Module 2 Harm Reduction and the Needle and Syringe Program
What we will be doing
1.A brief look at the basics of injecting drugs and doing it as safe as possible.
2.The Needle and Syringe Program – why we have it and what it does?
3.A look at local harm reduction services in your area.4.Discuss mandatory reporting requirements in the
context of NSP service provision.5.‘Fitpacks’ – a show and tell.
Safer Drug use – the basics Injecting drugs can come with many complications
People should be encouraged to use alternatives when possible:
1. Smoke2. Swallow3. Snort4. Shelve/Stuff
How young people may come to inject? – a reminder
• Peer pressure, connection to otherswho inject
• Often opportunistic and unplanned• Disadvantage: homelessness, poverty, neglect• Pragmatic reasons: cheaper than smoking,
bigger high
Peers and injecting
• 26% of young people have been exposed to injecting through friends or peer groups or have been offered drugs to inject in the past
• “The role of peer networks is not necessarily productive of injecting practice, but rather provides the historical moment in which injecting may or may not happen” (Bryant et al 2012)
• Meth/amphetamines – especially young people• Steroids – greater numbers among young
people/new to injecting• Heroin• Cocaine • Benzodiazepines• Methadone• Oxycontin/oxycodone• Morphine
Commonly injected drugs
Avoiding Overdose Basic but good advice you can give
• Have a small ‘taste’ first - you can never be sure of what you’re injecting
• Mixing downers can lead to overdose eg benzos, heroin, alcohol, methadone
• Do not inject drugs when you are alone
• Know what to do if someone else overdoses – Dial “000” place in recovery position wait with them and let the ambos know what they’ve taken. Police rarely attend an overdose call out.
Basic messages around BBV preventionand safer injecting
• get injecting equipment first• find a safe place to inject• having your own equipment• having enough equipment• be aware of hygiene and cleanliness• think about injecting site choice and rotation• dispose of injecting equipment safely
This will help reduce
• Blood borne virus infections
• Other bugs (bacterial and fungal infections)
• Overdose risk
• Collapsed veins
The Needle and Syringe ProgramAn Overview Including:• The Australian Drug Strategy• Types of NSP• Services Offered• Local Services• Equipment distributed
Harm Minimisationhas formed the basis of Australia’s Drug Policy since 1985
Three strands includeDemand Reduction – eg Education, Taxation Supply Reduction – eg Police, Customs Harm Reduction – eg NSP
Harm Reduction
Harm reduction works on the overriding
principle that human beings will engage in
certain activities despite a demonstrated risk
in those very activities
Why?• Accepts, for better and for worse, that licit and illicit
drug use is part of our world and chooses to work to minimise its harmful effects rather than simply ignore or condemn.
• Does not attempt to minimise or ignore the real and tragic harm and danger associated with licit and illicit drug use.
Harm Reduction
The Needle and Syringe Program
An evidence based public health program that aims to protect the community from the spread
of infections such as HIV and hepatitis C among people who inject drugs and the wider community
in NSW, 2012
33 Primary300 Secondary NSPs141 Automatic Dispensing Machines488 Community Pharmacies
The Needle and Syringe Program
Types of NSP servicePrimary Staffed by specialist NSP workers, offer bulk equipment, large range
of equipment, health education and health promotion activities,
referral into broader health/social services, sometimes clinical
services
SecondaryLocated in a range of settings, eg. Community Health Centres,
hospital Emergency Departments, youth services etc. Non-specialist
staff involved in NSP duties. Core business is not NSP delivery.
OutreachVehicle and foot patrols which allow services to be provided
directly to street based drug using scenes, may also involve home
visits to clients in geographically isolated areas, those who are
unwell or face other restrictions to travel.
ADMsAllows for a completely anonymous service, 24 hour availability.
May have a financial cost to user (usually $2 -$4)
Types of NSP service
PharmaciesThrough the Pharmacy Fitpack Scheme, selected pharmacies provide
additional access points in a range of community settings. Privately
operated , NSW health funded.
Types of NSP service
• Core NSP services:o injecting equipmento brief interventionso education and harm reduction advice o referral informationo responsive community clean-up and disposal serviceSome also offer:• Primary clinical management of BBV • BBV screening; assessment; HBV vaccination
NSPs What do they do?
1.NSPs increase drug use?
2.NSPs lead to increased discarded syringes?
3.NSPs lead users into treatment?
NSPs True or False?
• During 2000 – 2009, $243m funding for NSP services resulting in:
• An estimated 96,667 cases of hepatitis C being averted
• An estimated 32,050 cases of HIV averted
• For every $1 of expenditure more than $4 in health care cost-
savings in the short term
• For every $1 of expenditure more than $27 returned when
including patient/client costs and productivity gains and losses
• Making net present value of NSP’s $5.85 billionReturn on Investment 2: Evaluating the cost-effectiveness of needle and syringe programs in Australia 2009 DOHA,NCHECR, 2009
NSPs Do they work?
• protecting children & young people is everyone’s responsibility, including NSP workers
• persons in professional work or paid employment delivering NSP services are mandatory reporters
• under NSP Guidelines a child is a person below the age of 16 years, a young person is someone aged 16 or 17 years
NSPs and Young People
Under NSW NSP Guidelines an NSP worker:
• must report children under 16 at “risk of significant harm” A child injecting drugs is at risk of significant harm
• may report:– Young persons aged 16 or 17 years– Homelessness in a child or young person– Prenatally if you believe child will be risk
of significant harm after birth
NSPs and Young People
• To think about a balanced approach• To engage the child or young person in order to assess
their situation and their exposure to harms• To identify and respond to any risk of significant harm
It is important that interventions do not discourage the child or young person from continuing to use the service, where this is appropriate, as this may place their health at further risk.
What is the role of the NSP worker?
• To attempt to engage the child/young person to assess the level of risk (including risk of exposure to blood borne virus)
• To assess whether provision of clean equipment is appropriate
• To assess extent of any other risks faced by the child/young person and provide appropriate support, advice, referrals or other interventions
• Prior to providing equipment NSP staff must provide the child/young person with information on alcohol and other drug support services.
What are the responsibilities of the NSP worker?
NSP and mandatory reporting
As Mandatory Reporters NSP providers must
• Be clear on differences ‘Children’ vs ‘Young people’ in reporting
• Follow NSW Mandatory Reporter Guide (May 2013)• Follow decision making tree and process for reporting • If in doubt consult your Child Well Being Unit for guidance• Refer to NSW NSP Guidelines (NSW Ministry of Health 2013) • Refer to your own organisation's policies• Be aware of the anonymous nature of NSP services
Do you have your own reporting proceduresDo these sit with the above policies?
Given the information provided what are some key questions that would assist in assessing if a young NSP client was at risk of significant harm?
NSP and mandatory reporting
• The Mandatory Reporter Guide (MRG) http://sdm.community.nsw.gov.au/mrg/screen/DoCS/en-GB/summary?user=guest
• ‘Keep Them Safe’ Support Line1800 772 479
• The NSW NSP Guidelines (2013)see hand out
Resources
Alcohol and Drug Information Service(ADIS) 9361 8000 / 1800 422 599
A 24 hour, confidential telephone service for people in NSW. It provides information, counselling, referral and advice to anyone concerned about their own or another’s alcohol or other drug use.
ADIS
Tel: 02 9332 1599 (Sydney)Tel: 1800 803 990 (NSW)
On line support: www.hep.org.au
Hepatitis Infoline
NSW Users and Aids Association (NUAA)• Tel Offices: (02) 8354 7300• NSP direct: (02) 8354 7343• For rural callers: 1800 644 413 (NSW only)
NUAA