Drug Treatment Matrix cell D1: Organisational functioning; Reducing harm

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Organisational functioning; Reducing harm

Seminal and key studies on the influence of the organisation on reducing drug-related harm.

S Seminal studiesK Key studiesR ReviewsG Guidancemore Search for more studies

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S How needle exchange is organised is critical (2003). Findings analysis of seminal and more recent studies from six cities demonstrating that how needle exchange is organised is critical to its success. See also other parts of the same series of reviews (2003 and 2004) on needle exchange and hepatitis C. For discussion click here and scroll down to highlighted heading.

S Abstinence-oriented ethos undermines methadone’s harm reduction potential (1995). Australian study of two clinics, one oriented to abstinence, the other to indefinite maintenance. At the former lower doses and time-limited treatment led to more substance use and poorer retention (1993), both associated with increased harm. Shorter retention at the abstinence-oriented clinic seemed to account (1992) for increased criminal convictions among its (former) patients. Across both clinics, the higher the maximum dose a patient received, the longer (1991) they stayed in treatment. For discussion click here and scroll down to highlighted heading.

K For needle exchanges, coverage is the key (2007). Research in California confirms that liberal exchange policies (providing as much equipment as an injector needs) increase the extent to which a fresh set is available for each injection (‘coverage’), which in turn reduces exchange users’ risks of contracting or spreading blood-borne diseases. For discussion click here and scroll down to highlighted heading.

K Vancouver’s needle exchange: lessons of failure (2012). The city which hosted North America’s most prolific exchange nevertheless saw HIV and hepatitis C sweeping through its drugs quarter. Prime among the reasons are believed to have been restrictions imposed and self-imposed on the service, including limited opening hours and one-for-one exchange. Related study below. For discussion click here and scroll down to highlighted heading.

K Focusing on syringe distribution rather than exchange cut HIV risk in Vancouver (2010). Among the policy changes followed by step-downs in risk behaviour and HIV incidence were removing the limit on how many syringes could be obtained, not requiring returns, and separating syringe distribution from collection of used equipment. For more on the dire situation which prompted policy change, see a Findings analysis listed above (turn to p. 3 of the PDF file, p. 26 of document). Related study above. For discussion click here and scroll down to highlighted heading.

K Policies stem from underlying vision of the purpose of needle exchange (2002). Canadian exchanges whose staff saw syringes/needles primarily as a risk to injectors and the public rather than the means to avoid infection, tended to counterproductively limit distribution and to insist on one-for-one exchange. More on the study in a Findings analysis (p. 2 of the PDF file, p. 26 of document) listed below. For related discussion click here and scroll down to highlighted heading.

K Health promotion ethos guides Finnish exchanges (Finnish National Public Health Institute and Department of Infectious Disease Epidemiology and Control, 2008). Finnish exchanges are known as health counselling centres, symbolising that though needle exchange is core, the aim is a comprehensive health-care and disease-prevention service. The evaluation thoughtfully describes the choices and dilemmas in setting up and developing such a service as they have played out in practice.

K Build on access and trust to open doors to other services (2011). Feeling safe and accepted meant users of Canadian needle exchanges were more likely to seek and act on referrals to services such as those providing counselling, nursing, financial support, housing, and HIV, hepatitis C and sexual infection testing and information – important life-savers and life-improvers for a multiply disadvantaged population divorced from mainstream provision.

R Organisational policies on equipment supply and ancillary services determine exchange effectiveness (2004). Last of a four-part Findings series on needle exchange and hepatitis C identifies the active ingredients needed to maximise impact, including service policies. For related discussion click here and scroll down to highlighted heading.

R Philosophy should be that abundant needle/syringe supply is good (2013). Extensive UK review updated in 2013 which underpinned the NICE guidance below. Review found that spread of disease was maximally curbed by exchange policies and philosophies which promote unrestricted and convenient supply of a range of injecting equipment. For related discussion click here and scroll down to highlighted heading.

G NICE says abundance is the objective for injecting equipment provision ([UK] National Institute for Health and Care Excellence, 2014). UK’s official health technology assessor says needle exchanges should supply customers with as much of the right kind of equipment as they need and to allow them to take equipment for others, while at the same time promoting moves away from injecting drug use. Underlying evidence review above. For related discussion click here and scroll down to highlighted heading.

G Scottish guidance on running and commissioning needle exchanges (Scottish Government, 2010). Includes needs assessment, locations, opening hours, staff training, injecting equipment provision policies, and integration with other services.

G Guide to starting and managing needle and syringe programmes (World Health Organization [etc], 2007). Detailed manual for service planners and managers including where and how services should operate, types of injecting equipment provided, other services, staffing, gaining community support, and monitoring how well you are doing.

G Organising a treatment service which also focuses on reducing drug-related deaths ([UK] Collective Voice and NHS Substance Misuse Provider Alliance, 2017). Recommendations and practice examples developed (with the support of Public Health England) by bodies representing drug and alcohol treatment services in England. Itemises characteristics of treatment organisations likely to hinder or promote reduction of harm.

G Methadone as recovery platform and harm reduction ([UK] National Treatment Agency for Substance Misuse, 2012). UK clinical consensus on methadone maintenance and allied programmes tries to balance harm reduction objectives with a commitment to long-term recovery. For related discussion click here and scroll down to highlighted heading.

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