Needle exchange changes: 'It takes time to build up trust'
Photo:
RNZ / Nate McKinnon
Changes to a decades-long needle exchange contract have left a Christchurch drug-user and health expert worried the decision will breed distrust, potentially leading to needle-sharing.
Health NZ has not renewed the contract for DISC Trust, which has operated needle exchange services across the South Island for 35 years and has instead opted for a new provider He Waka Tapu from 30 September.
RNZ understands 19 staff are waiting to hear about the future of their jobs, while people who use the service were worried He Waka Tapu might not replicate the "peer-to-peer" approach that made them comfortable using DISC Trust's services.
The man, who spoke to RNZ on condition of anonymity, had been using DISC Trust's needle exchange at Christchurch's Rodger Wright Centre for about 10 years.
He said DISC Trust staff were knowledgeable and most of them had been drug users themselves.
"You're talking to someone who, who really, you know, actually gets it," he said.
"There are no ulterior motives. They're not trying to convince you to give up your drugs and go and do treatment. If you want other services or information, you can ask and they'll give you that help, but they're not going to pressure you to go to rehab.
"You see people in there who look like they're probably bodybuilders and you see other people that you know are using meth - all sorts of drugs. Whatever you're injecting, that's the place to get your needles from and to get rid of them safely."
The man had sought advice about methadone and Hepatitis C treatment and received safe injecting equipment to take methamphetamine and heroin, including getting drugs checked for potency and any unwanted contaminants.
DISC Trust also provided advice on overdose prevention and injection techniques that did not lead to tissue damage, he said.
The man was concerned He Waka Tapu - a kaupapa Māori health organisation - would not have the same level of impartiality because it also offered a range of rehabilitation and treatment plans.
"Just because someone's got the equipment to give out, it doesn't mean that I'm going to trust them. It takes time to build up trust in a service," he said.
"I can't imagine, like, doing treatment there and then deciding I'm going to inject some drugs and having to go back to the same place. That would be so embarrassing."
Health NZ said the needle exchange contract stipulated that people with "lived and living experience" had significant roles in the design, delivery and leadership of the programme.
Needle exchange locations and employment details were still under negotiation, although it was confident there would not be any disruption to services, Health NZ said.
When approached for comment, He Waka Tapu referred RNZ to Health NZ, which declined to provide further details.
"Health New Zealand is currently negotiating a contract with the preferred provider. It is therefore premature for either Health New Zealand or the provider to respond to your query," Health NZ said.
Photo:
RNZ / Nate McKinnon
DISC Trust executive director Philippa Jones said it ran six needle exchanges from Nelson to Dunedin and staff had about 30,000 "interactions" with drug users each year.
She said the trust was "incredibly surprised and disappointed" to loose its needle exchange contract, but it would continue to provide other services such as HIV screening and vaccinations.
"We've built a really deep connection with our communities and that's not something that can be replaced overnight, especially for people who are really stigmatised when they engage with the mainstream health system," she said.
"This was a service established by the community of injecting drug users, for them. That's a unique feature of the service and that's how it's able to build that significant trust with clients."
Jones said DISC Trust was informed of the contract loss on 16 June and staff were yet to hear from He Waka Tapu.
University of Otago Professor Jeff Miller said people might re-use or share needles if they did not feel comfortable with the new service.
"So you're moving into physical [tissue] damage and you're also moving into potential increase in exposure to hepatitis C in particular," he said.
The loss of DISC Trust's needle exchange contract was "bizarre", he said.
"It's a source of huge frustration and a little bit of disbelief to see this particular service, which incidentally is the most effective hepatitis C treating service in the country, apparently disappearing off the map," he said.
Photo:
RNZ / Nate McKinnon
RNZ understands funding for South Island needle exchange services has been reduced from $1.4 million to $1 million.
Health NZ would not confirm the figures and declined RNZ's interview requests.
In a statement, it said funding for regional needle exchange and harm reduction services was allocated based on population statistics.
"The national budget for the delivery of needle exchange and harm reduction services and free safe injecting equipment is around $6 million per annum," HealthNZ said.
Miller said the shift to a population-based approach was new and concerning, because data suggested the South Island had a higher proportion of people who injected drugs than the rest of the country, so deserved a bigger funding share.
DISC Trust distributed about 40 percent of the country's sterile drug equipment, despite Te Wai Pounamu having only 23 percent of the country's total population.
Know Your Stuff spokeswoman Casey Spearin said her organisation had worked with the trust to provide drug-checking services and she was also concerned abut the change.
"It's disappointing to note that the overall funding amount for this service in Te Waipounamu has been scaled back. We have over three decades of evidence showing that needle exchange services reduce the burden of disease and other downstream effects on our health services and save taxpayer money," she said in a statement.
"While we are pleased to see that He Waka Tapu provides wraparound support and whānau and tikanga-based approaches, there are likely to be some impacts when transferring needle exchange services to a new provider.
"Ideally, He Waka Tapu would have been brought on to complement the existing services provided by DISC and helped provide these vital services to more people who need them."
Health NZ said the services would transition to He Waka Tapu over the next two months and it was confident staff would "deliver the required services to people who inject drugs and who live in Te Waipounamu".
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