June 2002 issue Pharmacy Today magazine

NEEDLE EXCHANGE PROGRAMME 'TOO STRESSFUL'

Threats, verbal abuse, and a brawl in the pharmacy have signalled the end of the only level-two needle exchange in Wanganui.

Pharmacist Trevor Hawkins wrapped up four and a half years of supplying injecting equipment to drug-users after a series of incidents over recent months involving Needle Exchange Programme (NEP) customers.

Two men trading blows outside the pharmacy, a fight between three women in his retail area, and, finally a woman hurling threats and abuse at a staff member were major factors in the decision, he says.

Although the incidents represented a small proportion of those buying injecting gear, there was an element whose behaviour and personal hygiene left a lot to be desired. Customers' safety and wellbeing had to come first, he says.

Stress

"It had come to the point where we had to be hyper-vigilant and when we finally stopped (the programme) there was a huge reduction in stress levels.

"We hadn't realised what a psychological load we'd been carrying and of course it's unfair to regular customers," he says.

Regular clients are supportive, he says, feeling secure enough to browse rather than buy and run when exchange clients were in the pharmacy.

Each exchange transaction was usually valued at a few dollars, requiring intensive staff assistance and strict adherence to SOPs. The returns didn't equate to a very profitable line of business, he says.

With the bureaucratic pressures on community pharmacy, Trevor Hawkins is hesitant to recommend pharmacists take on the responsibility of providing a needle exchange service.

But the value of NEP in arresting the spread of HIV and controlling hepatitis C can't be overstated, he says.

"It's just time to pass the job on to someone else."

Sympathetic

Needle Exchange New Zealand co-ordinator Charles Henderson is sympathetic.

"If there is a real fear for staff and customer safety, then maybe it is time to pull out of the programme," he says.

About 180 community pharmacies take part in the programme - a number that has remained static, he says.

He suggests the aggression experienced by Trevor Hawkins is an isolated case or there would be an exodus of pharmacists from the programme.

But he is concerned Wanganui intravenous drug-users now have to travel to Palmerston North to access a level-two provider.

Under the programme, level-two outlets sell a range of single syringes and needles as well as filters, sterile water and swabs. Level-one outlets sell only packs of 10 needles with 3ml syringes.

Two other pharmacies in Wanganui provide level-one services.

Owner of one, Bruce Stimpson, has seen his modest needle exchange transactions multiply since Trevor Hawkins' withdrawal from the programme.

Any decision to obtain a level-two license will wait until he has analysed the pros and cons, he says.

Responsible

Auckland pharmacist and the Pharmacy Guild's representative on the Needle and Syringe Stakeholders Group, Maree Jensen, says she empathizes with Trevor Hawkins and his staff and understands his decision to discontinue the service.

"But basically the injecting drug community has been pretty responsible and greatly appreciative of pharmacy's work."

Pharmacists who withdraw from the NEP after bad experiences with clients often quit the methadone programme as well.

Trevor Hawkins says there is significant difference between clients of both programmes and he will remain part of the methadone programme.

NEP providers distribute about 900,000 units of injecting equipment annually.

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