Return on investment in needle and syringe programs in Australia: report

Australian Capital Territory

Page last updated: 2002

Snapshot
History and program framework
Types of programs
Barriers and challenges

Snapshot

  • Number of NSPs: 35 (including pharmacies)
  • Syringes distributed in 1999-2000: 593,000
  • Approximate cost: $539,000

History and program framework

Needle and Syringe Programs have been operational in the ACT since 1989. The Drugs of Dependence Act 1989 was amended to provide for the licensing of three occupational groupings (doctors, nurses and pharmacists) plus individuals who had successfully completed an authorised training program and who were accredited by the Chief Health Officer. The training program is currently conducted by Assisting Drug Dependence Inc (ADDInc) with funding from ACT Department of Health and Community Care. ADDInc is also contracted to coordinate all other services associated with the operation of NSPs including supply, distribution and returns.

Types of programs

As at June 2001, there were 35 NSPs operating in the ACT consisting of:
  • 2 primary outlets (ADDInc and Canberra Injectors Network);
  • 11 secondary outlets such as government funded health services like community health centres and non Government services; and
  • 22 pharmacy based programs.
There is usually a small outreach service provided for sex workers, but this is not operational at this time. The pharmacy program is relatively new, having been established with the assistance of COAG funds some 12 months ago. A person has been employed at ADDInc to coordinate the development and growth of the pharmacy program. Except for this paid position, the program is largely self-funded.

Pharmacy packs (consisting of 4 syringes, 4 ampoules of water, swabs, spoons and a disposal unit) are provided to the pharmacy at a cost of $2 and sold to customers for $4. All pharmacies in the program (along with all other NSP sites in the ACT) provide disposal facilities. However, there is no discount for people who return packs to pharmacies (as is the case in some jurisdictions).
Top of page
The primary and secondary outlets provide a different type of kit consisting of syringes, water ampoules, swabs, spoons, cotton wool and a disposal unit. All of this equipment is available to users without charge. They also have available other forms of injecting paraphernalia such as butterfly clips and wide boar syringes, some of which is sold at cost recovery rates. The primary outlets provide the full range of ancillary services including information, education, referral, disposal and condoms.

The ACT has a comprehensive needle and syringe disposal strategy. As noted above, all NSPs (including pharmacies) have disposal facilities. This is supported by the following strategies (largely funded by the Department of Urban Services):
  • sharps disposal facilities in every public toilet in the ACT;
  • a Sharps hotline – a city ranger collects disposed syringes from public land and from private citizens who find a syringe on their land. Businesses are expected to pay for disposal costs;
  • training for individuals (such as cleaners) on how to collect and dispose of syringes safely;
  • a depot for bulk waste; and
  • a range of brochures advising "how to dispose safely of used syringes" and "what to do if you find a syringe". ( to be released soon)

Barriers and challenges

The issues confronting the ACT NSP over the past 12 years are similar to those experienced in other jurisdictions. The primary issue provoking community angst has been the disposal of needles and syringes. The ACT has responded to public concern by strengthening its strategies around disposal. A related issue has been the call for one-for-one exchange of syringes (i.e. that supply of a needle is contingent on the return of a used needle). This has been resisted to date, and its continued resistance largely rests on the political will of the ACT Legislative Assembly.

An interesting historical event was the move towards the provision of a greater range of injecting paraphernalia in each pre-packed kit that was distributed. The rationale for this was the risks of transmission of hepatitis C in ways other than through sharing syringes. Some consumers did not like the new packs as they were too big and bulky. NSPs received strong negative comment about the packs and subsequently streamlined the packs.

It is expected that the issues of disposal and one-for-one exchange will continue to arise on a periodic basis. In addition, there has been some discussion about a move towards a user-pays system in the NSP's primary and secondary outlets (as is already the case in community pharmacies).

The other issue that is of some import is after-hours access. Only one service (Calvary Hospital) provides FitPacks after 9pm and is not centrally located. ADDInc is currently negotiating with other potential hosts with a view to expanding the range of after-hours services.