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 Jane.Buxton@bccdc.caEmma Preston, Sunny Mak, Stephanie Harvard

and HR committee

Outline Background

What is Harm Reduction (HR)? Current HR supplies in BC

Methods Mapping product distribution using GIS Qualitative interviews

Results

What can we do with this information? Future directions and recommendations

Background

The BC Harm Reduction Strategies and Services (HRSS) committee Representation for each regional health authority

(5), the BC Ministry of Health, FNIH & BCCDC The BC HRSS policy states that:

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 Current Supply list includes

varieties of: condoms lubricants needles and syringes alcohol swabs sterile water vials

> 150 ordering sites in BC Preliminary analysis revealed wide

variations between and within HAs

The objective of this study is to:

1) Analyze distribution of HR products by site using geographic information systems (GIS)

2) Investigate the range, adequacy and methods of HR product distribution using qualitative interviews

MethodsSupply Distribution

The BCCDC pharmacy database tracks HR supplies distributed to health units and community agencies 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.

MethodsQualitative Interviews

Eleven face-to-face interviews were conducted in eight mainland BC communities: Included outside Vancouver Used an open-ended questionnaire

Questionnaire domains included: 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

ResultsQualitative Interviews

How are HR supplies distributed?

How supplies were made available: 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

Degree of client engagement Referrals to detox, blood borne pathogen/STI testing

Secondary distribution First Nations communities Sex trade workers Groups of IDUs

ResultsQualitative Interviews

Perspectives on the adequacy of Harm Reduction products

Male condoms available at each site Lubricated were generally preferred (~5:1) Younger clients preferred flavoured

Female condoms not widely used Highest distribution where actively engaged and educated the women

Needles and syringes Most clients use 0.5 or 1 cc syringes with needles attached Larger syringes likely used for injecting steroids

Water vials Generally, clients are not using sterile water for every injection One site no vials- no one asked for them

Additional requests include: Injection: cookers, filters, tourniquets, sharps containers Miscellaneous: brown paper bags, drinking water Crack use: pipes, mouthpieces, screens

ResultsQualitative Interviews

Collection of used needles

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

Yellow biohazard container, empty rigid shampoo bottles Requested that they be returned to the provider site when full

ResultsQualitative Interviews

Alternate uses of HR supplies

Condoms 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 Plungers used as a pusher for crack pipes to recover crack resin dried

on the inside of the pipe as it cools ~ 1 in 5 syringes used for this purpose as reported by Vancouver front

line staff

ResultsQualitative Interviews

Community buy in and readiness

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?

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 With secondary distribution, true reach and availability of

supplies cannot be determined Variations within jurisdictions

First Nations communities No official HR distribution on First Nations reserves Several barriers to comprehensive HR services

Where do we go from here? ‘Understanding Harm Reduction’ health file developed

Health file re: ‘needle distribution vs. exchange’ in development News letter strategies A consultant employed to develop a ‘best practice’ document

Development of standard training and protocols within HAs 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:

The interviewees who provided their valuable time, experience, and insights

Funding for this study was provided through the BC harm reduction budget

QUESTIONS???