More than Just Needles:
an evidence-informed approach to
enhancing harm reduction supply
distribution in British Columbia
Canadian Public Health Association Meeting
June 2008
Jane Buxton
[email protected]
Emma Preston, Sunny Mak, Stephanie Harvard
and HR committee
Outline
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Background
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What is Harm Reduction (HR)?
Current HR supplies in BC
Methods
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Mapping product distribution using GIS
Qualitative interviews
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Results
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What can we do with this information?
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Future directions and recommendations
Background
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The BC Harm Reduction Strategies and Services
(HRSS) committee
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Representation for each regional health authority
(5), the BC Ministry of Health, FNIH & BCCDC
The BC HRSS policy states that:
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Each health authority and their community partners will
provide a full range of HR services to their jurisdiction
HR products should be available to all who need them,
regardless of where they live and choice of drug
Are we there yet?
Background
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Current Supply list includes
varieties of:
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condoms
lubricants
needles and syringes
alcohol swabs
sterile water vials
> 150 ordering sites in BC
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Preliminary analysis revealed wide
variations between and within HAs
The objective of this study is to:
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1) Analyze distribution of HR products by site
using geographic information systems (GIS)
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2) Investigate the range, adequacy and methods
of HR product distribution using qualitative
interviews
Methods
Supply Distribution
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The BCCDC pharmacy database tracks HR supplies
distributed to health units and community agencies
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A 19 month period (May 2006 - November 2007) was used
to ensure inclusion of sites that placed infrequent orders
Distribution of HR supplies were calculated
 All needles (with or without syringe) were collated to
produce the total volume of needles distributed
 Data was analyzed using GIS.
Methods
Qualitative Interviews
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Eleven face-to-face interviews were conducted in
eight mainland BC communities:
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Included outside Vancouver
Used an open-ended questionnaire
 Questionnaire domains included:
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How HR supplies are distributed
Perspectives on the adequacy of current HR products
Collection of used needles
Alternative uses of supplies
Perceived community buy-in
Themes were identified using standard iterative methods
Results were discussed with HRSS committee
Results
Supply Distribution
Results
Qualitative Interviews
How are HR supplies distributed?
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How supplies were made available:
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Degree of client engagement
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Privacy: separate rooms, brown paper bags
One-for-one needle exchange vs. needs based distribution
Clients required to ask for all supplies, place order in
advance, basket at reception desk
Referrals to detox, blood borne pathogen/STI testing
Secondary distribution
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First Nations communities
Sex trade workers
Groups of IDUs
Results
Qualitative Interviews
Perspectives on the adequacy of Harm Reduction products
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Male condoms available at each site
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Female condoms not widely used
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Most clients use 0.5 or 1 cc syringes with needles attached
Larger syringes likely used for injecting steroids
Water vials
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Highest distribution where actively engaged and educated the women
Needles and syringes
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Lubricated were generally preferred (~5:1)
Younger clients preferred flavoured
Generally, clients are not using sterile water for every injection
One site no vials- no one asked for them
Additional requests include:
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Injection: cookers, filters, tourniquets, sharps containers
Miscellaneous: brown paper bags, drinking water
Crack use: pipes, mouthpieces, screens
Results
Qualitative Interviews
Collection of used needles
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All sites reported encouraging clients to return used needles
Only one site reported trying to ensure one-for-one exchange
Some sites provided clients with individual sharps containers
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Yellow biohazard container, empty rigid shampoo bottles
Requested that they be returned to the provider site when full
Results
Qualitative Interviews
Alternate uses of HR supplies
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Condoms
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Non-lubricated as tourniquets
Used by crack smokers to hold exhaled smoke to share or inhale it ‘for a
second take’
Water balloons
Unusual use of female condoms and Lube
Syringes
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Plungers used as a pusher for crack pipes to recover crack resin dried
on the inside of the pipe as it cools
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~ 1 in 5 syringes used for this purpose as reported by Vancouver front
line staff
Results
Qualitative Interviews
Community buy in and readiness
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Participants reported few community development initiatives
regarding HR or pick-up of discarded needles
Perception that the HR philosophy is new to many healthcare
workers and the general public
Some interviewees felt their community was ripe to hear the
messages because ‘there’s been a few drug related tragedies
[recently]’
What have we learned?
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There is evidence in BC that HR supplies are not
equally available throughout the province.
GIS illustrates where availability of HR supplies may
be lacking
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With secondary distribution, true reach and availability of
supplies cannot be determined
Variations within jurisdictions
First Nations communities
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No official HR distribution on First Nations reserves
Several barriers to comprehensive HR services
Where do we go from here?
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‘Understanding Harm Reduction’ health file developed
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Health file re: ‘needle distribution vs. exchange’ in development
News letter strategies
A consultant employed to develop a ‘best practice’ document
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Development of standard training and protocols within HAs
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Staff to give HR advice and referrals for services and testing
Increase client awareness and engagement
Enhance profile and availability of culturally appropriate HR services for
Aboriginal populations
Improve 2nd distribution date collection
Crack pipe mouthpieces and wooden push sticks are now available
and distribution is being explored at local level
Different sizes of needles being rationalized
Single distributor being explored; acceptability of needles
With thanks to:
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The interviewees who provided their valuable
time, experience, and insights
Funding for this study was provided through
the BC harm reduction budget
QUESTIONS???