Needle+and+syringe+exchange+-+Reducing+harm+within+Australia

Michelle Jankalns 8839735 Tutor: Mangalam Sankupellay

Needle and syringe exchange - Reducing harm within Australia
 * Artefact **

This is a photograph that I took of the closest centre offering needle exchange to where I live. This facility is located at 568 Gympie Road, Strathpine and offers not only needle exchange but a range of other services to the community including community child health, sexual health, child, youth and adult mental health as well as aged and primary health care. This centre accepts sharps containers up to 200ml in size to reduce the risk and potential dangers that needles and syringes have to the community.

Prior to numerous other countries, the Australian Government adopted Harm minimisation in 1985 and it was seen as a breakthrough in the approach of a national drug policy (Wodak, 2000). Harm minimisation acknowledges that some people will always use drugs and focuses on taking steps to reduce the damage and burden that these people cause to themselves, their friends and families and the community as a whole (van Beek, 2009). Needle and syringe exchange programs (NSEP) are one facet of a harm minimisation approach.
 * Public Health Issue **

National drug strategy Australia's 2010-15 national drug strategy (NDS) has a threefold mechanism to address drug use within Australia (Ministerial Council on Drug Strategy, 2011).
 * Literature review of current evidence **
 * 1) Demand Reduction which has a focus in preventing the uptake of drugs, reducing their misuse and supporting people in the recovery from drug dependencies.
 * 2) Supply Reduction this focuses on reducing the current and emerging supply of drugs mainly using law enforcement. This involves both seizures of illicit drugs as well as convictions of traffickers, dealers and individual drug users.
 * 3) Harm Reduction which focuses on reducing the harm caused by drugs to communities, families and individuals (Department of Health and Aging [DHA], 2011). Under this strategy the NSEP targets the reduction of blood borne viruses and infections from unsafe injecting practices and the methadone maintenance programs providing a substitute for heroin that prevents cravings and withdrawals for users allowing them to actively participate in their lives and contribute to society (World Health Organisation [WHO], 2006).

Harm Reduction Harm Reduction is seen by many as the most important initiative within the NDS as it focuses on raising awareness within the community and it also provides assistance for people to change their attitudes and behaviours towards drugs (Stimson, 1998). Thousands of people every year suffer the short and long term health effects of drug dependencies, unsafe injecting practices and infections (Douglas & McDonald, 2012). An advantage of the Harm minimisation strategy is that it helps to reduce this burden, for example the NSEP which according to the Australian Drug Foundation (ADF) June 2012, these programs are estimated to have prevented 32,000 cases of HIV and averted nearly 97,000 cases of Hepatitis C between 2000/09. The ADF also state that for every $1 invested by the Australian Government on NSEP it returned $27 to the community in health and other savings (ADF, 2012). This can then be compared to the figure provided by the Australian Federal Police's Drug Harm Index which provides a measure of the overall economic value of illicit drug seizures both domestic and overseas for the Australian community it shows that $5 was returned to the community for every $1 spent for 2009/10 (DHA, 2011).

According to the 2013 report by National Drug & Alcohol Research Centre (NDARC) between 2009/10 the Australian state and federal governments spent $1.7billion on strategies for illicit drugs. $1.12billon (66%) of this amount went towards law enforcement, $518million (30%) was spent on treatment and prevention and only $36million (2%) was spent on harm reduction (NDARC, 2013). This is not to say that Supply reduction is not extremely important within Australia. In 2011/12 alone 23.8 tonnes of illicit drugs were seized nationally and the number of seizures and arrests for illicit drugs are the highest on record in the last decade (Australian Crime Commission [ACC], 2013). Although given the proven success within the community of a harm reduction approach, it has been suggested that responding to illicit drug use within Australia and internationally should require a more balanced approach between the law enforcement and health focused responses (NDARC, 2013).

Harm Reduction and Incarceration One way this harm reduction strategy is currently lacking is in regards to HIV, Hepatitis C and other blood borne infections contracted and spread by addicts and drug users in our prison system. The NDARC says that one third of convicted injecting drug users continued to inject while within the prison system and another one third of these users went on to contract Hepatitis C while incarcerated (NDARC, 2013). This is not only an individual health problem for the inmate but it also has public health repercussions within society. When these inmates then leave prison they return home to infect their families, friends and other members of the community (Levy, Treloar, McDonald, & Booker, 2007). Even though, within Australia it has become widely accepted that clean needles are offered to users to help reduce the spread of blood bone viruses and the harm that they cause to the community, there are currently no NSEP within Australian prisons (Levy et al, 2007).

At the end of June 2012 there were 29,383 prisoners within Australia's prisons and 12% of this was for illicit drug offences (Australian Bureau of Statistics [ABS], 2013). In 2012-13 the average cost per prisoner within the Australian prison system was $315 per day. Indigenous Australians are currently vastly overrepresented in Australian prisons sitting at 27% of the prison population when at the same time Indigenous Australians only made up 3% of the total Australian population as of June 30, 2011 (ABS, 2013). Research has shown that indigenous offenders have worse outcomes from incarceration than for non-indigenous prisoners and that there are considerable benefits in the diversion of offenders into community residential drug and alcohol rehabilitation services over incarceration. This rehabilitation approach is estimated to financially save almost $111,500 per offender in monetary value and almost $93,000 in non-financial benefits including lower mortality rates and greater health benefits upon release (Australian National Council on Drugs [ANCD], 2012.

Social constructionism Social constructionism occurs when ideas and values become so widespread that through general consensus they become the habitual 'way things are done' and influence the thoughts and actions within a society (Andrews, 2012). Within Australia there are still some negative socially constructed ideas that criticise this strategy and the way it deals with illicit drug use. The NSEP are seen to condone drug use and send the wrong message to young people. As a community worker in Victoria said "My personal opinion, as a parent, is that we shouldn’t have a needle exchange. I think that . . . if there’s a needle exchange, like based at the Aboriginal Health Service . . . that means that the Aboriginal Health Service, which is seen as a very, very strong organisation, a good organisation in this Community, is saying to young people, you use drugs and we’ll give you a clean needle. We can’t be seen to be in a position of condoning drug use. We always have to maintain the position that we are against drug use . . .We have to promote a healthy life-style" (Van der Sterren, Anderson & Thorpe, 2006, p. 222).
 * Cultural and Social Analysis **

Social and Cultural groups affected Society has constructed very stigmatised views in regards people who fail in their attempt to become abstinent which can cause even more psychological damage to the user (McKeganey, Morris, Neal, & Robertson, 2004). If users are unable to achieve abstinence they may believe the socially constructed idea that they have failed, lack self restraint and personal control and have no moral judgement (Ahern, Stuber, & Galea, 2007). It can be a long and difficult journey for an addict to abstain completely as found by McKeganey et al. in a 2004 study of 859 illicit drug users, where 8 months after rehabilitation and treatment only 11% had been able to have a period of abstinence of at least 2 weeks.

Otherness For people who are injecting they often become socially isolated and alienated by the community and their families and friends making them outsiders to the community. This alienation affects not only their physical health but their self esteem and cultural health and identity as well leaving them spiritually bereft as a result (Van der Sterren, et. al. 2006, p. 221). This underlines why drug use and addiction should be seen as a public health issue as well as a social issue not punishing the victims of addiction, criminalising and disconnecting them from their communities, their family, potential future employment and acceptance as a member of society (Douglas, Wodak, & McDonald, 2012).

Social and cultural forces of influence

Social ideals and perceptions have played a large part in societies opinion of drug use and have changed drastically since the 1900's. Since then drug use has become seen as a large scale social problem and since then there has been a growing stigmatisation of drug users (Whitlock, 1980). In 1971 President Nixon (United States of America [USA]) declared a 'War on Drugs' criminalising drug users and stating that drugs are 'public enemy number one', even for very small infractions. This provides youth with criminal records for the rest of their life, eliminating their work potential and restricting their chances for a better future (Johnson, & Wanta, 1996). Rather than providing minimum offenders with civil penalties, for instance fines, this approach criminalises people. This criminalisation approach also prevents youth from seeking help or talking about these issues and asking questions, because they are scared of the consequences not only from their parents and the police but the way society has already constructed its views about them and what kind of people they are (Douglas et al, 2012).

Australia has a very close relationship with the USA and as such we follow closely in the constructed ideals that they put before us from shared political views to cultural forms (Bell, 1996). The 'War on Drugs' became an International standpoint with the implementation of the United Nations Drug-Related Treaties in 1961, 1971 and 1988 (United Nations Office on Drugs and Crime, 2013) and has shaped the views of many people within Australian society (Douglas et al, 2012). It is a completely abstinent, prohibition, zero-tolerance and criminalising approach to dealing with illicit drugs and does not take into account the underlying public health issues perpetuating drug use in communities (Morris, 2010).

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When I first started looking into Harm Minimisation and investigating this topic, I had a view shared by many people within our society, that drug users need to just be abstinent and have some self control about what they are doing to themselves. The more I researched I found that while abstinence is a goal that every illicit drug user should aspire to it can be a hard goal to achieve, and this is why an approach of harm minimisation is so essential to help to reduce the impact that these users have on the community while they are still in the clutches of addiction.
 * Personal Reflection and Artefact Analysis **

I chose to use this image of the Pine Rivers Community Health Centre for my artefact because of how confronted I was from my own constructed ideas about what a needle exchange should look like. Before going to take my photos I was worried "is it going to be safe to bring my good camera?" and wondering if I would be harassed or even accosted by 'unsavoury' people if I parked anywhere near the place to take a photo. When I arrived to take a photo of my closest 'intimidating' needle exchange I found that the car park was full of mothers with prams taking their children to a ordinary community medical facility, a couple of elderly people were even eating sandwiches under a tree. It really struck home how much I had assumed that because of the services offered there this place would be daunting and possibly dangerous. After doing so much research into drugs and the people that use them, I had thought that I was much more open minded and accepting of these people, but I was shocked to see how ingrained these socially constructed ideas are within our minds.

This assessment piece has shown me that it takes more than just acceptance to change your view of the world and the way that you perceive things. It takes a conscious effort to change your thought patterns and to question the information that is put in front of you. In working on this skill, in the future I will be more prepared to analyse information that is given to me, to adapt to situations and environments and gain understanding before jumping to conclusions and applying unwarranted judgments which would just emphasise my own ignorance.

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1. Name: Hui Jie Chee  Wiki: How Soon Will They All Be Forgotten Again? http://healthcultureandsociety2013.wikispaces.com/How+Soon+Will+They+All+Be+Forgotten+Again%3F
 * Reflections **

Well done on your wiki, it certainly made me reconsider my own shopping tendencies. I agree that as consumers we have an ethical obligation to pay more attention to where our clothes are coming from. It is interesting to see that a very small increase in wages would have such a minuscule effect on the end cost of a garment. It definitely makes me wonder why these companies don’t feel more obligated to look after their workers. I would absolutely be willing to spend more money to know that a garment has been made ethically! One question I had while reading your wiki was when you said ‘living wage’, do you mean the cost of living for these workers? Overall I found the information that you supplied on this subject compelling and that your choice of artefact was very well suited to your discussion. 2. Name: Caitlan Golder Wiki: Sex position of the week.   http://healthcultureandsociety2013.wikispaces.com/Sex+position+of+the+week. Great work! I found your wiki a very interesting read. It certainly brought forward emotions and a strong feeling against the way society seems to embrace a ‘rape culture’. I find it disturbing to see such a low rate of reporting for sexual assaults and how unlikely it is for the ones that are reported to result in a conviction. It is encouraging that Australia is moving away from a focus of blaming the victim and beginning to put the onus on the perpetrator. Your artefact definitely drew me to read your wiki. It certainly depicts how society accepts funny, inappropriate images rather that seeing them for what they are. Unfortunately, it seems that images like these are found everywhere these days and it is becoming a societal norm to be exposed to them. I found your personal reflection excellent and I really liked the cartoon that you finished on. Well done!

Ahern, J., Stuber, J., & Galea. S. (2007). Stigma, discrimination and the health of illicit drug users. //Drug and Alcohol Dependence, 88//(2-3). p. 188-196. Retrieved September 16, 2013 from []
 * References **

Andrews. T. (2012). What is Social Constructionism?. //The grounded theory review, 11//(1). Retrieved September 10, 2013 from http://groundedtheoryreview.com/2012/06/01/what-is-social-constructionism/

Australian Bureau of Statistics. (2013). 4517.0 - Prisoners in Australia, 2012. Retrieved October 30, 2013 from http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/4517.0Main%20Features12012?opendocument&tabname=Summary&prodno=4517.0&issue=2012&num=&view=

Australian Bureau of Statistics. (2013). 3238.0.55.001 - Estimates of Aboriginal and Torres Strait Islander Australians, June 2011 Retrieved October 30, 2013 from []

Australian Crime Commission. (2013) Illicit drug data report 2011-2012. Retrieved October 19, 2013 from http://www.crimecommission.gov.au/publications/illicit-drug-data-report/illicit-drug-data-report-2011-12

Australian Drug Foundation. (2012). Needle and syringe programs in prison - June 2012. Retrieved September 5, 2013 from http://www.adf.org.au/policy-advocacy/policytalk-june-2012

Australian National Council on Drugs. (2012). An economic analysis for Aboriginal and Torres Strait Islander offenders - Prison vs residential treatment. Retrieved September 15, 2013 from http://www.deloitte.com/assets/Dcom-Australia/Local%20Assets/Documents/Services/Corporate%20Finance/Access%20Economics/Deloitte_Prison_vs_Residential_Treatment.pdf

Bell, P. (1996). "Americanization": Political and cultural examples from the perspective of "Americanized" Australia. //American studies (Lawrence)(0026-3079)//, //37//(1), p. 5. Retrieved September 25, 2013 from https://journals.ku.edu/index.php/amerstud/article/view/2778/2737

Department of Health and Aging (2011). Australian Government activities against the NDS priorities. Retrieved October 20, 2013 from http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/Publishing.nsf/content/6CF0F14624F192A2CA2578560081C38C/$File/ar3.pdf

Department of Health and Aging. (2011). National Drug Strategy. Retrieved September 10, 2013 from http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/nds2015

Douglas, R. & McDonald, D. (2012). //The Prohibition of illicit drugs is killing and criminalising our children and we are all letting it happen//. Australia21, Canberra.

Douglas, R., Wodak, A., & McDonald, D. (2012). //Alternatives to prohibition: Illicit drugs: How we can stop killing and criminalising young Australians.// Australia21, Canberra.

Johnson, T. J., & Wanta, W. (1996). Influence Dealers: A path analysis model of agenda building during Richard Nixon's War on Drugs. //Journalism and Mass Communication Quarterly, 73//(1), 181-194. Retrieved from []

Levy, M. H., Treloar, C., McDonald, R. M., & Booker, N. (2007). Prisons, hepatitis C and harm minimisation. //Medical Journal of Australia, 186//(12), p. 647-9. Retrieved from http://search.proquest.com/docview/235775335?accountid=13380

McKeganey, N., Morris, Z., Neal, J., & Robertson, M. (2004). What are drug users looking for when they contact drug treatment services: Abstinence or harm reduction? Drugs: Education, Policy and Prevention, 11(5), 423–435.

Ministerial Council on Drug Strategy. (2011). National Drug Strategy 2010-2015. Retrieved September 15, 2013 from []

Morris, K. (2010). Drug crime and criminalisation threaten progress on MDGs. //The Lancet, 376//(9747), 1131-2. Retrieved from http://search.proquest.com/docview/756679283?accountid=13380

National Drug and Alcohol Research Centre. (2013). Law enforcement takes the lion's share of illicit drug spend. The University of New South Wales: Sydney

Roy. E., Nonn. E., & Haley, N. (2008). Transition to injecting drug use among street youth - A qualitative analysis. //Drug and Alcohol Dependence, 94//(1-3). p. 19-29. Retrieved October 30, 2013 from []

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Van der Sterren. A. E., Anderson. I. P., & Thorpe. L. G. (2006). "'Individual' harms, Community 'harms': reconciling Indigenous values with drug harm minimisation policy". Drug and alcohol review(0959-5236), 25(3), p.219. Retrieved October 20, 2013 from http://informahealthcare.com.ezp01.library.qut.edu.au/doi/abs/10.1080/09595230600644681

Whitlock, F. A. (1980). //Drugs: Drinking and Recreational drug use in Australia//. Stanmore, N.S.W: Cassell Australia.

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Drug siesure - Retrieved from [|__http://www.heraldsun.com.au/news/law-order/police-investigation-leads-to-500m-drug-seizure/story-fnat7jnn-1226439104619__] Needle exchange - Retrieved from [] Heroin advertisement. Retrieved from [] Coca Cola advertisement. Retrieved from [] Cocaine advertisement. Retrieved from [] Douglas, R. & McDonald, D. (2012). //The Prohibition of illicit drugs is killing and criminalising our children and we are all letting it happen//. Australia21, Canberra Douglas, R., Wodak, A., & McDonald, D. (2012). //Alternatives to prohibition: Illicit drugs: How we can stop killing and criminalising young Australians.// Australia21, Canberra.
 * Reference list for images **