Abstract
Objectives
The British Columbia Centre for Disease Control (BCCDC) tracks the distribution of all harm reduction products subsidized by the BC government, including needles and syringes, sterile water vials, alcohol swabs, condoms, and lubricant. This study measures the distribution of harm reduction products in BC, identifies regional variation in distribution, and estimates the supply/demand ratio for needle and syringe units.
Methods
Using three years of administrative data (2004–2006) from the BCCDC, the quantity of harm reduction products distributed was calculated by Health Service Delivery Area (HSDA). Regional hepatitis C virus (HCV) case report rates were calculated to reflect potential variation in IDU populations at the HSDA-level and the number of needle and syringe units distributed per reported case of HCV was calculated and ranked by HSDA. To compare the demand for sterile injecting equipment to the distribution, the number of illicit drug injections per year was approximated using established estimates of IDU populations in BC and Vancouver.
Results
Marked regional variation exists in the rates of harm reduction product distribution per 100,000 residents aged 15–64. The average number of needle and syringe units distributed annually in BC from 2004–2006 was 5,382,933. The estimated number of injections per year in BC is 24,951,144, suggesting the province distributed 21.5% of the units required to cover all illicit drug injections in the province.
Discussion
Harm reduction product distribution is not equitable between BC HSDAs. The current level of distribution of sterile injecting equipment is inadequate to provide a clean needle for every injection.
Keywords: Harm reduction, needle-exchange programs, British Columbia, substance abuse, intravenous
Résumé
Objectifs
Le BC Centre for Disease Control (BCCDC) suit la distribution des produits de réduction des méfaits subventionnés par le gouvernement de la Colombie-Britannique (aiguilles et seringues, flacons d’eau stérilisée, compresses alcoolisées, condoms, lubrifiants). Nous avons voulu mesurer la distribution de ces produits dans la province, repérer les écarts régionaux dans cette distribution et estimer l’écart entre l’offre et la demande pour les ensembles seringue-aiguille.
Méthode
Nous avons calculé le nombre de produits de réduction des méfaits distribués par zone de prestation de services de santé (Health Service Delivery Area, HSDA) en prenant trois années de données administratives du BCCDC (2004 à 2006). Nous avons aussi calculé les taux de déclaration régionaux des cas d’infection par le virus de l’hépatite C (VHC) pour tenir compte des écarts possibles dans les populations d’utilisateurs de drogue par injection (UDI) dans chaque zone, puis calculé et classé selon la zone le nombre d’ensembles seringue-aiguille distribués par cas déclaré de VHC. Pour comparer la demande d’accessoires d’injection stériles aux quantités distribuées, nous avons calculé le nombre approximatif d’injections de drogues illicites par année à l’aide des estimations établies des populations d’UDI en Colombie-Britannique et à Vancouver.
Résultats
Il existe des écarts régionaux marqués dans les taux de distribution des produits de réduction des méfaits par tranche de 100 000 habitants (15 à 64 ans). Le nombre moyen d’ensembles seringue-aiguille distribués annuellement dans la province entre 2004 et 2006 était de 5 382 933. Le nombre estimatif d’injections par année dans la province était de 24 951 144, ce qui donne à penser que la Colombie-Britannique n’a distribué que 21,5 % des ensembles nécessaires à toutes les injections de drogues illicites sur son territoire.
Discussion
La répartition des produits de réduction des méfaits entre les zones de prestation de services de santé de la Colombie-Britannique est inégale. Les quantités actuelles d’accessoires d’injection stériles que l’on distribue sont insuffisantes pour que chaque injection se fasse avec une aiguille propre.
Mots clés: réduction des méfaits, programmes d’échange de seringues, Colombie-Britannique, toxicomanie, drogue intraveineuse
Footnotes
Formerly at BC Centre for Disease Control, Vancouver, BC
Acknowledgements of support: At the time of the study, Stephanie Harvard was supported by the Canadian Institutes of Health Research and the Western Regional Training Centre for Health Services
References
- 1.BC Ministry of Health. Harm reduction: A British Columbia Community Guide. Vancouver, BC: BC Ministry of Health; 2004. [Google Scholar]
- 2.BC Centre for Disease Control. BC Harm Reduction Supply Services Policy and Guidelines. Vancouver, BC: BC Centre for Disease Control; 2004. [Google Scholar]
- 3.World Health Organization. Biregional strategy for harm reduction: HIV and injecting drug use. Geneva, Switzerland: World Health Organization; 2005. [Google Scholar]
- 4.World Health Organization. Evidence for Action: Effectiveness of Sterile Needle and Syringe Programming. Geneva: World Health Organization; 2004. [Google Scholar]
- 5.Van Den Berg C, Smit C, Van Brussel G, Coutinho R, Prins M. Full participation in harm reduction programmes is associated with decreased risk for human immunodeficiency virus and hepatitis C virus: Evidence from the Amsterdam Cohort Studies among drug users. Addiction. 2007;102:1454–62. doi: 10.1111/j.1360-0443.2007.01912.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Zou S, Forrester L, Giulivi A. Hepatitis C update. Can J Public Health. 2003;94(2):127–29. doi: 10.1007/BF03404585. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.BC Centre for Disease Control. Enhanced Hepatitis Strain Surveillance System (EHSSS) Review. Vancouver, BC: BC Centre for Disease Control; 2005. [Google Scholar]
- 8.Patrick DM, Tyndall MW, Cornelisse PG, Li K, Sherlock CH, Rekart ML, et al. Incidence of hepatitis C virus infection among injection drug users during an outbreak of HIV infection. CMAJ. 2001;165(7):889–95. [PMC free article] [PubMed] [Google Scholar]
- 9.Wood E, Kerr T, Stoltz J, Qui Z, Zhang R, Montaner JS, et al. Prevalence and correlates of hepatitis C infection among users of North America’s first medically supervised safer injection facility. Public Health. 2005;119(12):1111–15. doi: 10.1016/j.puhe.2005.05.006. [DOI] [PubMed] [Google Scholar]
- 10.Fischer B, Powis J, Firestone Cruz M, Rudzinski K. Hepatitis C virus transmission among oral crack users: Viral detection on crack paraphernalia. Eur J Gastroenterology Hepatology. 2008;20:29–32. doi: 10.1097/MEG.0b013e3282f16a8c. [DOI] [PubMed] [Google Scholar]
- 11.Tortu S, McMahon J, Pouget E, Hamid R. Sharing of noninjection drug-use implements as a risk factor for hepatitis C. Subst Use Misuse. 2004;39:211–24. doi: 10.1081/JA-120028488. [DOI] [PubMed] [Google Scholar]
- 12.Remis RS, Bruneau J, Hankins CA. Enough sterile syringes to prevent HIV transmission among injection drug users in Montreal? J Acquir Immune Defic Syndr Hum Retrovirol. 1998;18(Suppl1):S57–S59. doi: 10.1097/00042560-199802001-00011. [DOI] [PubMed] [Google Scholar]
- 13.Canadian Community Epidemiology Network on Drug Use. Vancouver Drug Use Epidemiology. Vancouver, BC: Canadian Community Epidemiology Network on Drug Use; 2005. [Google Scholar]
- 14.Canadian Centre on Substance Abuse. Canadian Addiction Survey 2004. Ottawa, ON: Canadian Centre on Substance Abuse; 2004. [Google Scholar]
- 15.Vancouver Coastal Health. Injection drug use in the DTES. Vancouver, BC: Vancouver Coastal Health; 2003. [Google Scholar]
- 16.Vancouver Coastal Health. Saving Lives: Vancouver’s Supervised Injection Site. 2006. [Google Scholar]
- 17.Public Health Agency of Canada. I-Track: Enhanced surveillance of risk behaviours among injecting drug users in Canada. Ottawa: Public Health Agency of Canada; 2006. [Google Scholar]
- 18.Prithwish D, Cox J, Boivin JF, Platt RW, Jolly AM. Rethinking approaches to risk reduction for injection drug users: Differences in drug type affect risk for HIV and hepatitis C virus infection through drug-injecting networks. J Acquir Immune Defic Syndr. 2007;46(3):355–61. doi: 10.1097/QAI.0b013e3181565dde. [DOI] [PubMed] [Google Scholar]
- 19.Aceijas C, Hickman M, Donoghoe MC, Burrows D, Stuikyte R. Access and coverage of needle and syringe programmes (NSP) in Central and Eastern Europe and Central Asia. Addiction. 2007;102:1244–50. doi: 10.1111/j.1360-0443.2007.01848.x. [DOI] [PubMed] [Google Scholar]
- 20.Hickman M, Higgins V, Hope V, Bellis M, Tilling K, Walker A, Henry J. Injecting drug use in Brighton, Liverpool, and London: Best estimates of prevalence and coverage of public health indicators. J Epidemiol Community Health. 2004;58:766–71. doi: 10.1136/jech.2003.015164. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Razali K, Thein HH, Bell J, Cooper-Stanbury M, Dolan K, Dore G, et al. Modelling the hepatitis C virus epidemic in Australia. Drug Alcohol Depend. 2007;91(2-3):228–35. doi: 10.1016/j.drugalcdep.2007.05.026. [DOI] [PubMed] [Google Scholar]