REDUCING HARM FROM INJECTION

DRUG USE

NSP Work & Outcomes

SUMMARY

� Who is AIVL?

� Myth Busting about IDU

� What is harm reduction?

� What is the role of NSPs?

� Have NSPs been successful?

� Useful resources & contacts

WHO IS AIVL?

� National peak organisation for the state and territory peer-based drug user organisations and…

� Represents issues of national significance for � Represents issues of national significance for people who use/have used illicit drugs

� Work on all issues affecting people who use/have used illicit drugs including hepatitis C, other BBVs, harm reduction, drug treatment, overdose, welfare reform, housing, drug policy and other health, social and legal issues.

QUIHN

NAP

WASUA

CAHMA

TASCAHRD

VIVAIDS

SAVIVE

QUIHN

NUAA

AIVL works

through member

organisations &

networks

� AIVL operates on a peer-based, user-centredphilosophy, which means the organisation is run by and for people who use/have used illicit drugs.

WHO IS AIVL?

illicit drugs.

� AIVL promotes the health and human rights of people who use/have used illicit drugs.

� AIVL also believes people have the right to be treated with dignity and respect.

� And to live their lives free from discrimination, stigma and human rights violations.

MYTH BUSTING - IDU

� Who are injecting drug users?

� Is there an average injecting drug user?

� Why do people inject drugs?

� What drugs are being injected?

� What are some of the harms?

WHO ARE IDU?

� People who inject drugs are one of the most marginalised groups in the community.

� IDU come from all cultural and socio-economic backgrounds.

� Drug user or the “junkie” stereotype exists for a � Drug user or the “junkie” stereotype exists for a reason – most visible/obvious

� But people who fit the stereotype are the minority of IDU – just as people with severe alcohol problems do not represent everyone who uses alcohol.

� IDU are members of the community – people’s parents, siblings, children, partners, etc.

WHO ARE IDU?

� Demographics from available data:

� Need to be cautious about data due to illicit nature of behaviour

� Surveys capture a small sample/based on limited modelling or formulamodelling or formula

� National NSP Survey:

� Median age of IDU early 30’s

� 12-25% young IDU (under 25 in sample 2002-2006)

� Hep C Projections 2006:

� 120,000 regular

� 210,000 occasional IDU

IS THERE AN AVERAGE IDU?

� Short answer – “NO”

� There are however clusters of issues and experiences that many IDU experience to varying degrees.

� These often get depicted as “all drug users are…” or � These often get depicted as “all drug users are…” or “the average drug user does …” - myths

� In reality however, there are many cultural, socio-economic, physical, environmental and opportunistic variables that impact on an individual’s drug using ‘journey’ or ‘career’ – there are no generalisations.

� This is important – it means no-one is a ‘lost cause’ or ‘too far gone’

WHY DO PEOPLE INJECT?

� How long is a piece of string?

� As many reasons as people who use drugs but..

� No-one expects to become an injecting drug user.

� Myth No.1: “peer pressure”� Myth No.1: “peer pressure”

� Myth No. 2: “one shot and you’re hook”

� Myth No. 3: “all drug users are dependent”

� The “Pleasure Factor”

� Myth No. 4: “drug users are bigger risk takers than others”

� Impact of discrimination and stigma on health

WHAT DRUGS ARE BEING INJECTED?

� Main source of data nationally and in NSW is IDRS (Illicit Drug Reporting System) http://ndarc.med.unsw.edu.au/ndarc.nsf

� Annual survey of injecting drug users

� Good way to stay informed about trends and � Good way to stay informed about trends and emerging issues

� Key issues from 2007:

� Increase in opioid use (heroin & pharmaceutical);

� Decrease in methamphetamine use;

� Stabilising of methadone/buprenorphine injecting;

� High levels of cocaine use in minority of NSW sample;

� Increase in benzo injecting/combined with opioids.

WHAT ARE SOME OF THE HARMS?

� Many people use for years without significant harms.

� Not to say that people cannot and do not overdose, contract a blood borne virus first injection or early.

� But this is not the experience of the majority.

� Harms in Reality:� Overdose rates: have dramatically decreased since 2000

� HIV: very low rates – less than 5%

� HCV: high – 62% national prevalence in 2006

� Other health harms – endocarditis, vein care problems, abscesses, septicemia, amputations (rare) , thrombosis, etc

� Other harms – financial, legal, social (family & friends), employment, children, etc.

WHAT IS HARM REDUCTION?

� Harm Reduction Vs Abstinence

� What is Harm Reduction?

� Harm Reduction in everyday life� Harm Reduction in everyday life

� Harm Reduction in relation to illicit drugs

� What is the relationship between Harm Reduction and Harm Minimisation?

� Does harm reduction work?

HARM REDUCTION Vs ABSTINENCE

� Too often harm reduction approaches and abstinence approaches are described as “polar opposites”.

� Wrongly harm reduction is seen as “encouraging” or “promoting” drug use – this is NOT TRUE!

� Harm reduction simply mirrors the drug use continuum.

HARM REDUCTION Vs ABSTINENCE

� Obviously not using at all reduces your risk of harm.

� But it is also possible to significantly reduce the risk of harm from illicit drug use while people risk of harm from illicit drug use while people continue to use.

� This is the basis of the harm reduction approach.

� Put simply, harm reduction values people and values lives and does not agree that illicit drug use needs to = death, disease or discrimination.

� Harm reduction is about keeping people alive.

HARM REDUCTION IN EVERYDAY LIFE

Harm Reduction is NOT something new and is not just about illicit drugs…

� Seat belts in cars

� Cancer Screening� Cancer Screening

� Wearing helmets on bikes

� Sun Protection (hats, sunscreen, etc)

� Using condoms/Safer Sex

� Nicotine patches/gum/nasal-spray

� Heart-smart foods

HARM MINIMISATION

SUPPLY REDUCTION DEMAND REDUCTION HARM REDUCTION

Police Abstinence Based Peer Education

Customs Treatments NSPCustoms Treatments NSP

Current Drug Laws Prevention Education Drug User Organisations

Prisons Drug Courts OST Programs

Courts Naltrexone Treatment Safe Injecting Rooms

Diversion Heroin Prescription

NEP in Prisons

OST in Prisons

BBV Prevention

DOES HARM REDUCTION WORK?

� Harm reduction is officially endorsed and supported by WHO, UNAIDS & UNODC

� Australia has one of the lowest HIV rates among IDU in the world

� Opioid Substitution Treatment makes up vast majority of in-demand drug treatment programs

� Methadone and buprenorphine – now on WHO Essential Medicines List

� NSP shown to be one of the most effective public health programs available

� Peer education evaluates as highly effective

WHAT IS THE ROLE OF NSPs?

� How & when did NSPs start?

� What range of services to NSPs offer?� What range of services to NSPs offer?

� What is the NSW picture?

HOW & WHEN DID NSPs START?

� First illegal NSP in Sydney in 1986

� First legal programs followed soon after

� NSP has been in operation for 22 years� NSP has been in operation for 22 years

� Australia now has NSPs in all states and territories

� Primary outlets, secondary services, pharmacy, vending machines

� Approx. 800 NSP outlets in NSW

� This does not include pharmacy (over 400)

RANGE OF SERVICES NSW NSPs OFFER?

� Access to new injecting equipment

� Needles & syringes

� Other equipment (spoons, swabs, water)

� Disposal containers� Disposal containers

� Specialised equipment (large barrels, butterflies, pill/bacterial filters, etc)

� Education & harm reduction information

� Ancillary services – BBV & sexual health screening, Hep B vaccination, vein care, etc.

� Referrals to drug treatment and other health, social and legal services

WHAT’S THE NSW PICTURE?

� Primary outlets – NSP specialist services

� Secondary outlets – community health, youth & AOD services, A&E Depts.

� Mobile Outreach & Pedestrian Outreach

Pharmacy outlets – majority under Pharmacy NSP � Pharmacy outlets – majority under Pharmacy NSP Scheme, small number (2-5% of total distribution) independent.

� Over 35 million N&S distributed nationally each year with over 12 million of these in NSW.

� Over 91% of NSW respondents in National NSP Survey used new N&S for all (68%) or most injections (23%)

SUCCESS OF NSPs?

� Return on government investment?

� But what about hepatitis C?� But what about hepatitis C?

� Why have NSPs had less impact in relation to hep C?

� Could we be doing better?

WHAT’S THE RETURN ON GOVT INVESTMENT IN NSPs?

� Nationally – Return on Investment Study 2002 between 1991 and 2000 Australian NSPs are estimated to have:� Prevented approximately 25,000 HIV transmissions among

people who inject drugs;

� Saved over $7 million in HIV/AIDS lifetime treatment costs;

� Prevented approx 21,000 cases of hepatitis C transmissions among people who inject drugs between 1988 and 2000; and

� Saved an estimated $783 million in HCV lifetime treatment costs.

� Provide a return on investment of $7.7 billion for an investment of $150 million.

WHAT’S THE RETURN ON GOVT INVESTMENT IN NSPs?

� NSW – Return on Investment in HIV/AIDS Programs 2007 found that:� Return on investment in HIV prevention programs direct cost

to direct benefit ratio of 1:13 (every $1 invested/$13 saved);

Compared to 1:2 (Tobacco) and 1:0.70 (Heart Disease)� Compared to 1:2 (Tobacco) and 1:0.70 (Heart Disease)

� Prevented 44,500 cases of HIV – with 75% of these among IDU;

� Representing a 99% reduction in HIV cases that would otherwise have occurred among IDU;

� Saved an estimated $18 million in HIV lifetime treatment costs through prevention programs.

WHAT ABOUT HEP C?

� No NSW Return on Investment in NSP Study in relation to hepatitis C as yet.

� National Study does show a very worthwhile investment.investment.

� But not as effective as the return on investment for HIV.

� National HCV prevalence of over 60%

� In 2006, 71% of NSW respondents to the National NSP Survey were HCV antibody +

� But some success – reported use of used injecting equipment is declining.

WHY LESS IMPACT WITH HEPATITIS C?

� Complex range of factors including:

� High levels of injecting in Australia;

� Did not commence prevention efforts early enough;enough;

� NSPs have not been sufficiently ‘scaled-up’ to address the additional challenge of hep C;

� Not reaching young/new IDU;

� Insufficient access to equipment;

� Legal barriers;

� High levels of stigma & discrimination.

CAN WE DO BETTER?

� Need to reach people before they commence injecting;

� Need to expand access to new injecting equipment through:equipment through:

� 24 hour access

� Increase number of outlets

� Increases in amounts of equipment available

� Commence NEP in Prisons

� Funding for more peer educators

� Reduce stigma & discrimination

FURTHER RESOURCES

� IHRA Global State of Harm Reduction Report May 2008 www.ihra.org.au

� NSP - Questions Answered & NSP - Review of the Evidence www.health.gov.au

� National NSP Survey 2002-2006 � National NSP Survey 2002-2006 www.med.unsw.edu.au/nchecr

� Returns on Investment in NSP Study www.health.gov.au

� NSW Return on HIV/AIDS Investment www.health.nsw.gov.au

� AIVL Disposal Report & NEP in Prisons www.aivl.org.au

CONTACT DETAILS

� My Details:

� Annie Madden

� Executive Officer

� Australian Injecting & Illicit Drug Users League (AIVL)

� Ph: (02) 6279 1600

� Email: anniem@aivl.org.au

� Website: www.aivl.org.au

CONTACT DETAILS

� NSW Drug User’s Organisation:

� Nicky Bath

� General Manager

� NSW Users & AIDS Association (NUAA)

� Ph: (02) 8354 7300

� Email: nickyb@nuaa.org.au

� Website: www.nuaa.org.au