1. Module 2 Harm Reduction and the Needle and Syringe Program

2. What we will be doing 1.A brief look at the basics of injecting drugs and doing it as safe as possible. 2.The Needle and Syringe Program – why we have it and what it does? 3.A look at local harm reduction services in your area. 4.Discuss mandatory reporting requirements in the context of NSP service provision. 5.‘Fitpacks’ – a show and tell.

3. Safer Drug use – the basics Injecting drugs can come with many complications People should be encouraged to use alternatives when possible: 1. Smoke 2. Swallow 3. Snort 4. Shelve/Stuff

4. How young people may come to inject? – a reminder Peer pressure, connection to others who inject Often opportunistic and unplanned Disadvantage: homelessness, poverty, neglect Pragmatic reasons: cheaper than smoking, bigger high

5. Peers and injecting 26% of young people have been exposed to injecting through friends or peer groups or have been offered drugs to inject in the past “The role of peer networks is not necessarily productive of injecting practice, but rather provides the historical moment in which injecting may or may not happen” (Bryant et al 2012)

6. Meth/amphetamines – especially young people Steroids – greater numbers among young people/new to injecting Heroin Cocaine Benzodiazepines Methadone Oxycontin/oxycodone Morphine Commonly injected drugs

7. Avoiding Overdose Basic but good advice you can give Have a small ‘taste’ first - you can never be sure of what you’re injecting Mixing downers can lead to overdose eg benzos, heroin, alcohol, methadone Do not inject drugs when you are alone Know what to do if someone else overdoses – Dial “000” place in recovery position wait with them and let the ambos know what they’ve taken. Police rarely attend an overdose call out.

8. Basic messages around BBV prevention and safer injecting get injecting equipment first find a safe place to inject having your own equipment having enough equipment be aware of hygiene and cleanliness think about injecting site choice and rotation dispose of injecting equipment safely

9. This will help reduce Blood borne virus infections Other bugs (bacterial and fungal infections) Overdose risk Collapsed veins

10. The Needle and Syringe Program An Overview Including: The Australian Drug Strategy Types of NSP Services Offered Local Services Equipment distributed

11. Harm Minimisation has formed the basis of Australia’s Drug Policy since 1985 Three strands include Demand Reduction – eg Education, Taxation Supply Reduction – eg Police, Customs Harm Reduction – eg NSP

12. Harm Reduction Harm reduction works on the overriding principle that human beings will engage in certain activities despite a demonstrated risk in those very activities

13. Why? Accepts, for better and for worse, that licit and illicit drug use is part of our world and chooses to work to minimise its harmful effects rather than simply ignore or condemn. Does not attempt to minimise or ignore the real and tragic harm and danger associated with licit and illicit drug use. Harm Reduction

14. The Needle and Syringe Program An evidence based public health program that aims to protect the community from the spread of infections such as HIV and hepatitis C among people who inject drugs and the wider community

15. As of 2014 over 1000 outlets in NSW Where? What? The Needle and Syringe Program

16. in NSW, 2012 33 Primary 300 Secondary NSPs 141 Automatic Dispensing Machines 488 Community Pharmacies The Needle and Syringe Program

17. Types of NSP service Primary Staffed by specialist NSP workers, offer bulk equipment, large range of equipment, health education and health promotion activities, referral into broader health/social services, sometimes clinical services Secondary Located in a range of settings, eg. Community Health Centres, hospital Emergency Departments, youth services etc. Non-specialist staff involved in NSP duties. Core business is not NSP delivery.

18. Outreach Vehicle and foot patrols which allow services to be provided directly to street based drug using scenes, may also involve home visits to clients in geographically isolated areas, those who are unwell or face other restrictions to travel. ADMs Allows for a completely anonymous service, 24 hour availability. May have a financial cost to user (usually $2 -$4) Types of NSP service

19. Pharmacies Through the Pharmacy Fitpack Scheme, selected pharmacies provide additional access points in a range of community settings. Privately operated, NSW health funded. Types of NSP service

20. Core NSP services: o injecting equipment o brief interventions o education and harm reduction advice o referral information o responsive community clean-up and disposal service Some also offer: Primary clinical management of BBV BBV screening; assessment; HBV vaccination NSPs What do they do?

21. 1.NSPs increase drug use? 2.NSPs lead to increased discarded syringes? 3.NSPs lead users into treatment? NSPs True or False?

22. During 2000 – 2009, $243m funding for NSP services resulting in: An estimated 96,667 cases of hepatitis C being averted An estimated 32,050 cases of HIV averted For every $1 of expenditure more than $4 in health care cost- savings in the short term For every $1 of expenditure more than $27 returned when including patient/client costs and productivity gains and losses Making net present value of NSP’s $5.85 billion Return on Investment 2: Evaluating the cost-effectiveness of needle and syringe programs in Australia 2009 DOHA,NCHECR, 2009 NSPs Do they work?

23. Where? Who? How? Your local NSP services

24. Example slide: services available in Nowra

25. protecting children & young people is everyone’s responsibility, including NSP workers persons in professional work or paid employment delivering NSP services are mandatory reporters under NSP Guidelines a child is a person below the age of 16 years, a young person is someone aged 16 or 17 years NSPs and Young People

26. Under NSW NSP Guidelines an NSP worker: must report children under 16 at “risk of significant harm” A child injecting drugs is at risk of significant harm may report: – Young persons aged 16 or 17 years – Homelessness in a child or young person – Prenatally if you believe child will be risk of significant harm after birth NSPs and Young People

27. To think about a balanced approach To engage the child or young person in order to assess their situation and their exposure to harms To identify and respond to any risk of significant harm It is important that interventions do not discourage the child or young person from continuing to use the service, where this is appropriate, as this may place their health at further risk. What is the role of the NSP worker?

28. To attempt to engage the child/young person to assess the level of risk (including risk of exposure to blood borne virus) To assess whether provision of clean equipment is appropriate To assess extent of any other risks faced by the child/young person and provide appropriate support, advice, referrals or other interventions Prior to providing equipment NSP staff must provide the child/young person with information on alcohol and other drug support services. What are the responsibilities of the NSP worker?

29. NSP and mandatory reporting As Mandatory Reporters NSP providers must Be clear on differences ‘Children’ vs ‘Young people’ in reporting Follow NSW Mandatory Reporter Guide (May 2013) Follow decision making tree and process for reporting If in doubt consult your Child Well Being Unit for guidance Refer to NSW NSP Guidelines (NSW Ministry of Health 2013) Refer to your own organisation's policies Be aware of the anonymous nature of NSP services

30. Do you have your own reporting procedures Do these sit with the above policies? Given the information provided what are some key questions that would assist in assessing if a young NSP client was at risk of significant harm? NSP and mandatory reporting

31. The Mandatory Reporter Guide (MRG) http://sdm.community.nsw.gov.au/mrg/scre en/DoCS/en-GB/summary?user=guest http://sdm.community.nsw.gov.au/mrg/scre en/DoCS/en-GB/summary?user=guest ‘Keep Them Safe’ Support Line 1800 772 479 1800 772 479 The NSW NSP Guidelines (2013) see hand out Resources

32. Activity: Fitpacks – a show and tell

33. Alcohol and Drug Information Service (ADIS) 9361 8000 / 1800 422 599 A 24 hour, confidential telephone service for people in NSW. It provides information, counselling, referral and advice to anyone concerned about their own or another’s alcohol or other drug use. ADIS

34. Tel: 02 9332 1599 (Sydney) Tel: 1800 803 990 (NSW) On line support: www.hep.org.auwww.hep.org.au Hepatitis Infoline

35. NSW Users and Aids Association (NUAA) Tel Offices: (02) 8354 7300 NSP direct: (02) 8354 7343 For rural callers: 1800 644 413 (NSW only) NUAA

36. Lunch break (45 mins)