Logistical problems plague plans for syringe exchange programme

The reintroduction of a needle-exchange programme has not been totally discarded by the responsible government agency but it would have to overcome logistical problems that botched the scheme in 2002.

"We are still considering introducing the programme again," said Sedqa's clinical and acting operations director George Grech, highlighting the importance of preventing sharing needles to avoid the spread of disease.

The next step would be to discuss the project's re-implementation with the recently-appointed national commission for addictions, he said.

Although the syringe distribution programme works well, the needle-exchange practice, initiated by the national agency against drug and alcohol abuse and the Primary Health Care Department, had failed due to drug users' widespread suspicion that they could be prosecuted if found in possession of used syringes and their "lack of cooperation" to dispose of them appropriately.

Their resistance to use what are known as safe bins led to the project's discontinuation. However, Dr Grech said research into hundreds of drug-related cases has shown that only two used syringes had actually been produced as evidence in court.

"The used syringes could potentially implicate the drug user but, in reality, it never happened," he said.

Moreover, the police had shown the will for complete cooperation on the matter, Dr Grech said. After all, appropriate disposal was also in their interest as they too could sustain needle injuries when searching houses.

Dr Grech also entertained the "interesting" concept of prosecuting drug users if they were discarding syringes in an unsafe and unhealthy way, rather than if they were found in their possession, for the protection of society as a whole.

Although funding the needle-exchange scheme was also an issue - since it entailed ongoing costs, which the government would have to budget for - it was the logistics that proved to be a stumbling block.

Who would be handling the used syringes when these were exchanged for new ones was also a problem, Dr Grech said, envisaging the possibility that nurses and paramedics may be reluctant to do so. In the past, some reluctance had already been registered among them. Even though there was the will to cooperate, it was not just about safety but also the fact that they had other duties to perform.

In 2002, funding had been obtained for the safe bins to be distributed for free to drug users for the disposal of their old syringes. Collecting points had also been identified outside health centres but finding a private contractor to pick up the hazardous waste was another problem.

Former Caritas coordinator Mariella Balzan recently said that as many as 750 syringes are collected by heroin addicts from health centres every day and that the figure was growing. That, in itself, was good news, from the health and disease prevention point of view, as it signified that syringes were not being shared. But while their distribution was a good measure, it was a "half-baked" job, begging the question as to where they were being discarded after use, Ms Dimech had pointed out.

Dr Grech said most injecting drug users did, however, dispose of their used needles safely, putting them in bottles, for example. However, the scheme, which was standard practice in other countries, was still required in Malta.

Facts and figures

• Since syringe distribution started in Malta in the 1980s, reaching national coverage in 1994, the number of syringes distributed yearly has risen steadily.

• In 2006, a total of 230,000 syringes were distributed - not exchanged - in Malta.

•Most syringes were distributed from health centres in the southern and northern harbour regions of Malta and one particular health centre in the southern harbour region distributed 30 per cent of all syringes.

• During the 2002 campaign to introduce a needle-disposing and collection programme, apart from the bins, long-armed forceps were also manufactured and distributed to the police, the Civil Protection Department, health centres, local councils, postal services and the Armed Forces of Malta to handle safely used syringes dispensed in the environment.