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From Baltimore in the USA, evidence that encouraging syringe exchange participants to enter treatment will reduce their drug use, crime and injecting more than syringe exchange alone.
DOCUMENT 2011 HTM file
Prevention and control of infectious diseases among people who inject drugs
European Union drug misuse and disease control agencies have come together to offer guidance on how to prevent injection-related disease spread in Europe. Towards the top of the list are widespread injecting equipment supply and heroin substitute prescribing, but neither chime well with the UK's recovery-focused addiction policies.
Until June 2008 Victoria in Canada had a comprehensive extended hours needle exchange at a fixed site in the city. Neighbourhood pressure led to closure, creating a natural experiment in the withdrawal of services. The result seemed to be more sharing of injecting equipment entailing a greater risk of infection.
STUDY 2012 HTM file
Estimating the cost-effectiveness of needle-syringe programs in Australia
Latest mathematical model from Australia probably broadly applicable also to the UK suggests that needle and syringe programmes have cost-effectively saved/improved lives, and in the long run save the health service money due to averted HIV and hepatitis C infections. But in both countries adequately curbing hepatitis C requires much more.
The evidence which led the UK government's drug policy advisers to call for the legalisation of the supply of foil by medical and drug services to drug users to promote transition from injecting to smoking heroin and crack cocaine.
British needle exchanges which piloted distribution of foil packs for smoking heroin found they were widely used and may have increased attendance and reduced the number of injections, lending weight to calls to legalise such provision.
This systematic review of 35 trials found that several sessions of information and skills training were no more effective than minimal educational interventions at reducing the kind of substance use and sexual behaviour which risks HIV infection in drug users who inject and/or use cocaine.
A major concern about needle exchanges is that after use the injecting equipment they supply will be left unsafely disfiguring public areas, but this US study based on a comparison between San Francisco (has legal exchanges) and Miami (exchanges illegal) strongly suggests the opposite.
This thorough review formed the evidential basis for recent guidance from England's National Institute for Health and Clinical Excellence on how best to distribute sterile syringes. Maximising the proportion of injections done with sterile equipment is the key objective.
Consolidates WHO guidance on HIV prevention, diagnosis, treatment and care for key populations including prisoners and people who inject drugs. Strongly advocates universal access of injectors to needle exchange and of dependent opioid users to indefinite, high dose methadone and buprenorphine maintenance.
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