The Syringe in the Machine

1
The Syringe in the Machine

• Jane Dodding Matt Gaughwin.
• Drug Alcohol Unit, Royal Adelaide Hospital
• Australian Journal of Public Health 1995 Vol 19
  number 4.
• Vending machines likely to prevent some sharing.
• Vending machines be introduced to complement or
  supplement existing services,but not as a
  replacement strategy

2
Stark K, Leicht A, Muller R. (1994)
Characteristics of users of syringe vending
machines in Berlin. Soz Praventivmed
39(4)209-216

• Found that compared to other studies of IDU in
  Berlin (conducted at syringe exchange programs)
  the users of the vending machines had
  significantly shorter history of iv drug use.

3
Curtin University The Fitpack study

• Project Team
• Chief Investigator Dr Simon Lenton
• Project
• Aims To (i) access drug injectors with little
  or no prior contact with drug treatment agencies
  (ii) describe their characteristics, BBVI risk
  behaviours and feedback on services and (iii)
  challenge some stereotypes about citizens who
  inject drugs.
• Findings
• Most respondents wanted to see sterile water
  (75.7) and swabs (65.6) sold with Fitpacks, and
  79.7 wanted Fitpacks available in vending
  machines.
• The most common problems buying Fitpacks were the
  negative attitudes of pharmacy staff and
  unavailability e.g.. after hours. Conclusions
  The study successfully accessed a diverse group
  of drug injectors not typically seen in agency
  and peer recruited research. They provided useful
  feedback about how harm reduction strategies to
  reduce BBVI transmission among injectors can be
  improved. However, they also reported higher
  rates of injecting and sharing than previously
  found in traditionally recruited samples of
  injectors which suggests there is no room for
  complacency.
• International Journal of Drug Policy
  11(4)285-297.

4
Syringe Vending Machines for Injection Drug
Users in Marseille, France

• Obadia, Yolande Feroni, Isabelle Perrin,
  Vincent et al.
• American Journal of Public Health (12/99) Vol.
  89, No. 12, P. 1852
• These individuals were more likely to be under
  the age of 30, to report no history of drug
  maintenance treatment, and to report no sharing
  of drug injection equipment. The researchers
  concluded that vending machines may help provide
  access to syringes for younger drug users, who
  have typically avoided needle exchange programs
  and pharmacies.

5
Needle and Syringe Vending Machine Trial
Evaluation Report 2 Albury (Sept 1995)

• There was no increase in inappropriate disposal
  and the disposal bin located nearby was well
  used.
• There were no reports of vandalism and the police
  said that there had been no complaints made to
  them about the machine.
• Staff at the hospital were provided with
  in-service training prior to installation of the
  machine to allay their concerns regarding safety,
  dealing with IDU and encouraging drug use by
  providing needle and syringes. There were no
  reports of problems encountered by hospital staff
  in relation to dispensing machine clients.

6
New Zealand Needle and Syringe Exchange Programme
Review Final Report. Aitken C. The Centre for
Harm Reduction (circa 2003)

• Three electronic dispensers provide after hours
  access to injection equipment in NZ. Two of the
  machines are co-located with needle exchange
  services. These two machines are responsible for
  approximately 15 of total needle and syringe
  distribution at each exchange.
• Over one third of respondents to a survey of
  needle exchange users about service delivery
  issues selected out-of-hours fit vending
  machines (36.7) as their preferred method of
  improving NE services. A further 23.7 selected
  longer opening hours indicating that users see
  increased availability of equipment as important.
• The review recommends that the use of electronic
  dispensers be expanded to provide greater
  after-hours service.

7
Moatti JP, Vlahov D, Feroni I, Perrin V, Obadia Y
(2001). Multiple access to sterile syringes for
injection drug users vending machines, needle
exchange programs and legal pharmacy sales in
Marseille, France. Eur Addict Res 7(1)40-45.

• Compared to NEP users, vending machine users were
  younger and less likely to be enrolled in a
  methadone program or to report being HIV
  positive. They also had lower financial resources
  (vending machines exchange a used syringe for a
  new one at no cost) and were less likely to be
  heroin injectors than both pharmacy and NEP users.

8
Evaluation of the Fitpack Vending machine at
Kalgoorlie Hospital

• Adrianne Moloney
• Northern Goldfields Health Services, Public
  Community Health 
• Fewer people entering the hospital at night
  increased security for staff.
• Public and Community Health unit experiencing an
  increase in Fitpacks distributed.  

9
Evaluation of the Fitpack Vending machine at
Kalgoorlie Hospital

• In terms of disposal of Needle Syringes there
  does not appear to be any significant difference
  since the introduction of the Fitpack vending
  machine.
•   Clients satisfied, with the convenience of
  after hours access and anonymity.
• Overall the trial of the Fitpack vending
  machine has been successful.  

10
Report on the Harm Reduction Needs of Aboriginal
People Who Inject Drugs

• (National Drug Research Institute, 2002
  Recommends
• Vending machines with 24 hour access in both
  metropolitan and rural locations (specific
  locations should be determined on the basis of
  identified need and in consultation with local
  communities).

11
More Needle Provisions Called for in Ireland

• Birchard, Karen
• Lancet (www.thelancet.com) (03/04/00) Vol. 355,
• No. 9206, P. 818 In their Feb 21 report Making
  Contact An Evaluation of a Needle Exchange, the
  Merchant's Quay Project, Dublin, recommend
  syringe-vending machines to provide 24-hour
  needle supplies pharmacy involvement in
  distribution of syringes and mobile needle
  exchanges.

12
THE STATE OF NEEDLE SYRINGE SUPPLY MEASURES IN
AUSTRALIA

• Dave Burrows, http//users.xcel.net.au/drugarm/re
  search/burrows_full.htm
• IDU Policy Officer, Australian Federation of AIDS
  Organisations
• Several respondents called for more vending
  machines to increase access to equipment. AFAO
  supports the use of these machines, as long as
  peer education and other types of education (eg,
  of residents' groups, community groups, health
  workers) are maintained or expanded.

13
A Rapid Situation Assessment of injecting drug
useand blood-borne viruses in the Eastern
Metropolitan Region

• RECOMMENDATIONS
• (depending on possible policy changes) the
  installation of syringe vending machines to
  provide anonymous out-of-hours service,
  especially in outer areas
• increasing safe injecting equipment disposal
  options across the EMR
• Conducted byThe Epidemiology and Social Research
  ProgramMacfarlane Burnet Institute for Medical
  Research and Public Health

14
SUPPORT STATEMENTS

• Peter Parkes, Manager
• Canberra Alliance for Harm Minimisation and
  Advocacy.
• Whilst CAHMA is conscious of the ongoing need for
  delivery of quality education and intervention in
  Needle and Syringe Programs (NSPs), and for an
  increase in Peer Based models of NSP delivery, we
  feel that it is equally important that further
  outlets for injecting equipment become available.
  As such, CAHMA fully supports the integration of
  vending machines (providing sterile injecting
  equipment) into current and newly established
  Needle and Syringe Programs in Australia.

15
SUPPORT STATEMENTS

• Stuart Loveday, Executive Officer
• Hepatitis C Council of NSW
• "The Hepatitis C Council of NSW fully supports
  any initiative that facilitates access to sterile
  injecting equipment by people who inject drugs.
  Australia is a world leader in having prevented
  high levels of HIV infection among those people
  who inject. As a result, HIV rates in the
  broader, heterosexual Australian community have
  remained exceptionally low. This major public
  health success has been achieved through the
  provision of sterile injecting equipment,
  information and education through Australia's
  needle and syringe program. (continued)

16
SUPPORT STATEMENTS

• Stuart Loveday, Executive Officer
• Hepatitis C Council of NSW
• Vending machines are an easy, convenient and
  safe way to dispense sterile injecting equipment,
  and we support their use. Of course they need to
  be used in conjunction with the existing
  education services provided by primary and
  secondary NSP services, and we would not support
  budget cuts to staffed NSP services in order to
  fund any exclusive expansion in vending
  equipment. In other words, we see them as
  complementing, not replacing, staffed needle and
  syringe programs.
• They are an essential health service, and vending
  machines play a very important role in providing
  access to sterile equipment - particularly out of
  hours, when other health services are closed."

17
SUPPORT STATEMENTS

• Charles Roberts, Convenor
• Top End Users' Forum Inc.
• TUF supports the expansion of NSPs to include a
  range of outlet types including mobile NSPs and
  vending machines. This must be done in
  conjunction with peer education programs to
  ensure that people who inject drugs are properly
  informed about viruses such as hepatitis C."

18
SUPPORT STATEMENTS

• Nicky Bath, Policy Officer
• Australian Injecting and Illicit Drug Users
  League
• "The Australian Injecting and Illicit Drug Users
  League, (AIVL) supports the provision of sterile
  injecting equipment via static needle vending
  machines. International research shows that such
  machines play an important role in increasing the
  accessibility of injecting equipment to injecting
  drug users thus further contributing to the
  minimising of the transmission of blood borne
  viruses and other injecting related health
  issues. AIVL believes however, that only with a
  coordinated approach that has the key involvement
  of peers and includes broad based education and
  awareness raising will such an initiative be most
  effective and fully endorsed by AIVL."

19
SUPPORT STATEMENTS

• JEAN WYLDBORE
• The Centre for Harm Reduction, Melbourne
• Re Needle Vending Machines (NVM). I am delighted
  to say that expansion is warranted, and that here
  in Victoria, we eagerly await government's
  decision to initiate their programmed
  installation, especially in rural areas. NVM
  appear to have complemented other forms of
  IDU-related harm reduction, and they are a
  valuable asset in public health.
• I am delighted to support the provision and use
  of these machines, but would add that this should
  happen in tandem with peer/user education and
  other types of education (eg of residents'
  groups, community groups, health workers, local
  government), and that - if possible - these
  education programs should in fact be expanded.

20
SUPPORT STATEMENTS

• Shelley Cogger, Peer Education and Support Worker
• DUNES Inc
• Drug User's Network Education and Support (DUNES
  Inc) fully supports any initiative that
  facilitates IDU access to sterile injecting
  equipment. While acknowledging the unique value
  of Peer Education models, limiting the
  transmission of Blood Borne Viruses is a priority
  that may be met by the implementation of vending
  machines in discreet locations.

21
Main Points

• Pharmacists report no noticeable impact on the
  number of Fitpacks they distributed.
• No increase in discarded equipment.
• No negative impact on local free distribution
  (reports of increased distribution).
• In terms of security, there had been no incidents
  reported.
• Clients reached that will not use other services.