Your Health

Needle distribution plays key role in harm reduction effort

Photo of single-use needles.
Photo of Dr. Pierre Plourde. DR. PIERRE PLOURDE
Winnipeg Regional Health Authority
Published Friday, November 30, 2018

As a medical officer of health for the Winnipeg Regional Heath Authority, I sometimes get asked for my opinion about the best way to deal with injection drug use in our city.

Unfortunately, there is no easy way to reduce injection drug use and its harmful consequences. However, I also point out that those of us working within the Population and Public Health Program of the WRHA are doing our utmost to help people who use drugs.

At the core of our approach to dealing with drug use is a concept known as harm reduction.

Simply put, harm reduction involves implementing policies, without discrimination, that focus on preventing of the harms of drug use to individuals and their communities, recognizing that many people are unable or unwilling to stop using drugs.

One of the more successful elements of our overall approach to harm reduction is the needle distribution program, which is run through our Street Connections initiative.

Needle distribution programs were created in part to help reduce needle sharing among drug users, which can lead to the spread of infections such as hepatitis B and C and HIV. Over the years, studies have shown that these programs are successful in doing just that. They’ve also been shown to play a role in helping people access appropriate resources, such as housing, health care, or drug treatment.

Despite this success, needle distribution programs are often criticized. For example, some complain that the Winnipeg program gives needles to people who use drugs, who then discard them on city streets, vacant lots and parks, posing a health risk to unsuspecting passers-by.

While we can all agree that no one wants to see discarded needles while out for a walk in the park, it is also important to keep the issue in perspective.

Consider the following facts. This year, our needle distribution program will distribute an estimated two million needles to about 5,000 people who inject drugs.

More than half of these needles will be returned to the needle distribution program, either directly to staff or in one of about 12 drop-off containers located throughout the city. A significant proportion are taken out of the city altogether for use in rural Manitoba. Most needles that don’t return to the program are discarded safely by other means. Only a very small proportion – about two per cent – of distributed needles end up discarded in the community.

Some of these needles will be improperly discarded, making some people feel unsafe or have negative attitudes towards the people who inject drugs. However, it is important to remember that needle sharing actually poses a much greater risk to public health – and cost to the health-care system – than improperly discarded needles. The fact is that the health risk to the general public – including children – from improperly discarded needles is very small. Needle stick injuries in the community are uncommon and carry an extremely low risk of disease transmission.

That’s not to say we can’t do more as a community to reduce improper needle disposal.

Discarded needles generally arise from outdoor injection use, due to unstable housing among some people who use drugs. While most individuals who use drugs prefer to dispose of their needles safely, some are reluctant to return them to a needle distribution program, as they usually travel on foot and do not want to be caught carrying needles and harassed by police. So, one solution to reducing discarded needles is to provide stable housing. Another solution involves providing more needle drop-off containers in the city, as Edmonton has done.

It goes without saying that the best way to reduce improperly disposed needles is to eliminate the issues that contribute to drug use. That isn’t going to happen overnight. But as a community, we can work to address some of the social conditions surrounding drug use. Striving for health equity, addressing the Calls to Action in the Truth and Reconciliation Commission, and providing better housing options for people who use drugs are part of the answer.

In the meantime, let’s not overlook the fact that our needle distribution program does more good than harm. By helping to contain the spread of infection, it plays a key role in helping those who are struggling with drug use. In doing so, it is also helping to keep our entire community a safer – and better – place for all of us. 

Dr. Pierre Plourde is a medical officer of health with the Winnipeg Regional Health Authority. This column was originally published in the Winnipeg Free Press on Friday, November 30, 2018.

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The Winnipeg Regional Health Authority acknowledges that it provides health services in facilities located on the original lands of Treaty 1 and on the homelands of the Metis Nation. WRHA respects that the First Nation treaties were made on these territories and acknowledge the harms and mistakes of the past, and we dedicate ourselves to collaborate in partnership with First Nation, Metis and Inuit people in the spirit of reconciliation.
Click here to read more about the WRHA's efforts towards reconciliation

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