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A review of needle exchange programs in Saskatchewan. (2010, December 8). Saskatchewan Ministry of Health, 12. Retrieved June 12, 2014

Brosnahan, M. (2012, September 25). Lawsuit seeks needle exchange programs for prisons. CBC News. Retrieved from http://www.cbc.ca/news/canada/lawsuit-seeks-needle-exchange-programs-for-prisons-1.1221229

Des Jarlais, D. C. (1995). Harm reduction--a framework for incorporating science into drug policy. American Journal of Public Health, 85(1), 10-12.

Elliot, D. (2014). Debating safe injecting site sin Vancouver's inner city: Advocacy, conservatism and neoliberalism. Contemporary Drug Problems, 41(1), 5-40.

Jacobs, p., et al. (1999). Cost effectiveness of streetwork's needle exchange program of Edmonton. Canadian Journal of Public Health, 90, 168-71.

Moore, D., & Fraser, S. (2006). Putting at risk what we know: Reflecting on the drug-using subject in harm reduction and its political implications. Social Science & Medicine, 62(12), 3035-3047. doi:10.1016/j.socscimed.2005.11.06

O'Hare, P. (2007). Merseryside, the first harm reduction conferences and the early history of harm reduction. International Journal of Drug Policy, 18, 2, 141-144.

Strike, C., Leonard, L., Millson, M., Anstice, S., & Berkeley, N. (2006, March). Ontario needle exchange programs: Best practice recommendations. Ontario Needle Exchange Coordinating Committee

Webster, P. C. (2012). The redlining of harm reduction programs. Canadian Medical Association.Journal, 184(1), E21-2. Retrieved from http://search.proquest.com/docview/922044130?accountid=1461

Needle Exchange Program as Harm Reduction

What is Harm Reduction?

Models

  • Methods that address the 'risk' in risky behavior instead of eliminating the behavior

History of NEPs

Pharmacy

Fixed Location

Efficiency (Cost)

Dispensing Machine

Used by legal injections users

Pro Con

Need for extended hours

Pros:

Cons:

Ideal for providing

education and referrals

There is no anonymity

Less need for anonymity

Pro Con

Easy to maintain data

Hard to find perfect location

'too gov't, too medical, too busy, not discrete'

Already established location

commercial, a store

24/7 Availability

No face-to-face interaction

Limited Staff Required

can run more than one

program not just NEP

Difficult to be anonymous

Pharmacist Concerns

Affordable to extend hrs.

Needle-exchange programs started appearing in the 1970’s

Easy to Use

No sharp containers

Ultimately, only works if the pharmacist agrees.

High rate of returned needles

Statistics:

In 2011, in New Zealand, 1/3 of the pharmacies provided needle exchange, which accounted for 1/4 of needles distributed

A study done in Chicago found a demographical trend to access

  • Sees the behavior as unlikely to be eliminated

Methods

Where Needle exchange began

Sero-prevalence Study

The first government-approved initiative

  • Necessarily involves the voice of the people at risk

Program Cost

Mobile Outreach

Peer Distribution

Prison

Pros Cons

The Aids Pandemic

Pro Con

Huge variability in Statistics

Reaches High Risk Users

some risk for staff

Culture building

Demands Training

2-24% prison population use IV drugs while incarcerated

Can Create Employment

Reaches lower income areas

better

cost of van and

maintenance

Conflicting identities

for educator

34% did so with 'used' needles.

A Quebec study found as high as 63% Men & 50% women when accounting for tattoos

Reaches High Risk

A study of 900 men

Reaches those at large

risk of discovery

Harder to refer or

talk

Reaches Night Time Users

22% had a history of drug use

Statistics

3% during previous incarceration

Cost Effectiveness

75% agreed to HIV testing

5% were positive

2% didn't know that

In Saskatchewan, it was found mobile users

were more likely to be newer users, recently jailed, to be Aboriginal, and to use cocaine

4 Canadian studies found:

An extremely good example of mix-model and often necessary in sparsely populated service areas

Providing syringes did not increase violence towards staff or other inmates

did reduce risky injections

did not increase drug use

did virtually eliminate HIV transmission

  • Harm Reduction does not ignore or minimize the dangers in the behavior or activity, it addresses it

Works Cited

MODELS

GOALS

Models of NEP

Examples of Harm Reduction

To Be Effective Must

Be implemented as soon as possible

Be community based: where the drugs are

Methadone Programs

provide the right equipment

  • needles, sterile vehicle, filter, cooker, pipes, acidifiers, swabs

Condom in High School

instead of abstinence

only education.

Qualitative Goals of NEP

Be able to provide education

Accept and not eliminate drug use as a part of every community

Be consistent in their hours

Heroin Prescriptions

  • in British Columbia and the UK

Not demand needles back but encourage and provide containers

Chooses to work to minimize harmful effects rather than ignore or throw them in jail

Amnesty when reporting

violent crimes

TRUST

Legalizing Sex Work

Consistency

Identify and acknowledge barriers

To give service users a voice in the programs as they start and develop "nothing about us, without us"

Sharing of power

Use simple language

Programs against Drunk Driving

instead of prohibition

No Exploitation

Prescribing Birth Control, STI testing

grew from harm reduction stand point

Promote well being and quality of individual as well as community life

Needle Exchange Program (NEP)

Philosophy and Advantages

Challenges to NEPs

Affirms and Empowers Service Users

Many disturbances originate outside the service (Community)

Service users are active not passive, they are capable and play an important role in prevention, treatment and recovery

Requires profound shift in thought from medical or abstinence models

Amanda Hatt

Hannah Gray

Josh Drennan

Natania Hettrick

Victoria Looker

May only reach certain groups

Views clients as consumers or service users, not addicts

  • This is not a medical model

Have to overcome legal boundaries (cannot distribute paraphernalia)

Recognizes this is better for the entire community and the individual

Funding in Fredericton

an argument for fiscal effectiveness

One Goal of NEP: To reduce the spread of blood borne illness Hep-C

Everyone involved must recognize the

strengths of other programs

Hep-C: takes 1 year to treat, the treatment does not promise eradication and is brutal

Cost of 1 year of Medication: $70,000

Fredericton's NEP (ran by AIDS NB) has many costs: 1 salary, rent at the VHC, promotion, computer, supplies, transportation, etc.

Cost of 1 year of NEP: $68,900

Must maintain funding

Effectiveness is not determined by drug reduction

Provide Contact for injection drug users (IDU) without judgement

  • soft referral

Attempt to mediate inequalities that make people vulnerable

  • no cost, referrals from service users, demographics, outreach ability

Quantitative Goals

Reduce the spread of Blood Borne Illnesses through shared needles and needles left in the community

  • HIV, Hepatitis B, Hepatitis C
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