- Number of NSPs: 797
- Syringes distributed in 1999-2000: 11,566,000
- Approximate cost: $10,290,000
HistoryIn 1987, the NSW government legalised possession of needles and syringes by amending the Drug Misuse and Trafficking Act 1985. A subsidised pharmacy program (the Pharmacy Distribution Scheme, later renamed the Pharmacy Fitpack Scheme) was funded in 1986 with the objectives of increasing access and encouraging the exchange of used syringes for new ones.
The public sector Needle and Syringe Program commenced in NSW in 1986 with a pilot program. In 1988, the program was rolled out across the state on an expanded pilot basis, with a focus on access, education, consumer involvement and the free supply and exchange of equipment.
Although possession of needles and syringes was legalised in 1987, possession of other items used to administer prohibited drugs, including other items of injecting equipment, remains illegal. Pursuant to the Act, the Director- General of Health is empowered to authorise a specified person or a specified class of persons to lawfully dispense needles and syringes (supply of which would otherwise be an offence). Two classes of agency can apply for approval to operate as an NSP. namely non-government organisations and public health sector agencies. Approval is ultimately considered by the Chief Health Officer (NGO's) or Chief Executive Officer or Director (PHSA's).
Responsibility for statewide policy and planning of the NSP rests with the AIDS/Infectious Diseases Unit of the NSW Health Department. Responsibility for service delivery and operational matters is devolved largely to the state's 17 Area Health Services and, to a lesser extent, to a small number of community-based NGO's.
A recent significant event was the NSW Drug Summit, held in May 1999, which resulted in many progressive outcomes for the management and operation of drug-related programs in NSW. In the case of the NSP, the main benefit of the Drug Summit was that it demonstrated that there was broad support for the program and recognition of the need to expand the program commensurate with demand.
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Types of programsNSW has significant numbers of all types of NSPs. It has 34 primary outlets, 282 secondary outlets, 28 outreach services, 56 vending machines and 397 community pharmacy outlets. Within each of the 17 Area Health Services, there is usually at least one primary outlet, often incorporating an outreach component, and a range of secondary outlets which are usually located within community health services, hospital emergency departments and local NGOs This 'hub and spoke' type of approach to NSPs means that the local primary outlet provides support, training and supply of equipment to the secondary outlets within the same area.
There is a small number of primary NSPs operating through non-government organisations, some of which operate in a limited way or cater to a specific target population.
All primary, secondary and outreach NSPs provide needles and syringes, Fitpacks or other disposal containers and other injecting equipment (such as swabs, water, spoons and cotton balls) free of charge. Community pharmacies, operating as part of the Pharmacy Fitpack Scheme, supply Fitpacks that contain either 3, 5 or 10 syringes for a cost of around $3.30 or free if the customer has an exchange. The pharmacies are provided the equipment, through the NSP program at no cost. Vending machines mostly supply a 5 pack with water and swabs for a cost of up to $3 ($1 and $2 being most common).
Injecting equipment is also sold through about 400 non-participating pharmacies on a purely commercial basis. A 1 mL insulin syringe costs an average of $1.50 through these pharmacies, although prices of up to $4.50 for a single syringe have been reported.
All NSPs, including pharmacies, operating as part of the Pharmacy Fitpack Scheme, have disposal facilities provided as part of the program. In addition, a Needle Clean Up Hotline was introduced in 1997 in response to community disquiet generated through disposal of syringes. Whilst the initiative has had relatively modest resources committed, it appears to have significantly reduced visible community complaints about discarded needles. The program is now working on a strategy to further improve local responses to discarded needles by increasing the commitment and involvement of the local government sector.
Barriers and challengesThe early days of the program in NSW were characterised by a significant level of community acceptance in many areas and support from a number of key sectors, most notably the police. In more recent times there has been an erosion of bipartisan political support and the emergence of concerted, organised opposition from particular groups including some local government bodies. During the recent increase in heroin use, street-based drug activity became much more visible in a number of areas, leading to a marked increase in community anxiety. The issue of needle and syringe disposal continues to be the major source of community dissatisfaction with the program.
As a result of the Drug Summit in 1999, a range of new initiatives are now being trialed, including the medically supervised injecting centre in Kings Cross. Following the summit, it seems likely that there will be support for further development of harm reduction programs in NSW (in contrast to the fight to simply preserve the status quo evident in some other states).
Currently the NSP appears to be limiting injection-related transmission of HIV to a very low level and this seems likely to continue for the foreseeable future. The main challenge to this relates to the possibility of outbreaks of HIV infection among particular populations with high levels of risk behaviour, including some indigenous populations and prison inmates. Ensuring effective access to prevention services for high-risk groups of this kind is a priority at this time.
The second major challenge is to achieve a significant reduction in hepatitis C infections. The extent to which further development of the NSP will enable this to be achieved is difficult to predict. Community understanding, acceptance and support for the NSP will probably be a key factor in determining whether such development occurs. Therefore, a key challenge now is to work out how to achieve a much higher, sustainable level of community support.
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