Drug and Alcobd Review (1996) 15, 307-310

BRIEF COMMUNICATION

Effects of needle exchanges in Hobart, Tasmania

P E T E R L U C A S 1 & G A R Y E A S T H O P E z

1Department of Community and Health Services, Tasmania and 2Sociology Department, University of Tasmania, National Drug and Alcohol Research Centre, University of New South Wales, Australia Abstract

An examination was conducted of three Tasmanian cohorts of injecting drug users interviewed before the introduction of needle exchanges, during the operation of illegal exchanges and after the introduction of legal exchanges. The drugs reported as used were comparable with reports from Perth and Sydney samples. There are clear downward trends for both males and females toward reduced sharing of injecting equipment and increased use of new equipment which begin when the illegal exchanges were operating and accelerate when the number of exchanges increased and became legal. The use of bleach to clean equipment also increases in the 4-year period. There was a much higher use of open fires to dispose of equipment than has been reported elsewhere. These results strongly suggest that needle exchanges do lead to reduced sharing and to less needles in public places; vital outcomes ffAIDS and hepatitis are to be contained. [Lucas P, Easthope G. Effects of needle exchanges in Hobart, Tasmania, Drug Alcohol Rev 1996; 15:307-310.]

Key words: drug use, HIV infection, needle exchange, preventive medicine.

Introduction

Needle exchanges attempt to reduce the harm of injecting drug use. Providing new needles is ex- pected to reduce sharing and thus cross-infection. This is vitally important for both reducing the risk of HIV infection and hepatitis infection. Further, returning used needles, or disposing of them care- fully, reduces the risk of needle-stick injury to the public.

Most Australian states instituted exchanges as part of a 'harm minimization' strategy. In Tasmania

illegal exchanges operated from early 1992, at some pharmacies and community organizations, with tacit police approval.

The Bill presented to the Tasmanian parliament to establish legal exchanges was initially part of a package which included removing legislation making homosexual acts criminal offences. It was conse- quently defeated. With the separation of the Needle Exchange Bill from homosexual reform an Act was finally passed in July 1993. By May 1994 there were

Peter Lucas BA, MSocSci, Project Officer, Youth Health Strategy, Department of Community and HeaIth Services, Tasmania; Gary Easthope BA, NIA, Phi), Associate Professor, SocloIogy Department, University of Tasmania and Research Fellow, National Drug and Alcohol Research Centre, University of New South Wales, Australia. Correspondence to Gary Easthope at the University of Tasmania, Socioiogy Department, GPO Box 252C, Hobart, Tasmania.

Received 16 February 1996; revised 19 April 1996; accepted for pubfication 17 May 1996.

0959-5236/96/030307-04 © Australian Professional Society on Alcohol and Other Drugs

308 Peter Lucas & Gary Easthope

60~

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40

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~-~ 20 n

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1990 1991-92 Year

0

1994

Figure 1. Reported frequent use (more than 25% of times) offits already used by someone else ([]female, n = 27; [] male, n = 48).

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g 70!

60 g 50 C

40 I g 3o 20

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All New All New (Female) (Male)

75

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Mo~ New

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Most New

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Figure 2. Reported use of new (more than 75% of times) fits by gender (female n = 27; male n = 4& • 1990; [] 1991-92; [] 1994).

78 outlets throughout Tasmania: 65 in pharmacies, 10 in community organizations and three in hospi- tals. Community outlets distribute 72% of syringes (8000) with pharmacies distributing most of the rest (27%, or 3000 syringes).

Methods

Commencing in 1989 the Australian National &ADS and Injecting Drug Use Study (ANAIDUS) interviewed injecting drug users in all state capitals although results have only been reported for Perth [1-3], Sydney [4] and Hobart [5]. The final interviews in Hobart were deliberately deferred until 1994, to ascertain if the introduction of legal ex- changes affected injecting drug users' behaviour. As in the other capitals respondents were re~-uited through word of mouth and advertising in coffee shops, pubs, youth health services and treatment services [6,7].

Two hundred and fifteen interviews were

conducted using the standard national schedule (100 in 1989-90, 90 between 1991 and 1993 and 25 in 1994). To enable comparison between these inter- view sets, three cohorts were constructed: 25 ran- domly selected cases drawn from the 1990 interviews, 25 from the 1991-92 interviews and the final cohort of all 1994 interviewees. Respondents were predominantly male (64%) with a mean age of 24.0 years (a similar composition to the Perth sam- ple but there were more males [75%] in the Sydney sample).

The data were analysed using SAS producing cross-tabulations which were examined for trends [8].

Results

Drugs used and injected

The most common drugs used were alcohol (95%), cannabis (96%) and amphetamines (speed) (100%).

Effects of needle exchanges in Hobart, Tasmania 309

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1990 1991-92 1994 Year

Figm'e 3. ReDorted frequent use (more than 90% of times) of bleach to clean dirty fits (~ male, n = 26; Il female, n = 16).

Of interest is the high use of opium (76% of respondents). Opium is a commercial crop in Tas- mania grown for medical purposes which, despite fences and police action, is sometimes illegally har- vested in small quantities.

Injected drugs were amphetamines (99% of re- spondents), heroin (56%), morphine (55%), pethidine (40%) and cocaine (37%). All the drugs above, except cannabis, were injected at some time.

Heroin use was low (59%) compared with Perth (95%) and Syndey (91%) but amphetamines were more likely to be injected (99%) than in Sydney (89%) or Perth (94%).

Injection practices

Respondents were asked how frequently they shared 'a fit'. There is a consistent trend to reporting less sharing (Fig. 1). Reports of frequent sharing (more than 25% of the time) fall consistently over the three cohorts with no respondents reporting frequently sharing once legal exchanges are operating. A cor- ollary of the fall in frequent sharing is a rise in reported occasional sharing (i.e. between 5% and 25% of the time), especially for females (73% of females and 50% of males report occasional sharing in 1994).

Respondents were also asked how often they used new equipment (see Fig. 2). The use of new equip- ment most or every time rose dramatically when illegal exchanges were operating. Further, it is only in the last two periods that some report the use of solely new equipment.

Reports of frequent use of bleach to clean equip- ment rose i n 1991-92 for males then dropped slightly in 1994. Females report using bleach more

than males for the first time in 1994, a difference which may be related to their higher reported rate of occasional sharing than males (see Fig. 3).

Disposal of used equipment

Of respondents, 45% said equipment should be properly disposed of to avoid injury to the public, especially children. Other reasons given for proper disposal were to avoid public complaint (3%), to stop police hassles (14%) and to stop others using the equipment (6%).

Respondents were also asked what would make disposal easier. In 1990 and in 1991-92 the call was for fitpacks and/or pharmacies accepting used equip- ment. However, by 1994, when these disposal meth- ods were provided, the demand was for bins in public toilets.

In practice many burnt their equipment; 32% said this was their usual method compared with 10% in Perth and 1.5% in Sydney. It probably reflects greater access to open fires in Hobart. It is important to note because evaluations of exchanges often use return rates as indicators of effectiveness [9].

Discuss ion

Overall, these results reiterate more extensive surveys in Holland [9,10], Wales [11], the United States [12,13] and elsewhere in Australia [1-4]. A unique result was the high percentage of fits disposed of in open fires.

These results--and results from all the other sur- veys-could be a result of a general decline in sharing. American research [12,13] found decline in sharing among all respondents. Such a decline could

310 Peter Lucas & Gary Eastbol)e

result from effective harm reduction campaigns or be a result of the spread of needles among non-atten- ders of exchanges. However, both Dutch [9] and W e l s h [ l l ] studies found sharing declined only among exchange users.

Consequently, the most parsimonious explanation for these results is that exchanges do lead to reduced sharing and to less needles in public places. Both these outcomes are vital if AIDS and hepatitis are to be contained. In this respect these Tasmanian results are particularly usefifl as they show a downward trend in reported sharing which began with a few illegal exchanges and accelerated when the number of exchanges increased and became legal. Such a trend is strong evidence that a behavioural change has occurred and that it is a result of providing needle exchanges.

References

[1] Loxley W, McDonald C, Marsh A. The Australian National AIDS and Injecting Drag Use Study; Perth 1990. Perth: National Centre for Research into the Prevention of Drug Abuse, Curtin University, 1992.

[2] Loxley W, Marsh A, McDonald C. Injecting Drug Use in Perth: the Australian national AIDS and injecting drug use study; 1989-1990, summary re- port. Perth: National Centre for Research into the Prevention of Drug Abuse, Curtin University, 1992.

[3] Loxley YV, Marsh A. The Australian National AIDS and Injecting Drug Use Study; Perth: differences between 1989 and 1990. Perth: National Centre for Research into the Prevention of Drug Abuse, Curtin University 1992.

[4] Wodak A, Dwyer R, Ross M, Drury MJ, GoM J, Miller ME. Life at the Epicentre: sexual and drug using behaviour in Sydney, 1989. Second Report of the Australian National AIDS and Injecting Drug Use Study. Sydney: ANAIDUS, I992.

[5] Forbes J, Grimwood A. AIDS risk behaviour of injecting drug users in Tasmania--an 'isolated com- munity'. Paper delivered at the Window of Oppor- tunity Conference, Adelaide, 1991.

[6] Marsh A, Loxley W. Coffee shops and clinics: the give and take of doing HIV/AIDS research with injecting drug users. Aust J PuN Hlth 1992;16:182- 187.

[7] Spooner C, Flaherty B. Comparison of three data collection methodologies for the study of young illicit drug users. Aust J Publ Hlth 1993;17:195-202.

[8] Lucas P. Drug Control--From Punishment to Risk Management. M. Soc. Sci. thesis, Sociolog 9- Depart- ment, University of Tasmania, 1994.

[9] Buning EC. Effects of Amsterdam needle and syr- inge exchange. IntJ Addict 1991;26:1303-1311, esp. p. 1309.

[10] van Ameijden EJC, van den Hoek JAR, Coutinho RA. Injecting risk behavior among drug users in Amsterdam. Am J Publ Hlth 1994;84:275-281.

[11] Keene J, Stimson GV, Jones S, Parry-Langdon N. Evaluation of syringe-exchange for HIV prevention among injecting drug users in rural and urban areas of Wales. Addiction 1993;88:1063-1071.

[12] Guydish J, Clark G, Garcia D, el al. Evaluating needle exchange; do distributed needles come back? Am J Pub1 Hlth 1991;81:617-619.

[13] Watters JK, Estilo/vIJ, Clark GL, LorvickJ. Syringe and needle exchange as HIV/AIDS prevention for injection drug users. JAMA 1994;271:115-120.