Following more than 20 years of harm reduction programming and education, needle-sharing practices have generally declined across Canada. However, programs cannot be complacent because sharing continues at varied rates across the provinces and territories.17,20-25
A large Canadian study tells us that people who inject drugs continue to participate in behaviours that can transmit HIV, hepatitis C and hepatitis B. According to this study, 15% of people who inject drugs reported that in the previous six months they had borrowed needles/syringes already used by someone else.17 Rates ranged from 9% to 27% in different parts of Canada. In addition, 31% of people who inject drugs reported borrowing other injection equipment already used by someone else.17 Rates ranged from 24% to 41% in different parts of Canada. Studies also show that people who have trouble accessing a sterile supply of needles are more likely to borrow and share needles.21,26
Given ongoing risk behaviour, and concerns that restricted or lack of access might fuel sharing, the Working Group recommends that sterile needles are distributed to clients in the quantities requested by clients, without requiring the return of used needles, and that programs place no limit on the number of needles provided per client, per visit. These recommendations will help ensure that people who inject drugs will have enough sterile needles and will reduce the need for sharing.
The Working Group also recommends that programs encourage clients to return and/or properly dispose of used needles and syringes. A comprehensive set of recommendations to ensure proper disposal of used needles and syringes is available.
People who inject drugs have individual preferences for needle gauge, syringe volume and brand, and may not use needle and syringe program services if they cannot obtain their preferred types. Needles with a higher gauge are thinner (have a smaller diameter) than needles with a lower gauge. Many people who inject drugs prefer higher-gauge needles because they are often less painful and less likely to result in vein damage.27 People who are experienced with injecting drugs sometimes prefer lower-gauge needles, which can be less likely to clog than higher-gauge needles and are better able to pierce through thick scar tissue.27 To ensure that programs provide equipment that clients want to use, the Working Group recommends that programs:
Best Practice Recommendations: Part 1 provides recommendations and summary of evidence regarding risk, behaviours and prevention related to other injection equipment including cookers, filters, ascorbic acid, sterile water, alcohol swabs and tourniquets. Each of these pieces of equipment can play a role in the transmission of infections and access to all this equipment is important in helping reduce risk. The Working Group offers recommendations for each piece of equipment in individual chapters.
The Working Group recommends that programs provide pre-packaged injection kits and also individual safer injection supplies concurrently. Making it easier to access a sterile supply of all injection supplies will help to reduce transmission of infections and other health-related problems.
We have highlighted one set of recommendations here, but the full document provides recommendations for many other aspects of harm-reduction programming including other injection-equipment distribution, safer crack cocaine smoking equipment distribution, disposal and handling of used drug use equipment, safer drug use education, and education and naloxone distribution in opioid overdose prevention. In an upcoming Prevention in Focus article, we will focus on the distribution of safer crack cocaine smoking supplies.
We are also developing Part 2 of the Best Practice Recommendations, which will focus on program models, testing and vaccination, first aid, referrals and counselling, and relationships with law enforcement and other organizations. Phase 2 is scheduled to be completed in the latter part of 2014.
The authors would like to thank the Canadian Institutes of Health Research for its funding of the project development activities. We are very grateful to the funding received from the AIDS Bureau, Ontario Ministry of Health and Long Term Care to complete the chapters related to needles and syringes, other injecting equipment, safer crack smoking equipment and disposal and handling.
The Best Practice Recommendations for Canadian Harm Reduction Programs that Provide Service to People who Use Drugs and are at Risk of HIV, HCV and Other Harms: Part 1 is the product of the Working Group on Best Practice for Harm Reduction Programs in Canada that, in addition to Strike and Watson, includes: Hopkins S, Watson TM, Gohil H, Leece P, Young S, Buxton J, Challacombe L, Demel G, Heywood D, Lampkin H, Leonard L, Lebounga Vouma J, Lockie L, Millson P, Morissette C, Nielsen D, Petersen D, Tzemis D, Zurba N.
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