Review
Introducing retractable needles into needle and syringe programmes: a review of the issues

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Abstract

Needle and syringe programmes (NSPs) are widely regarded as an effective strategy for controlling the spread of HIV and other blood-borne viruses (BBVs) amongst injecting drug users (IDUs). However, there have been frequent public expressions of concern regarding inappropriate syringe disposal and the perceived risk to the wider community due to needlestick injury. Replacing the injecting equipment currently distributed by NSPs with retractable needles could reduce the risk of needlestick injuries in community settings. This paper reviews the likely impact of such an intervention on the rate of BBV infection amongst IDUs, and the level of inappropriate syringe disposal. To date there has been no trial involving IDUs that assess the acceptability and effectiveness of such a device. However, it does appear that increasing the number of retractable needles distributed relative to current practice, and ensuring acceptability by IDUs is essential to prevent an increase in BBV infections amongst IDUs, and may achieve a decrease. It is difficult to assess the likely impact on the level of inappropriate disposal, as little is known about the origins of currently discarded syringes. The possibility that the level of inappropriate syringe disposal will increase cannot be excluded. Importantly, the introduction of retractable needles into NSPs is unlikely to have any impact on the risk of BBV infection following needlestick injury, as the risk (outside of health settings) is already extremely low.

Section snippets

Background

The introduction of needle and syringe programmes (NSPs) into Australia during the mid-1980s has contributed substantially to the relatively low rate of human immunodeficiency virus (HIV) infection amongst injecting drug users (IDUs) (Dolan, Topp, & MacDonald, 2000). Currently, more than 30 million needles and syringes are distributed to Australian IDUs annually, via over 3000 NSPs including primary (stand-alone) outlets, secondary (hospitals, community health centres, etc.) outlets, mobile

Impact on the rates of BBV infection among IDUs

The rate of BBV transmission amongst IDUs depends on a number of factors including the background prevalence of BBVs and the extent to which syringe sharing occurs. The infectivity of a given syringe containing infected blood is related to the number of infectious particles contained in the blood (Abdala et al., 1999), which is in turn dependant on the health state of the infected person who used the syringe (certain disease stages being more infectious than others), and the environmental

Current patterns of injecting equipment disposal

The current options for disposal of used injecting equipment varies from place to place. For example, in all Australian states it is possible to dispose of syringes by returning them to NSP outlets, and in some states they can be returned to pharmacies. Most states have public disposal bins located in strategic places. In some states it is acceptable to place syringes into an appropriate container (puncture-proof, rigid-walled and sealable), which can be disposed of in the household waste

Discussion

Despite a lot of uncertainties and limited rigorous data, this review highlights a number of points that have implications for the feasibility and desirability of introducing retractable needles into NSPs. The introduction of retractable needles will increase the costs associated with NSPs, but the benefits and cost-offsets remain uncertain and unquantified, making it difficult to evaluate the cost-effectiveness of such an intervention. Potential benefits include a reduction in the transmission

Acknowledgements

In Australia: Dr. Nick Crofts, Centre for Harm Reduction, Macfarlane Burnet Centre for Medical Research, Victoria; Ms. Margaret Macdonald, National Centre for HIV Epidemiology and Clinical Research, NSW; Dr. Adrian Reynolds, Alcohol, Tobacco and Other Drug Services, Queensland; Ms. Maggy Tompkins, The Albion Street Centre, NSW; Dr. Alex Wodak, Alcohol & Drug Service, St. Vincents Hospital, NSW. In the USA: Mr. Dan Bigg, Chicago Recovery Alliance; Dr. Robert Heimer, Department of Epidemiology

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