07/07/08

Dealing in health: do we dare?

Auto-destruct syringeStill on the topic of sensible policies to prevent disease among drug injectors, I’d like to pass on the idea of Wisdom reader Pierce Wetter. Pointing out that blackmailing brothel owners delivered very high levels of condom use in Bangkok’s brothels, Pierce suggests we use the same technique for drug dealers. Enlist them to sell auto-destruct syringes with the smack. (For those who don’t know, an auto-destruct is the “bee-sting” of injecting equipment — you can only use it once, then it dies, so no needle sharing, and no passing around of viruses).

Funnily enough, we started discussions with dealers about selling branded, subsidised needles in one country I worked in a while back. A couple of dealers were interested, but the cops were less keen. Pierce suggests that you might get them on side by changing the charge sheet. If you’re caught dealing drugs you still get rumbled, but if you’re selling each dose with a sterile syringe, you get a shorter sentence. Seems like a win-win situation for the dealers. After all, it is in their interests to help keep their clients alive…

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  1. Comment by Tera, 08/07/08, 03:12:

    That is a very clever idea. I’m sure some group will throw a hissy fit about it but it seems like you said to be a ‘win win’.

  2. Comment by Leah, 09/07/08, 03:05:

    I must disagree. IDUs still try to reuse the auto-destruct syringes and are more likely to hurt themselves and put themselves at higher risk of HIV. Most importantly, IDUs HATE these things. Most harm reduction folks will tell you this is the wrong strategy for IDUs.

    Here’s a quote from a UNODC Guide which includes Document on Auto-Destruct Needle-Syringe
    “Retractable (auto-destruct) syringes are not recommended for needle and syringe programmes. A
    review concluded that the usefulness of retractable
    syringes depends on the extent to which they replace
    or supplement existing injection equipment, and
    whether they are acceptable to injecting drug users.
    Trials have found that retractable syringes are unacceptable to injecting drug users in the United States of America, parts of Europe and Australia.”

    Elizabeth notes: I’m sorry it took so long to approve this comment. It got caught in my spam filter. It looks like the data weigh in against auto-destruct. But the strategy of working with dealers to promote safer injecting techniques: is that worth exploring at all?

  3. Comment by Mahmud Naqi, 15/07/08, 05:46:

    “But the strategy of working with dealers to promote safer injecting techniques: is that worth exploring at all?”

    Could be, I think that if I was drafting a project proposal I’d have a hell of a time identifying where dealers are and how to get a hold of them.

    These are people who spend significant amounts of time ensuring that they keep a low profile and typically zealously guard their privacy to protect themselves from the police, customers and competitors. You’d be focussing on geography (ie: locations where dealers tend to hang out) and on a rather limited number of dealers. Besides the fact that they are both illegal activities that increase the risk of HIV, owning a brothel (usually in a physical location or a flat with comparatively high traffic) and a dealer (who will either go to where the customers are or have a relatively small number of customers come to them)

    I can’t help but think that a better strategy would be to improve interventions to empower IDUs, especially considering that a significant number of IDUs do deal.

  4. Comment by Leah, 28/07/08, 05:41:

    I think that prison term reductions could work, with some adaptations.

    Most behavior change messages to IDUs are “do not accept a dose already in the syringe/needle”, because they cannot be sure it hasn’t already been used. I wouldn’t trust that the dealers aren’t reusing equipment. Enforcement is also hard- it takes lab work to ensure that a needle/syringe is HIV free. I think it is better to deal in terms of sterile needle-syringe fixes sealed in the original packaging.

    Why not arrange a deal to sell, at a discounted price and in bulk, sterile fixes directly to dealers (listed by their anonymous, unique identifier codes, not their names)? This could be in addition to free distribution to IDUs and fill in gaps in the “market”. Dealers would like the opportunity to make extra money and just as with the drugs themselves- competition between dealers should keep the cost of needle/syringes to IDUs relatively low. This is an opportunity for profit they don’t have to share with others.

    Participation in this program could be used as evidence to reduce the sentence of a prison term. Dealers are many- I bet most IDUs would admit selling now and again- but those who deal regularly might find the combination of the opportunity for additional profit and reduced term attractive enough to seek the program to sign up.

    There are existing programs that work with dealers, brothel owners, and other “gatekeepers”, but few work with them past getting access to the main target group. There is definitely more that could be done with them to make them positive agents of change and improve the situation of IDUs outside the reach of outreach.

  5. Comment by Ryan, 28/07/08, 04:21:

    I know that some ASO’s have had success with harm-reduction messages using dealers and regular members of the (I)DU community as “ambassadors,” providing them with basic training and information about HIV prevention, as well as with clean needles, condoms, etc.. The logic is that IDUs who are unwilling to go to a needle exchange site might be more likely to accept clean needles from their dealer.

    Of course, such programs suffer from a lack of accountability and oversight–there’s no way to ensure that the “ambassadors” aren’t re-selling the needles and/or condoms, and there’s no way to measure the outcomes of the project, really… but if the resources are available, it sounds like a good trial.

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