow separate examination of program elements, so the independent contribution of improving access to sterile needles and syringes cannot be assessed. For example, NSE is often one component of a multi-component HIV prevention program, making it difficult to isolate the exact effects of NSE alone.”[37]

The Palmateer reviews have been criticized by the drug prevention organization Drug Free Australia for their upgrading of the US Institute of Medicine assessment from ‘inconclusive’ to ‘tentative’ evidence, despite reviewing the same reviews as did the US Institute of Medicine. They noted that the Palmateer team had relied for their conclusion of 'tentative' support for HIV prevention on an unscrutinized acceptance of positive findings from the Wodak/Cooney World Health Organization (WHO) review, which had been found by Käll et al. to have been based on "significant errors which, when corrected, would alter the WHO finding from positive to inconclusive."[38][39][40]

U.S. programs

General Characteristics

As of 2011, there were at least 221 programs in the US.[41] Most of these programs (91%) were legally authorized to operate; 38.2% were managed by their local health authorities.[41][42] More than 36 million syringes were distributed annually, mostly through large, legal urban programs operating a stationary site.[41] More generally, US NEPs are also distributing syringes to drug users through a variety of methods including mobile vans, delivery services, and backpack or walked routes [42] that include secondary (peer-to-peer) exchange.

Funding

The use of federal funds for needle-exchange programs was banned in the United States of America in 1988, but this ban was overturned in 2009.[43] In the time before the federal funding ban was re-instated by the US Congress in 2011, at least three programs were able to obtain federal funds and two thirds reported planning to pursue such funding.[41] As advocacy continues to lift the ban on federal funding, US NEPs continue to be funded through a mixture of state and local government funds, supplemented by private donations.[42]

Legal Aspects

In the past, many U.S. states criminalized the possession of needles without a prescription, even going so far as to arrest people as they leave private needle-exchange facilities.[44] In jurisdictions where syringe prescription status presented a legal barrier to access, physician prescription programs had shown promise in addressing risky injection behaviors.[45] Epidemiological research demonstrating that syringe access programs are both effective and cost-effective helped change state and local laws relating to NEP operation as well as the status of syringe possession more broadly.[46] As of 2006, 48 states in the United States authorized needle exchange in some form or allowed the purchase of sterile syringes without a prescription at pharmacies.[47]

More specifically, at least 35 states had a legal syringe exchange program as of 2012.[41] In some settings, syringe possession and purchase had been totally decriminalized, while in others, card-carrying NEP clients enjoy special exceptions from drug paraphernalia laws.[48]

Despite the legal changes, gaps between the formal law and the street-level environment create an environment where many programs continue to face law enforcement interference (see law enforcement section below).[49]

Covert programs continue to exist within in the United States.[50]

One such state operating with covert needle operations is Colorado. Current laws in Colorado leave room for interpretation on the requirement of a prescription to purchase syringes. Because of this law the majority of pharmacies will not sell needles without prescription, and police will arrest people in possession needles without prescription.[51] Groups including The Works (Boulder) and The Underground Syringe Exchange of Denver (the USED) attempt to ease the burden this legislation places on IDUs in Colorado. Both exchanges operate covertly to avoid legal prosecution and are entirely funded by donations and operated by volunteers. Because of the illegal nature of the organization, the USED website specifies that new clients must be referred in order to exchange needles. Both organizations have been highly successful in supplying IDUs with an alternative to using dirty needles. According to The Works website this year they have received over 45,000 dirty needles, and distributed around 45,200.[52]

Law Enforcement

Interference with NEP, regardless of the law

Removal of legal barriers to operation of NEPs and other syringe access initiatives has been identified as an important part of a comprehensive approach to reducing HIV transmission among IDUs.[46] Legal barriers include both "law on the books" and "law on the streets," i.e., the actual practices of law enforcement officers,[49][53] which may or may not reflect the formal law. Changes in syringe and drug control policy can be ineffective in reducing such barriers if police continue to treat syringe possession as a crime or participation in NEP as evidence of criminal activity. [54]

Although most NEPs in the US are now operating legally, many report some form of police interference.[48] In a 2009 national survey of 111 US NEP managers, 43% reported at least monthly client harassment, 31% at least monthly unauthorized confiscation of clients’ syringes, 12% at least monthly client arrest en route to or from NEP and 26% uninvited police appearances at program sites at least every 6 months. In multivariate modeling, legal status of the program (operating legally vs illegally), jurisdiction’s syringe regulation environment were not associated with frequency of police interference.[48] This finding confirms a substantial gap between the formal law and its enforcement by police.

A detailed 2011 analysis of NEP client experiences in Los Angeles suggested that as many as 7% of clients report negative encounters with security officers in any given month.[55] Given that syringes are not prohibited in the jurisdiction and their confiscation can only occur as part of an otherwise authorized arrest, almost 40% of those who reported syringe confiscation were not arrested. This[55] raises concerns about extrajudicial confiscation of personal property. Approximately 25% of the encounters detailed by respondents involved private security personnel, rather than local police.[55]

Racial Gradient

NEPs serving predominantly IDUs of color may be almost 4 times more likely to report frequent client arrest en route to or from the program and almost 4 times more likely to report unauthorized syringe confiscation from clients.[48] A 2005 study in Philadelphia found that Black individuals accessing the city's legally operated exchange decreased at more than twice the rate of white individuals after the initiation of a police anti-drug operation.[56] These and other findings illustrate a possible mechanism by which racial disparities in the criminal justice enforcement can translate into disparities in HIV transmission.[55][57] Notably, the majority (56%) of respondents reported not documenting adverse police events; those who did were 2.92 times more likely to report unauthorized syringe confiscation from clients.[48] These findings suggest that systematic surveillance and interventions are needed to address police interference.[49]

Causes

Police interference with legal NEP operations may be partially explained by poor knowledge and the lack of targeted education of police about the law and public health rationale relating to the operation of such programs. A study of police officers in an urban police department four years after the decriminalization of syringe purchase and possession in the US state of Rhode Island suggested that up to a third of police officers were not aware that the law had changed.[49] This knowledge gap parallels other areas of public health law, underscoring pervasive gaps in dissemination.[58]

Even police officers with accurate knowledge of the law, however, reported intention to confiscate syringes from drug users as a way to address problematic substance abuse.[49] Police also reported being anxious about accidental needle sticks and acquiring communicable diseases from IDUs, but were not trained or equipped to deal with this occupational risk; this anxiety was intertwined with negative attitudes towards syringe access initiatives.

Training, Interventions to Address Law Enforcement Barriers

Police trainings by US NEPs have been shown to be feasible, especially when framed from the standpoint of addressing police occupational safety and human resources concerns.[24] Preliminary evidence also suggests that such trainings can shift police knowledge and attitudes regarding NEPs specifically and public health-based approaches towards problematic drug use in general.[59]

According to 2011 survey, 20% US NEPs reported participating in police trainings during the previous year.[60] Covered topics included the public health rationale behind NEPs (71%), police occupational health (67%), needle stick injury (62%), NEPs’ legal status (57%), and harm reduction philosophy (67%).[60] On average, trainings were seen as moderately effective, but only four programs reported conducting any formal evaluation.[60] Assistance with police trainings was identified by 72% of respondents as the key to improving police relations.[60]

Arguments for and Against

Pro-Needle Exchange Arguments

  • It is estimated that the average annual cost of HIV care per person in the United States is $15,745. Those with advanced HIV had an annual estimated cost of $40,678.[61]
  • Depending on when infection is detected and when the treatment process begins, it is estimated that total lifetime healthcare costs of HIV care to be between $303,000 and $619,000.[62]
  • The Centers for Disease Control and Prevention estimate that every HIV infection prevented through a needle exchange program saves an estimated $178,000+, as well as an overall estimate of 30 percent or more reduction in HIV cases in reported injection drug users.[63]
  • NEPs bring drug users into medical facilities and expose them to voluntary physical, psychological, and emotional treatment programs.[64]
  • NEPs offer a commitment to supporting drug users to focus on their health and well-being through: raising awareness, education, and empowerment[65]
  • NEPs treat addictive drug use as a health issue, as opposed to a moral one[65]
  • An estimated 1.2 million people in the United States had HIV, and one in five people with the virus were not aware of their infection. It is also estimated that over 50,000 new cases of HIV are developed each year[66]
  • Of those 1.2 million people infected, 25 percent resulted from injection drug use which is the fastest growing population of HIV[66]
  • Some states require a prescription to buy needles and syringes because they are considered drug paraphernalia and not used for direct medical purposes[67]
  • It costs about $0.97 per needle at an exchange clinic (Centers for Disease Control and prevention) as opposed to the estimated $36 it costs to pay for a day’s worth of Truvada, a pill sold as one of the numerous treatments necessary for HIV.[66]

Anti-Needle Exchange Arguments

  • The research regarding Needle Exchange programs has failed to demonstrate a demonstrable preventative effect with blood-borne diseases HIV and Hepatitis C (HCV) when this is the very rationale for their implementation.[68]
  • The HCV rates in countries with very significant government spending on, and commitment to, needle exchange is no different to rates of HCV in countries with no or little numbers of NEPs. If NEPs show no strong preventative effect with HCV it is evident that large percentages (65-70%) of drug users in these countries are still sharing needles despite free availability of clean needles.[69]
  • "Drug use in America, especially among children, increased dramatically under the Clinton-Gore Administration, and needle exchange programs signal nothing but abdication, that these dangers are here to stay. Children deserve a clear, unmixed message that there are right choices in life and wrong choices in life, that we are responsible for our actions, and that using drugs will destroy your life." - George W. Bush
  • Despite discussions for federal funding of Needle Exchange Programs since President Bill Clinton’s administration, the U.S. has yet to implement a permanent change in its federal policy.
  • Democrats in the House of Representatives repealed a 21 year long ban on federal funding for needle exchange program in 2009. The repeal made federal grants available to local NEPs.[70][71] But as part of a large spending bill passed to get the federal government through the 2012 fiscal year, federal funding for NEPs was banned again just two years after Obama repealed the original ban.[72]

Opposition

Discarded needles dangerous to the community

An Australian bi-partisan Federal Parliamentary inquiry which published recommendations in 2003 registered government concern about the lack of accountability of Australia’s needle exchanges, inadequate exchange and lack of a national register of resulting needle stick injuries.[73] Community concern about discarded needles[74] and needle stick injury led the Australian Federal Government to allocate $17.5 million in 2003/4 to investigating the provision of retractable technology for syringes.

See also

Wikimedia Commons has media related to Needle exchange.

Footnotes

  1. ^ Safer Ottawa
  2. ^ World Health Organization. "Effectiveness of Sterile Needle and Syringe Programming in Reducing HIV/AIDS Among Injecting Drug Users" (PDF). Evidence for Action Technical Papers. Retrieved 7 January 2012.
  3. ^ Attention: This template ({{cite pmid}}) is deprecated. To cite the publication identified by PMID 11318395, please use {{cite journal}} with |pmid=11318395 instead.
  4. ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1186/1471-2458-3-37, please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1186/1471-2458-3-37 instead.
  5. ^ United States Institute of Medicine "Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries". Retrieved 2010-01-09. 2006 p 149
  6. ^ a b Palmateer N, Kimber J, Hickman M, Hutchinson S, Rhodes T, Goldberg D (2010). "Evidence for the effectiveness of sterile injecting equipment provision in preventing hepatitis C and human immunodeficiency virus transmission among injecting drug users: a review of reviews". Addiction. 105 (5): 844–59. doi:10.1111/j.1360-0443.2009.02888.x. PMID 20219055. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  7. ^ Drug Free Australia "LATEST NEEDLE EXCHANGE REVIEW FINDS NO PROVEN EFFECTIVENESS ON HEP C TRANMISSION". Retrieved 2011-05-29.
  8. ^ Ritter, A and Cameron, J (2006) A Systematic Review of Harm Reduction, Drug Policy Modeling Project, Monograph 06, Turning Point Alcohol and Drug Center, University of Melbourne, December.
  9. ^ North American Syringe Exchange Network (2000). "2000 National Syringe Exchange Survey". Harm Reduction Coalition.
  10. ^ a b Centers for Disease Control and Prevention (CDC) (15 July 2005). "Update:Syringe Exchange Programs". MMWR Morb Mortal Wkly Rep. 54 (27). United States Centers for Disease Control and Prevention: 673–6. PMID 16015218.
  11. ^ a b National Institutes Of, Health (2002 Nov). "National Institutes of Health Consensus Development Conference Statement: Management of hepatitis C: 2002--June 10–12, 2002". Hepatology. 36 (5 Suppl 1): S3–20. doi:10.1002/hep.1840360703. PMID 12407572. {{cite journal}}: Check date values in: |date= (help)
  12. ^ United States Institute of Medicine "Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries". Retrieved 2010-01-09.
  13. ^ McDonald D (2006). "ACT Syringe Vending Machines Trial 2004–2006, Progress Report No. 3, August to December 2005, and preliminary evaluation findings". Siggins Miller Consultants and Social Research & Evaluation Pty Ltd, Brisbane; Canberra.
  14. ^ Islam MM, Conigrave KM (2007). "Syringe vending machines as a form of needle syringe program: Advantages and Disadvantages". Journal of Substance Use. 12 (3): 203–12. doi:10.1080/14659890701249640.
  15. ^ Islam MM, Stern T, Conigrave KM, Wodak A (2008 Jan). "Client satisfaction and risk behaviours of the users of syringe dispensing machines: a pilot study". Drug Alcohol Rev. 27 (1): 13–9. doi:10.1080/09595230701711199. PMID 18034377. {{cite journal}}: Check date values in: |date= (help)CS1 maint: date and year (link) CS1 maint: multiple names: authors list (link)
  16. ^ Brooner R, Kidorf M, King V, Beilenson P, Svikis D, Vlahov D (1998). "Drug abuse treatment success among needle exchange participants". Public Health Rep. 113 Suppl 1 (Suppl 1): 129–39. PMC 1307735. PMID 9722818. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  17. ^ Islam, MM, Topp, L, Day, CA, Dawson, A and Conigrave, KM (2012). "The accessibility, acceptability, health impact and cost implications of primary healthcare outlets that target injecting drug users: A narrative synthesis of literature". International Journal of Drug Policy. 23 (2): 94–102. doi:10.1016/j.drugpo.2011.08.005. PMID 21996165.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  18. ^ Islam, MM, Topp, L, Day, CA, Dawson, A and Conigrave, KM (2012). "Primary healthcare outlets that target injecting drug users: Opportunity to make services accessible and acceptable to the target group". International Journal of Drug Policy. 23 (2): 109–110. doi:10.1016/j.drugpo.2011.11.001. PMID 22280917.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  19. ^ Islam, MM, Reid, SE, White, A, Grummett, S, Conigrave, KM and Haber, PS (2012). "Opportunistic and continuing health care for injecting drug users from a nurse-run needle syringe program-based primary health-care clinic". Drug Alcohol Rev. 31: 114–115. doi:10.1111/j.1465-3362.2011.00390.x. PMID 22145983.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  20. ^ Islam, MM. "Needle Syringe Program-Based Primary Health Care Centers: Advantages and Disadvantages". Journal of Primary Care & Community Health. 1 (2): 100–103.
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References

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