- Number of NSPs: 215
- Syringes distributed in 1999-2000: 6,177,000
- Approximate cost: $4,767,000
HistoryNeedle and Syringe Programs commenced in Victoria with four pilot programs in 1987. In 1988, the program was expanded state-wide. NSPs are governed by the Drugs, Poisons and Controlled Substances Act 1981 (Vic) which provides an exclusion for people authorised by that Act from the laws governing aiding and abetting illicit drug use. The Act enables the authorisation of agencies wanting to host an NSP (and records the agency name, positions, roles and hours of operation), as well as a general authorisation for pharmacists and pharmacy assistants. Once authorised by the Minister for Health, any changes within a service (eg hours of operation) must be notified to the Department. The requests for authorisation are considered by the Department, prior to making recommendations to the Minister. The Department gives consideration to such issues as consultation with the local community, the proposed location, training and general understanding of the operations of an NSP.
Until the most recent change of government (in December 1999), the NSP administration was located within Communicable Diseases Branch of Public Health. It is now located within the Drugs Policy and Services Branch of Victorian Department of Human Services.
Reports indicate that the main drug being used in Victoria is heroin, although in its absence (such as during the recent heroin drought), amphetamine use increases.
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Types of programsOf the 215 registered programs in Victoria, 14 are primary outlets (fully funded through the program), 180 are secondary outlets (which provide consumables, written resources and training) and 22 are pharmacy-based programs. In addition, there are 3 enhanced secondary outlets, located in drug hotspots, which are funded for some staff time, some disposal facilities and some community education and promotion.
Pharmacy involvement in the government-auspiced program is fairly limited, but other pharmacies do sell equipment. Those participating in the NSP program receive consumables for free and are supposed to provide it to users free of charge (which removes the profit incentive for pharmacy involvement). The Department operates the ordering and supply process for all NSPs.
The equipment supplied through the NSPs includes needles, syringes (in a variety of sizes), swabs, condoms, lube, disposal units, plastic bags and printed materials. They do not currently supply water, spoon and filters, but consideration is being given to the possible provision of these items. There is some variation in what is supplied in a standard kit from NSPs as some choose to make up their own packs.
With respect to outreach services, there are two foot patrols, one of which operates on a fixed route. One foot patrol works within the CBD during the day and night. Another foot patrol, in the Springvale area, operates during the day only. In metropolitan Melbourne, there are also seven car-based outreach programs operating each evening, seven days a week, until about 11 pm. There are two car-based outreach programs operating during the day.
Another outreach project in Victoria is the steroid project, which employs a worker to provide information about safe using and consumables to users of anabolic steroids. This project was piloted in 1996 and has been running since 1997.
All needle and syringe programs have disposal facilities supplied and maintained by Departmental funding. A Helpline has also been established to provide advice and referral to people who find a syringe that has been disposed of. If there is an agency in the area that has a collection service, the referral is made to that agency (eg Fitzroy NSP or a local government authority). Otherwise the person is given information about how to pick up the syringe safely. In addition, many local councils have installed disposal units in locations such as public toilets.
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Barriers and challengesLike most jurisdictions, disposal incidents have plagued the operations of the NSP. The highest profile of these incidents involved a well-known triathlete who received a needle stick injury from a discarded needle on St Kilda beach. This resulted in huge media coverage and public outrage. There is a constant level of public concern about NSPs and a lack of understanding about the rationale for such programs. Like other states, the name of the program was changed (by the deletion of the word 'exchange') to reduce expectations that NSPs achieved or should achieve a 1-for-1 exchange of equipment.
The Minister for Health launched a 'Safe Needle Disposal Strategy' in January 2001 that includes the establishment of the HelpLine and a number of strategies relating to surveillance, best practice disposal and retrieval and working with local government to improve and expand retrieval services. A Monitoring Group with representation from NSPs, users, local government, pharmacies, public transport, police and epidemiology has been established to oversee the implementation of the strategy.
The role of NSPs within mainstream health services has also been a constant issue. It is not widely accepted that the provision of an NSP is part of the public health role of these services, and so the introduction of NSPs has been resisted by some health workers.
One issue that has not been raised in other jurisdictions is that of planning issues for local government that arise when application is made for planning approval for a needle and syringe program. Negotiations are currently underway to develop guidelines that will clarify this process.
Current debates and anticipated future issues in Victoria include the call for the use of retractable needles, educating the public about the real risks of transmission of communicable diseases as a result of a nonoccupational needle-stick injury (to reduce concerns about needle and syringe disposal) and an apparent increase in the intensity of media sensationalism about NSPs.
Another issue of concern in Victoria relates to the requirement for the legalisation of possession of used equipment. Whilst it is not illegal to possess used equipment, the equipment and its contents can be seized, tested and used in evidence to support other charges. This is reported by NSPs as being a barrier to appropriate disposal such as carrying a container of used syringes to an NSP and is likely to contribute to the immediate disposal of equipment at the location of its use (i.e. inappropriate disposal).
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