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A Saskatchewan health region is changing how it hands needles out in an effort to get more of them off the street.
“We had quite a large number of people who never brought anything back in,” said Brett Enns, vice-president of primary and community care with the Prince Albert Parkland Health Region.
Around 200 people, representing 28 per cent of those who use the needle exchange at Access Place, never returned their used equipment.
“We tried to continue to educate folks and we tried to ask them to just pick up a couple. We don’t want a one-for-one exchange, and it’s never going to be that, ‘but if you can do your part and bring a few in as you come that would be helpful and that would help with our program,’” Enns said.
“Now we’ve said to folks okay, here are a pack of needles, please bring back some and if you’re not going to bring back some; it’s not that were not going to give you needles, but there might be a reduction in the number of needles that we give you at any given time.”
The reduction of clean needles being handed out concerns Dr. Mark Tyndall, the medical director of the British Columbia Centre of Disease Control.
He was in Vancouver during the HIV and AIDS crisis in the 1990s and early 2000s and said it was restrictive policies with the distribution of needles that was partially to blame for the increased HIV transmission and AIDS deaths.
“So we’ve been down this route before and there’s really no, no room for an enforced exchange. The implications of messing around with something we know very well about, the downside can be quite catastrophic for an individual,” Tyndall said.
“It’s hard to be really critical of people who are really trying to do their best, but I think this is just an ill-advised experiment and the potential downside is that there will be another two cases of HIV that were really unnecessary.”
Enns said personal responsibility is an important piece.
“I think through the work that we have done in terms of education, that individuals do understand their role, they do understand what it means to be a part of the program, and they certainly know the benefit of clean needles and using clean needles, and they do their best to ensure that they get clean needles. This is about the choice of participating in a program for their benefit,” he said.
“I know from anecdotal evidence that it’s a bit of a power-and-control piece that ‘nobody is going to tell me what to do or what not to do,’ and that makes it kind of difficult,”
The health region has a 95 per cent return rate, but last year calculated 56,298 needles weren’t returned. Enns said taking into account the amount of needles these roughly 200 people use, the numbers pretty much match up.
The 200 people in questions are regulars who have used the exchange for several years, Enns said.
“They are folks that have been engaged in our program for a number of years, and so it’s just helping them kind of move along that journey and trying to encourage them to help out with the safe disposal,” he said.
Tyndall said the medical evidence around the prevention of the spread of HIV and AIDS in the injection drug user population says something different.
“The very critical thing that we know from many, many studies and much evidence is that the distribution of needles is much more important than exchange,” he said. “If we see situations where people go to get clean needles and they are told to go away and come back when they can bring their old ones back. I just find that from what we know now, that is totally inexcusable behaviour… We have trouble enough getting people to come and get clean needles sometimes, so I think anything we do to make a barrier to that is unacceptable.”
Tyndall said 28 per cent of people not returning used needles is more than he would have expected, but the best policy would be encouragement and creating incentives for return.
Prince Albert has seen its share of controversy around exchange, including a mayor who wanted to pay people to pick up and return needles, but Enns said this plan has nothing to do with community conversation.
“This isn’t a response to community pressure; it’s about being good stewards and being invested in the program,” he said.
The region is trialling the idea and will review it in the fall to see if it has made any improvements in returns, engaging clients, or if there is a change in accessing services.
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