B5.1 NSP servicesThe Victorian NSP began in 1987 with the aim of preventing the transmission of HIV (and later HCV) among injecting drug users through the provision of sterile injecting equipment; safe disposal options; information and education around injecting-related issues including vein care, overdose prevention, amphetamine use and appropriate disposal; and referrals to other health and welfare services, including drug treatment services. The Victorian NSP also supplies condoms and lubricants.
The NSP is administered by Health Protection Services (HPS), a unit within the Drugs Policy and Services Branch of the Department of Human Services (DHS). The Drugs Policy and Services Branch, part of the Mental Health and Drugs Division, has responsibility for strategic leadership in drug prevention and policy, service development, drug program funding, and in implementing, operating, monitoring and evaluating drug programs and initiatives.
Victoria's alcohol and other drug (AOD) treatment system operates pursuant to the Victorian Drug Strategy 2006-2009, which underpins a harm minimisation framework with four key objectives: reducing supply; reducing demand; improving access to services; and reducing harm. The Victorian Strategy sits within and complements the national policy approach, including The National Drug Strategy Aboriginal and Torres Strait Islander People's Complementary Action Plan 2003-2009.
Victoria's NSP is governed by the Drugs, Poisons and Controlled Substances Act 1981. Health Protection Services has responsibility for Primary Health, Mobile Drug Safety and Mobile Overdose Response Services, as well as Municipal Drug Strategies. These all cater for injecting drug users and have been established since 2000 under the Victorian Government Drug Initiatives (VGDI) Saving Lives Strategy.
In 2006-2007, over 7.1 million syringes were distributed across Victoria.
Primary, secondary and enhanced secondary NSP servicesOf Victoria's more than 200 active NSP outlets, only 19 receive direct funding specifically to provide NSP services. More than 90% are classified as secondary outlets, where the provision of NSP services is ancillary to the main functions of the host agency and is not directly funded.
Primary NSPs have the greatest capacity to engage in community education activities to provide clients with health information and education and with referrals to other health and welfare services, including voluntary drug treatment. They also provide a forum to maintain collaborative relationships with Police and other agencies, such as schools, pharmacies, local government, and health, drug treatment and welfare agencies.
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In areas of Melbourne with historically high levels of street-based drug use, primary NSPs are co-located with Primary Health Services for IDUs established under the VGDI Local Drug Strategies.
Primary NSP outlets may offer daytime or after-hours mobile services. Mobile services include the 'Foot Patrol' which operates in the Melbourne CBD providing outreach NSP access until 11:15pm seven days a week. Other services supporting NSP agencies are seven Mobile Overdose Response Services supporting hotspot NSPs and nine Mobile Drug Safety Workers operating in association with key NSP outlets – four in Melbourne and one in each of Victoria's five rural and regional DHS regions.
Most Primary NSPs provide needle and syringe retrieval services to the general public. Disposal initiatives include a 24-hour toll-free Disposal Help-line providing counselling, advice and assistance regarding the safe retrieval and disposal of inappropriately discarded injecting equipment. The Department also works in partnership with local government and other relevant agencies to reduce needle and syringe litter and also to improve access to retrieval and disposal facilities across Victoria.
Secondary outlets across Victoria include:
- community health centres
- hospital emergency departments
- local government offices
- drug treatment, accommodation, student, Indigenous, youth and family services
- other health and welfare agencies
- community pharmacies.
An Enhanced Secondary NSP is one of a select number of busier Secondary NSP services, operating from a Community Health or AOD Treatment Service, that is partially funded (through COAG) for staffing to provide education and information to IDUs and the wider community, and referrals to other health and welfare services.
All Primary, Secondary and Enhanced Secondary NSP outlets receive indirect support by way of the provision of consumables for distribution to clients (needles and syringes, alcohol swabs, sharps disposal containers, condoms and lubricant), a range of information and education resources, clinical waste disposal services and, crucially, orientation and further training for NSP workers.
Free hepatitis B vaccination is available to IDU clients of any NSP agency where a registered nurse is available to administer that vaccine, and there are facilities to store it.
Community PharmaciesIn 2004, 666 Victorian pharmacies sold almost one million needle and syringes on a retail basis, at a time when over 6.7 million needle and syringes were being distributed through the NSP. Hence it was gauged that community pharmacies accounted for approximately 13% of all needles and syringes accessed by IDUs.
Out of 1,218 community pharmacies across Victoria, 35 are more actively involved with the NSP – 11 as full secondary outlets and 24 for provision of disposal facilities for used injecting equipment. (The latter generally also provide pharmacotherapy dispensing services and sell injecting equipment on a retail basis.)
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B5.2 Serving Indigenous clientsVictoria's Indigenous population totalled 30,141 at the time of the 2006 Census, being 0.6% of the total Victorian population. Licit and illicit drug use in Indigenous communities has been well documented and remains a priority for DHS. In 2004 DHA collated available data on STI and BBV infection among Aboriginal Victorians; recommendations were made on improving data collection, access to services, training for Koori workers and education initiatives in secondary schools.
A 2006 survey of four Victorian NSPs revealed that 7% of their clients were of Aboriginal or Torres Strait Islander origin. Anecdotal evidence from Victorian Koori AOD workers suggests that illicit drug users are generally aged 30 years or younger.
Three of Victoria's 26 Aboriginal Community Controlled Health Services are currently authorised to offer an NSP service.
The Victorian Aboriginal Community Controlled Health Organisation (VACCHO) has taken a number of initiatives designed to improve the effectiveness of services for the State's Indigenous IDUS – for example a report on relevant partnerships and a proposed Memorandum of Understanding with Anex, the umbrella body representing NSP service providers.
DHS sees injecting drug users as a marginalised and hard-to-reach, at-risk population for whom NSPs may be the first point of contact within the health and welfare sectors. This puts NSPs in a unique position, with each service contact representing a potential opportunity to engage the client and encourage safer behaviours, from lower-risk injecting and appropriate disposal practices to accessing drug treatment. These issues are particularly relevant for Indigenous drug users. Stigma, shame and concerns regarding confidentiality and anonymity remain important issues for Indigenous IDUs and often affect their use of NSP services.
A specific project is due to commence in 2008 to raise awareness of the Victorian NSP among Aboriginal Community Controlled Organisations. This will be carried out in partnership with the Victorian Aboriginal Community Controlled Health Organisation (VACCHO) and the Koori AOD Network (Vic). An Access and Equity Project has recently commenced, managed by Anex and investigating culturally and linguistically diverse projects and Indigenous access to NSP services, with a desired outcome of a Memorandum of Understanding with the VACCHO.