The Syringe in the Machine

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					     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
   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.
                            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.

• 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.
“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
  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
• 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.
New Zealand Needle and Syringe Exchange
Programme Review: Final Report. Aitken
 C. The Centre for Harm Reduction (circa
• 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
 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
    Evaluation of the Fitpack®
  Vending machine at Kalgoorlie
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.
   Evaluation of the Fitpack®
 Vending machine at Kalgoorlie
 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.
Report on the Harm Reduction Needs
of Aboriginal People Who Inject Drugs
(National Drug Research Institute, 2002

• 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).
 More Needle Provisions Called
        for in Ireland
Birchard, Karen
Lancet ( (03/04/00) Vol. 355,
No. 9206, P. 818
  In 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
          IN AUSTRALIA
Dave Burrows,
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
  A Rapid Situation Assessment of
          injecting drug use
and blood-borne viruses in the Eastern
        Metropolitan Region
• (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 by
  The Epidemiology and Social Research Program
  Macfarlane Burnet Institute for Medical Research and Public Health
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
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)
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."
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."
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
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.
Shelley Cogger, Peer Education and Support Worker

• 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.
               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.

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