Needle Syringe

Hepatitis C prevalence and needle/syringe sharing behaviours in recent onset injecting drug users.

Robinson GM, Reynolds JN, Robinson BJ.

Wellington Drug Clinic.

AIM. To investigate the prevalence of hepatitis C antibody (anti-HCV) in injecting drug users (IDU), particularly amongst those of recent onset beginning since the advent of the needle-exchange programme. Secondly this study sought information on needle-sharing practices. METHODS. The records of injecting drug users over 2 years from January 1992 were examined for anti-HCV results and needle-sharing reports on initial assessment at the Wellington drug dependency clinic. RESULTS. Amongst 110 injecting drug users 92 (84%) were tested for anti-HCV, and 71 (77%) were positive. There was a significant (p = 0.02) association between the reported duration of intravenous drug misuse and the proportion of injecting drug users who were positive for anti-HCV. Of those injecting drug users who had reported use of less than 4 years, since the introduction of the New Zealand needle exchange programme, 53% were positive for anti-HCV. Needle-sharing was frequently reported to have ever occurred in 74% of these patients at some time, and in 64% of those who reported use of less than 4 years. These differences were not significant. However, in the period before presenting 67% had not shared over the last 3 months and 57% had not shared over the previous 1 year, which are improvements on previous studies of needle-sharing, considered to be the most important mode of transmission for blood-borne viruses in injecting drug users. CONCLUSIONS. These results suggest considerable potential for HIV infection rates among injecting drug users in New Zealand to increase from the current low level. There needs to be continuing emphasis on public health programmes to eradicate needle-sharing, and to promote safe injecting techniques for injecting drug users.

Pharmacists' attitudes about pharmacy sale of needles/syringes and needle exchange programs in a city without needle/syringe prescription laws.

Gleghorn AA, Gee G, Vlahov D.

Department of Health Policy and Management, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.

We assessed pharmacists' practices for needle and syringe (NS) sales and their attitudes toward a needle exchange program through a telephone survey of 75 randomly selected pharmacies in Baltimore, Maryland, where possession of drug paraphernalia is illegal but where NS can be purchased without a prescription. Pharmacists' (n=46) procedures for NS sales included asking for picture identification (54%), requiring a prescription (34%), or requiring a diabetic identification (DID, 34%) for NS purchase; multiple responses were allowed. The median number of prescription and nonprescription NS sold per month was 950. Most (86.6%) pharmacists reported selling NS without prescriptions at their discretion. Pharmacists sold a median of 16 nonprescription NS per month. Pharmacists who required prescriptions or DID (56.5%) sold nonprescription NS significantly less often than those who did not require prescriptions or DID (p=.007). Most pharmacists (87%) were aware of the needle exchange program, 78.3% supported the program, and 67.4% supported selling nonprescription NS in pharmacies. Although there was no difference in anticipated effects of needle exchange or in support for needle exchange between pharmacists who did or did not require prescriptions, DID, or both, pharmacists who did require these items were significantly less likely to support pharmacy sales of nonprescription NS than pharmacists with less restrictive sales policies (p=.04). Although most pharmacists surveyed supported access to sterile NS by injection drug users through a needle exchange program, there was a diversity of approaches to nonprescription NS sales among pharmacists in a city that does not require prescriptions for access to sterile NS. Most supported nonpharmacy needle exchange programs, and more than one half limited injection drug users' access to NS through restrictive sales practices. To reduce injection drug users' exposure to HIV, pharmacists should be educated about HIV prevention and injection drug use and be included in development of HIV prevention programs, including legal pharmacy NS sales.