The Syringe in the Machine

1. The Syringe in the Machine Jane Dodding & Matt Gaughwin. Drug & Alcohol Unit, Royal Adelaide Hospital Australian Journal of Public Health 1995 Vol 19 number 4. • Vending machines likely to prevent some sharing. • Vending machines be introduced to complement or supplement existing services,but not as a replacement strategy

2. Stark K, Leicht A, Muller R. (1994) Characteristics of users of syringe vending machines in Berlin. Soz Praventivmed; 39(4):209-216 • Found that compared to other studies of IDU in Berlin (conducted at syringe exchange programs) the users of the vending machines had significantly shorter history of iv drug use.

3. Curtin University The Fitpack study Project Team • Chief Investigator: Dr Simon Lenton • Project • Aims: To: (i) access drug injectors with little or no prior contact with drug treatment agencies (ii) describe their characteristics, BBVI risk behaviours and feedback on services and (iii) challenge some stereotypes about citizens who inject drugs. Findings: • Most respondents wanted to see sterile water (75.7%) and swabs (65.6%) sold with Fitpacks, and 79.7% wanted Fitpacks available in vending machines. • The most common problems buying Fitpacks were the negative attitudes of pharmacy staff and unavailability e.g.. after hours. Conclusions: The study successfully accessed a diverse group of drug injectors not typically seen in agency and peer recruited research. They provided useful feedback about how harm reduction strategies to reduce BBVI transmission among injectors can be improved. However, they also reported higher rates of injecting and sharing than previously found in traditionally recruited samples of injectors which suggests there is no room for complacency. International Journal of Drug Policy 11(4):285-297.

4. “Syringe Vending Machines for Injection Drug Users in Marseille, France” Obadia, Yolande; Feroni, Isabelle; Perrin, Vincent; et al. American Journal of Public Health (12/99) Vol. 89, No. 12, P. 1852; • These individuals were more likely to be under the age of 30, to report no history of drug maintenance treatment, and to report no sharing of drug injection equipment. The researchers concluded that vending machines may help provide access to syringes for younger drug users, who have typically avoided needle exchange programs and pharmacies.

5. Needle and Syringe Vending Machine Trial Evaluation Report 2: Albury (Sept 1995) • There was no increase in inappropriate disposal and the disposal bin located nearby was well used. • There were no reports of vandalism and the police said that there had been no complaints made to them about the machine. • Staff at the hospital were provided with in-service training prior to installation of the machine to allay their concerns regarding safety, dealing with IDU and encouraging drug use by providing needle and syringes. There were no reports of problems encountered by hospital staff in relation to dispensing machine clients.

6. New Zealand Needle and Syringe Exchange Programme Review: Final Report. Aitken C. The Centre for Harm Reduction (circa 2003) • Three electronic dispensers provide after hours access to injection equipment in NZ. Two of the machines are co-located with needle exchange services. These two machines are responsible for approximately 15% of total needle and syringe distribution at each exchange. • Over one third of respondents to a survey of needle exchange users about service delivery issues selected “out-of-hours fit vending machines” (36.7%) as their preferred method of improving NE services. A further 23.7% selected “longer opening hours” indicating that users see increased availability of equipment as important. • The review recommends that the use of electronic dispensers be expanded to provide greater after-hours service.

7. Moatti JP, Vlahov D, Feroni I, Perrin V, Obadia Y (2001). Multiple access to sterile syringes for injection drug users: vending machines, needle exchange programs and legal pharmacy sales in Marseille, France. Eur Addict Res; 7(1):40-45. • Compared to NEP users, vending machine users were younger and less likely to be enrolled in a methadone program or to report being HIV positive. They also had lower financial resources (vending machines exchange a used syringe for a new one at no cost) and were less likely to be heroin injectors than both pharmacy and NEP users.

8. Evaluation of the Fitpack® Vending machine at Kalgoorlie Hospital Adrianne Moloney Northern Goldfields Health Services, Public & Community Health  • Fewer people entering the hospital at night increased security for staff. • Public and Community Health unit experiencing an increase in Fitpacks® distributed.  

9. Evaluation of the Fitpack® Vending machine at Kalgoorlie Hospital • In terms of disposal of Needle & Syringes there does not appear to be any significant difference since the introduction of the Fitpack vending machine. ·  Clients satisfied, with the convenience of after hours access and anonymity. · Overall the trial of the Fitpack® vending machine has been successful.

10. Report on the Harm Reduction Needs of Aboriginal People Who Inject Drugs (National Drug Research Institute, 2002 Recommends: • Vending machines with 24 hour access in both metropolitan and rural locations (specific locations should be determined on the basis of identified need and in consultation with local communities).

11. More Needle Provisions Called for in Ireland Birchard, Karen Lancet (www.thelancet.com) (03/04/00) Vol. 355, No. 9206, P. 818In their Feb 21 report Making Contact: An Evaluation of a Needle Exchange, the Merchant's Quay Project, Dublin, recommend: syringe-vending machines to provide 24-hour needle supplies; pharmacy involvement in distribution of syringes; and mobile needle exchanges.

12. THE STATE OF NEEDLE & SYRINGE SUPPLY MEASURES IN AUSTRALIA Dave Burrows, http://users.xcel.net.au/drugarm/research/burrows_full.htm IDU Policy Officer, Australian Federation of AIDS Organisations Several respondents called for more vending machines to increase access to equipment. AFAO supports the use of these machines, as long as peer education and other types of education (eg, of residents' groups, community groups, health workers) are maintained or expanded.

13. A Rapid Situation Assessment of injecting drug useand blood-borne viruses in the Eastern Metropolitan Region RECOMMENDATIONS • (depending on possible policy changes) the installation of syringe vending machines to provide anonymous out-of-hours service, especially in outer areas • increasing safe injecting equipment disposal options across the EMR • Conducted byThe Epidemiology and Social Research ProgramMacfarlane Burnet Institute for Medical Research and Public Health

14. SUPPORT STATEMENTS Peter Parkes, Manager Canberra Alliance for Harm Minimisation and Advocacy. • Whilst CAHMA is conscious of the ongoing need for delivery of quality education and intervention in Needle and Syringe Programs (NSPs), and for an increase in Peer Based models of NSP delivery, we feel that it is equally important that further outlets for injecting equipment become available. As such, CAHMA fully supports the integration of vending machines (providing sterile injecting equipment) into current and newly established Needle and Syringe Programs in Australia.

15. SUPPORT STATEMENTS Stuart Loveday, Executive Officer Hepatitis C Council of NSW "The Hepatitis C Council of NSW fully supports any initiative that facilitates access to sterile injecting equipment by people who inject drugs. Australia is a world leader in having prevented high levels of HIV infection among those people who inject. As a result, HIV rates in the broader, heterosexual Australian community have remained exceptionally low. This major public health success has been achieved through the provision of sterile injecting equipment, information and education through Australia's needle and syringe program. (continued)

16. SUPPORT STATEMENTS Stuart Loveday, Executive Officer Hepatitis C Council of NSW Vending machines are an easy, convenient and safe way to dispense sterile injecting equipment, and we support their use. Of course they need to be used in conjunction with the existing education services provided by primary and secondary NSP services, and we would not support budget cuts to staffed NSP services in order to fund any exclusive expansion in vending equipment. In other words, we see them as complementing, not replacing, staffed needle and syringe programs. • They are an essential health service, and vending machines play a very important role in providing access to sterile equipment - particularly out of hours, when other health services are closed."

17. SUPPORT STATEMENTS Charles Roberts,Convenor Top End Users' Forum Inc. • TUF supports the expansion of NSPs to include a range of outlet types including mobile NSPs and vending machines. This must be done in conjunction with peer education programs to ensure that people who inject drugs are properly informed about viruses such as hepatitis C."

18. SUPPORT STATEMENTS Nicky Bath, Policy Officer Australian Injecting and Illicit Drug Users League • "The Australian Injecting and Illicit Drug Users League, (AIVL) supports the provision of sterile injecting equipment via static needle vending machines. International research shows that such machines play an important role in increasing the accessibility of injecting equipment to injecting drug users thus further contributing to the minimising of the transmission of blood borne viruses and other injecting related health issues. AIVL believes however, that only with a coordinated approach that has the key involvement of peers and includes broad based education and awareness raising will such an initiative be most effective and fully endorsed by AIVL."

19. SUPPORT STATEMENTS JEAN WYLDBORE The Centre for Harm Reduction, Melbourne Re: Needle Vending Machines (NVM). I am delighted to say that expansion is warranted, and that here in Victoria, we eagerly await government's decision to initiate their programmed installation, especially in rural areas. NVM appear to have complemented other forms of IDU-related harm reduction, and they are a valuable asset in public health. • I am delighted to support the provision and use of these machines, but would add that this should happen in tandem with peer/user education and other types of education (eg of residents' groups, community groups, health workers, local government), and that - if possible - these education programs should in fact be expanded.

20. SUPPORT STATEMENTS Shelley Cogger, Peer Education and Support Worker DUNES Inc • Drug User's Network Education and Support (DUNES Inc) fully supports any initiative that facilitates IDU access to sterile injecting equipment. While acknowledging the unique value of Peer Education models, limiting the transmission of Blood Borne Viruses is a priority that may be met by the implementation of vending machines in discreet locations.

21. Main Points • Pharmacists report no noticeable impact on the number of Fitpacks they distributed. • No increase in discarded equipment. • No negative impact on local free distribution (reports of increased distribution). • In terms of security, there had been no incidents reported. • Clients reached that will not use other services.