Syringe exchange

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The syringe exchange , also called syringe exchange , is a tertiary preventive measure for people who administer heroin and / or other drugs intravenously . Here, drug users are given the opportunity to exchange old syringes for new, clean syringes. The transmission of viruses via unsterile syringe equipment is an avoidable route of infection. Constant use of sterile syringes reduces the likelihood of infection with intravenous administration to almost zero.

History of the syringe exchange

Long before the emergence of AIDS , it was known that fatal infectious diseases such as hepatitis C can be transmitted very easily through the joint use of unsterile and contaminated syringes , but it was only AIDS that made the public aware of the importance of the problem of the prohibition of syringes. In October 1984, intravenous drug users accounted for only 2% of the total number of reported AIDS cases in Europe. After one year, in October 1985, this proportion was already 8%. Within a year, this share grew by six percentage points. In the mid-1980s, Switzerland had the highest incidence of AIDS in Europe. With 11.8 cases per million inhabitants, Switzerland was ahead of Denmark (11.2) and France (8.5) in autumn 1985. A year later, in autumn 1986, Switzerland again had the highest rate of all European countries with 21.2 cases per million inhabitants. The number of cases had nearly doubled within a year.

Amsterdam pioneer: syringe exchange since 1984

The initiative to install the first syringe exchange program in Amsterdam was taken by the then interest group of fixers, the "Junkie Bond" (Fixer Bund). Supported by social workers, the association advocated such a program, as a local pharmacy stopped selling needles and syringes to around 200 fixers in the summer of 1984 due to numerous complaints from the local area. The association feared that this ban on sales would lead to an increase in the transmission of infectious diseases among fixers.

The municipal health department (GG & GD) then bought large quantities of sterile needles and syringes, delivered them to the “Junkie Bond” once a week and took the used syringes back with them for proper disposal. At the start of the program in 1984, around a thousand syringes were exchanged each week. When the AIDS problem became alarming in 1985, other institutions decided to join the program. As a result, the options offered were used very often and intensively. The number of syringes exchanged grew from 100,000 in 1985 to 800,000 in 1989 and to over a million in 1992. In the mid-1990s, the number of syringes exchanged fell back to around 750,000 per year as the number of intravenous drug users in Amsterdam had become smaller.

Switzerland: Syringe sales in 1985/86 in Zurich controversial

In April 1985, the then Zurich canton doctor Gonzague Kistler claimed in the official drug bulletin that the distribution of sterile injection utensils to drug addicts was prohibited. Supported by the cantonal health director Peter Wiederkehr, he threatened doctors and pharmacists with "patent law measures up to and including withdrawal of licenses". The decree was vehemently contested by social workers, lawyers and with a self-inflicting action by 360 doctors. In its judgment of May 1986, the Zurich Administrative Court spoke of “a mere expression of opinion without a legal basis”. On July 4th, 1986 the so-called syringe sale ban was withdrawn.

The city council of Zurich decided in 1989 harm reduction (harm reduction) to nominate an integral part of drug policy measures. The first intervention strategy was to set up an extensive network with the possibility of exchanging old, used syringes for new ones. Less than ten years after the start of the syringe exchange program, millions of syringes were handed in annually in Zurich (in 1994 it was 4.3 million), with around 90% actually being replaced, i.e. the fixers handed in their old, used syringes so that they can could be properly disposed of.

In 1986/1987, syringe exchange programs were set up as an integral part of health services in Basel, Bern, Lucerne, St. Gallen and other cities. The syringe exchange programs introduced in various cities from 1986 had a lasting effect on the risk of infection, with the proportion of drug users in the total number of all reported HIV-positive test results falling from 69.5% in 1985 to 12.7% in 1998. This measure alone made it possible to reduce the risk of HIV infection among intravenous drug users by more than a factor of five.

Germany: Syringes have been legal since 1992

In Frankfurt am Main, the paradigm shift in drug policy was heralded in 1987 with a syringe exchange program. It was recognized that syringe exchange is of great and central importance in terms of AIDS prevention. The syringe exchange program introduced in the late 1980s was greatly expanded in 1990. The mobile syringe exchange project SAP was started in the summer of 1991 for the open drug scene in the Taunusanlage . Even after the open scene in the Taunusanlage was closed in November 1992, the SAP employees in the station district were able to ensure that the syringes were exchanged in full. In 1994, the SAP replaced almost two million needles and syringes.

In Hamburg, the “Drob Inn” opened on September 7, 1987, and in the years that followed, it supplied well over 500 fixers every day on an area of ​​50 square meters and exchanged 10,000 to 12,000 new syringes for used ones (also daily), more than four over the year Millions. In 1988, a syringe exchange program was launched in North Rhine-Westphalia. Other federal states followed. The distribution of sterile syringes was not legal in Germany. In 1992, the police in Dortmund confiscated a syringe exchange machine for the last time. It was not until the law amending the Narcotics Act of September 9, 1992 ( Federal Law Gazette I, p. 1593 ) that the distribution of sterile disposable syringes to drug addicts was legalized.

Free syringes reduce HIV risk

According to a worldwide study from 1996/1997, the free distribution of syringes to drug addicts reduces the number of HIV infections. In cities providing clean syringes to drug addicts, the number of new HIV infections has declined by an average of 5.8 percent from the mid-1980s to the mid-1990s. In contrast, the number of HIV infections in cities without such programs rose by an average of 5.9 percent over the same period.

Scientists from the University of Melbourne (Australia) evaluated the data from 81 cities. More than half (54 percent) of the cities surveyed were in the United States, about a third (32 percent) in Europe, and the rest in Asia and the South Pacific. After all, these results led to the fact that in the USA in the Appropriation Act of 1993 the ban on promoting syringe exchange programs is only to apply until the highest health authority in the USA has clearly established that such programs effectively counteract the spread of HIV and not Encourage drug use. To this day, however, this US agency has maintained its prohibitive position despite numerous studies.

Intervention strategy syringe exchange

The intervention strategy syringe exchange is intended to reduce the use of a syringe by more than one person ( needle sharing ) and thus the spread of infectious diseases such as hepatitis and HIV among drug users ( safer use ). In addition, illnesses caused by contaminated syringes should be avoided. The exchange can be done in person at a drug counseling center or anonymously at a syringe machine. In addition to the syringes, condoms for safer sex and care sets are usually offered. Furthermore, used (and thus potentially infectious) syringes are safely disposed of by the exchange system (also with the machine); this prevents third parties from sustaining needlestick injuries and becoming infected.

Web links

Individual evidence

  1. ^ Hans Kind, Urs Voser and Bernhard Gehrig: Neue Zürcher Zeitung, NZZ, June 22, 1985
  2. ^ Günther Stratenwerth: Legal opinion on syringe delivery, 1986
  3. ^ André Seidenberg: Advertisement in the daily newspaper of the city of Zurich from July 4th, 1986. On the same day, the so-called syringe dispensing ban was officially withdrawn as untenable.
  4. ↑ Dr. Emilie Lieberherr for the attention of the Zurich City Council: Drug Policy Strategy Paper, August 31, 1989
  5. ^ City Council of the City of Zurich: 10 theses on drug policy, June 19, 1990