- Number of NSPs: 80 (plus pharmacies)
- Syringes distributed in 1999-2000: 3,209,000
- Approximate cost: $3,576,000
HistoryThe Poisons Act 1964, was amended in 1994 to create a legal defence for persons participating in approved needle and syringe programs. The power to approve applications from organisations wishing to be authorised pursuant to this Act is vested in the Commissioner of Health, Health Department of WA. Legislatively, responsibility for the administration of needle and syringe programs in WA is carried by the Chief Pharmacist (Environmental Health: Drugs Poisons and Therapeutic Goods Control Section), Health Department of Western Australia. However, the Sexual Health Program, Communicable Disease Control Branch, Health Department of Western Australia plays a major role in liaison with service providers and providing statewide coordination of the program.
Until 1994, the provision of injecting equipment to people who were injecting drugs illicitly was illegal, and providers of needles and syringes could, as the law stood, have been charged with an offence under the Western Australian Criminal Code. Despite this, pharmacists and other services provided sterile needles and syringes to injecting drug users as a critical public health strategy in the prevention of further transmission of HIV. The Poisons Act amendments of 1994 led to an increase in the number of needles and syringes distributed and the number of outlets. NSPs first commenced in WA in 1987, with the Health Department of Western Australia administering a program providing sterile injecting equipment to injecting drug users (IDUs) in "SS5" kits (consisting of a disposal container, 5 sterile needles and syringes, condoms, and information pamphlets). These were distributed through the Western Australian AIDS Council and other agencies, and retailed through pharmacies. In July of 1992, Fitpacks® were introduced to replace the SS5 kits.
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Types of programsWA has one dedicated fixed-site primary needle and syringe exchange, three mobile outreach exchange services, 75 secondary outlets, and one vending machine. The primary site is operated by Western Australian Substance Users' Association (WASUA) and is located in Northbridge (Perth). The Western Australian AIDS Council (WAAC) operates two mobile services from a range of different sites in Perth and a new mobile program operated by WASUA has been established in the regional centre of Bunbury (funded through COAG Diversion Initiative). Secondary outlets are provided through other services such as hospitals (41 outlets), health units, nursing posts and community health centres. They account for less than 5% of total needle distribution in WA.
Two vending machines had been installed at a drug and alcohol service operated by the Health Department, but they are currently non-operational due to vandalism. When operational, the vending machines were disseminating just over 1% of all needles and syringes. A trial of a vending machine commenced operation at Kalgoorlie Regional Hospital in March 2001. In the first eight weeks of operation, similar numbers of Fitpacks® have been vended through the machine at cost of $3.00 as were given out at no cost over the counter of the Accident and Emergency Department for same time period last year. The machine has to date not been vandalised or broken into.
The operations of NSPs in WA are significantly different from those in other states in several significant ways. Firstly, approximately sixty-five per cent of needles and syringes distributed in WA are sold through pharmacies. Secondly, the two services that offer exchange do so on a cost-recovery basis, that is, a charge of 25c per needle if there is no exchange.
The pharmacy program is commercial in nature (equipment is ordered directly from the pharmaceutical wholesaler and sold at a price determined by the pharmacy). The Health Department of WA supplies information labels that are attached to the Fitpacks® at the point of manufacture and packing (i.e. prior to dispatch to the pharmaceutical wholesalers). Under a collective licence held by the Pharmaceutical Council of WA, pharmacists are licensed to sell only Fitpacks®, Fitpack® Plus and Sharpkitz, and most commonly retail a combination of these products. Fitpacks® consist of 5 syringes in a disposal unit (average price 5.50), whilst Fitpacks® Plus contain 3 syringes, water, swabs and spoons in a disposal unit (average price $6.50). Prices for each product vary significantly between outlets (including across location and hours of operation). There are no return discount or exchange, nor disposal facilities provided through pharmacies. There are a few pharmacists that have applied for individual licenses to allow them to sell loose needles and syringes with a disposal container.
The Health Department of WA includes safe disposal messages on all Fitpack® labels, and has produced a pamphlet to inform the general public on how to appropriately dispose of used needles and syringes they may find discarded. Further, HDWA has made available to local government authorities needle and syringe disposal bins for installation in their public amenities. Maintenance of the bins is the responsibility of the local government authority. The WASUA and WAAC NSPs provide disposal facilities for used equipment.
A demonstration project involving WA Drug Abuse Strategy Office, WA Police Service, HDWA, local governments (Town of Vincent and City of Perth) and WASUA has developed strategies and resources to educate both the general public and people who inject drugs in the practice of safe disposal of used injecting equipment.
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Barriers and challengesHistorically, public and political support for the program has been one of the most difficult barriers to overcome. There has been a level of recognition of the need for the program from the government, but this has fallen short of making public statements to that effect. The media occasionally seizes on events such as needle and syringe disposal and makes a significant public issue out of it. There is a minority within the community who voice marked opposition to the program.
The major issues in WA for the NSP are those of access and equity. The sheer size of the state and the distribution of the population across the state make access for many people problematic. There is now a reasonable coverage of NSPs and/or participating pharmacies across WA, but there are some areas (such as some mining towns) where injecting drug use is known to be occurring but the supply of injecting equipment is limited. 24-hour access also poses an issue, as there is only one 24-hour pharmacy based in Perth and some of the major regional centres do not have 24-hour outlets (NSPs or pharmacies). Historically, there was an informal agreement between the Health Department and the Pharmacy Guild (WA Branch) that the Department would not establish an NSP in an area during pharmacy trading hours. This agreement is now being revisited as it is restricting access in some locations.
Equity of access is an issue in WA more so than in any other state as it is the only state that operates its NSPs largely on a cost-recovery basis and its pharmacy program is commercial. This means that people in areas not serviced by an NSP can only access Fitpacks®, at full retail price (around $5 to $6 in rural areas and $5 to $7 in metropolitan areas) and this is likely to have an impact on people with lower incomes. As noted above, the only 24-hour service in Perth is located in a pharmacy. This raises an issue of after-hours access not only for people on lower incomes and others who are price sensitive, but also for those who live in outer metropolitan areas, and does not allow for choice in mode of service provision. These issues are currently being considered in WA, whilst recognising the costs involved in adding more NSPs to the current service system.
The WA Health Department is conscious of the advantages of having such a successful pharmacy program at a very low cost, but also recognises the dilemmas that have been created through the agreement with the Pharmacy Guild at the inception of the program. This issue is in the process of being explored with a view to widening access and the availability of needles and syringes.