Snapshot
History
Types of programs
Barriers and challenges

Snapshot

  • Number of NAPs: 88
  • Syringes distributed in 1999-2000: 1,381,000
  • Approximate cost: $622,000
The program in Tasmania is referred to as the "Needle Availability Program ("NAP").

History

In 1993, the Tasmanian Parliament passed the HIV/AIDS Preventive Measures Act, which established the regulatory framework for NAPs. Prior to this time, there had been some informal (and unlawful) dissemination of needles and syringes by individuals committed to preventing the transmission of HIV. The Act declares that permits are required to operate an NAP and identifies the basis upon which permits can be issued. Agencies wanting to run an NAP apply for a permit, nominate the individual (s) who will disseminate the equipment and have the conversation with the clients, attend education and training sessions etc. Once the permit is granted, the individual (permit holder) can delegate these powers to others, should they be unable to undertake them themselves.

The management of the NAP has always rested within the Sexual Health Branch under the Division of Health Advancement within the Department of Health and Human Services. There have been some suggestions that it should be moved to Drug and Alcohol Services within in the Department of Health and Human Services. This has, however, been resisted, on the basis that the focus of the program must be harm reduction and this is in sometimes in contrast with the philosophy surrounding the Alcohol and Drugs Services' approach to drugs.

The most commonly injected drugs in Tasmania vary between regions. Clients indicate, via a data-collecting tool administered to clients each time they access a NAP, that in Hobart the drugs mostly commonly injected are morphine or methadone; in Launceston it is morphine and amphetamines; and on the north-west coast, amphetamines are the drugs mostly injected. In 1999/00 only 4.3% of injecting drug users in Tasmania indicated that they mostly inject heroin.
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Types of programs

Tasmania has no primary outlets (its largest NAP is located within the Tasmanian Council on AIDS and Related Diseases TasCAHRD), 28 secondary outlets (disseminating approximately 80% of all syringes) and 60 pharmacy-based outlets (disseminating approximately 20% of all syringes).

The secondary outlets are co-located with a range of services including hospitals, community health services, youth health and drug and alcohol services. There are a few 24/7 services, located within Accident and Emergency Departments in hospitals. Unfortunately, this is not the case in either Hobart or Launceston, although in Hobart a 24/7 Alcohol and Drug Detoxification Unit is involved in the program.

The secondary outlets order injecting equipment from a Medical Supply Company with which the Tasmanian Department of Health and Human Services ("DHHS") has a contract. The equipment is available to the NAP at no cost, but the outlets do not receive funding to provide the NAP service nor any ancillary services (such as disposal, referral, information, staff etc).

Pharmacy-based outlets provide equipment to clients for a fee. They order equipment in the same manner as secondary outlets and, similarly, are not charged for the supply of this equipment. Unfortunately, due to a range of factors, the variety of equipment available through the pharmacy-based outlets is usually limited to 1mL Fitpacks.

The standard prices that are charged for equipment are $6 for a 10 pack (10 syringes, 10 swabs, 10 water ampoules, Fitpack10 disposal unit) and $4 for the 3 pack (3 syringes, 3 swabs, 3 water ampoules and FitPack3 disposal unit). If the client returns a FitPack they are able to purchase a 10 pack for $3 and a 3 pack for $2. If however, they cannot afford to pay, they will not be refused equipment. The Department of Health and Human Services has an agreement with pharmacies that was written 10 years ago. A Memorandum of Understanding is now being negotiated between the Department of Health and Human Services and the Pharmacy Guild of Australia (Tasmanian Branch) to clearly document the roles and responsibilities of both Government and Pharmacies in the NAP. All pharmacy-based outlets provide disposal facilities for returned equipment at their own cost.

NAPs provide an extensive range of equipment including different types and sizes of needles (18-30 gauge), different types and sizes of syringes (1mL-20mL), a range of sharps containers (1.4-68 litre), water swabs, FitPacks (3 and 10), insulin syringes (27 and 29 gauge). Outlets are able to order whatever equipment they believe their clients need, and package it in appropriate ways. In other words, there is no standard "pack" provided through Tasmanian NAPs. Secondary outlets do not charge consumers for any of the equipment that they supply through the NAP.

In addition to the pharmacy-based outlets participating in the NAP (approximately 50% of all pharmacies in Tasmania), other pharmacies sell syringes on a purely commercial basis.

Barriers and challenges

The biggest barrier that has been faced in Tasmania, like most jurisdictions, is the political sensitivity of needle and syringe programs. As a result, the government has chosen to take a low key, discrete approach to the operation of NAPs.

Some government health agencies, although well positioned to host an NAP (such as large metropolitan hospitals and community health centres), have declined invitations to be involved. They appear not to have been further encouraged by respective Ministers.

Another issue has been the trend away from bipartisan political support for the NAP in Tasmania since the last change of government. This has led to the NAP being used for political purposes, rather than being recognised as an important public health initiative. It is anticipated that this push to dampen down public health initiatives could have significant future consequences for the program.

As a result of the continual increase in the number of needles and syringes distributed, the costs of running the Program are also increasing. This has led to varying suggestions for strategies including a review of the program and a user-pays program.
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