- Number of NSPs: 151
- Syringes distributed in 1999-2000: 3,018,000
- Approximate cost: $830,000
HistoryIn South Australia, the "Clean Needle Program" (CNP) is operated by the Drug and Alcohol Services Council (DASC) within a licensing framework. The legislation (the Controlled Substances Act) provides for trained agency representatives to possess and distribute needles and syringes in compliance with agency protocols.
The Clean Needle Program commenced in South Australia in 1989. The first fixed-site services were located at SAVIVE (South Australia Voice for IntraVenous Education) and Warinilla (a drug treatment service). The pharmacy program commenced in SA in the early 1990's.
Types of programsOf the 151 NSPs in South Australia, there is 1 primary outlet (SAVIVE), 66 secondary outlets (located in hospitals, community health centres and youth services) and 84 community pharmacies (from a potential pool of 380 pharmacies). An informal outreach service is provided by SAVIVE, via their peer educators' informal network. A vending machine was installed at SAVIVE, but was vandalised and is no longer operational. An issue was raised about the appropriateness of vending machines given that they only disseminate equipment and do not provide users with information about safe using.
Of the primary and secondary outlets, 32 are based in the metropolitan area of Adelaide and 34 are in rural areas (mainly in country hospitals). The absence of any metropolitan hospitals from the program means that there are no 24-hour services in Adelaide, although there is 24-hour access through the majority of country hospitals.
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The community pharmacy program is run on a partial cost-recovery basis. The program supplies community pharmacies with Fitpacks at no cost and charges these pharmacies (at cost price) for syringes supplied ($0.1386 per syringe). Pharmacies sell Fitpacks to consumers at a cost of $5 for a 10 pack and $4 for a three pack. If consumers return a Fitpack, they receive a $2.00 discount on a new pack. Currently, the syringes for the Fitpacks are supplied in bulk through the program, with pharmacies being required to assemble the packs themselves. This element of the program has been identified as having an impact on pharmacists' willingness to participate in the program, and is currently being addressed.
In addition to pharmacies that participate in the Needle and Syringe Program, other pharmacies sell needles and syringes on a purely commercial basis. They order equipment (such as the SK-3) from pharmacy wholesales and retail them at whatever price they consider appropriate. As these transactions are outside the bounds of the program, there is very little information available about quantity and price.
Disposal facilities are provided through the program at all NSP sites, including community pharmacies. Some local councils also provide disposal facilities at various sites such as public toilets and council offices. SA has recently launched a Needle Clean Up Hotline, operated through the Alcohol and Drug Information Service (ADIS), whereby members of the public can report syringes found in public places.
Barriers and challengesAccess to NSPs in some locations (some country areas have resisted the introduction of an NSP into their community) and on a 24/7 basis in Adelaide have been issues for the program over the past few years. Only two sites in Adelaide provide after-hours access (at Hindmarsh and Norwood) and neither of these sites are open 24 hours. Encouraging metropolitan hospitals to participate in the program is identified as a major challenge for the immediate future.
There have been several barriers to the involvement of pharmacies in the program, including issues relating to clients' behaviour in the pharmacy (people accessing the methadone program rather than the NSP are not differentiated) and the time-consuming process of assembling the Fitpacks. One of the objectives for the program in SA is to increase the number of community pharmacies participating in the program and work has already commenced through the Pharmacy Guild (SA Branch), to further that objective. An initiative that is being pursued through the community pharmacy program is the provision of information and linkages with other services.
There is a reasonable level of political and community goodwill towards the program and it seems to have been relatively immune from the attacks that the program has faced in some other states.
As distribution of equipment increases, so do the costs of running the program. There is a desire to increase the range of equipment that is available through the program (including spoons and filters), but it is recognised that this will further exacerbate the problem of rising costs.