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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.
Fifteen years of research into Vancouver’s needle and syringe programme leads to the conclusion that such programmes can stop the spread of HIV and do not increase harms. However, they can only be effective if their policies allow sufficient sterile equipment to be distributed to ensure injectors always have fresh supplies.
Thorough search for evidence uncovers 37 studies which overall suggest that by tackling sexual and injecting risk behaviours, some interventions protect against HIV in adults with a history of criminal justice involvement. Methadone maintenance emerged as the best established.
Lower-risk needle and syringe combinations seem acceptable to people who inject drugs in England, but given that a sudden change in equipment can be difficult to adjust to, their gradual introduction seems best, alongside an intervention to educate and support.
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