A mixed bag of needle woes this weekend, which are no doubt just the tip of the iceberg!

So, and just to make the point, we must start with the results of a thoughtful and rigorous Australian study of Hepatitis C virus infection among IV drug users provided with clean needles through a needle exchange scheme demonstrated a significant reduction in hepatitis C incidence among those who attended needle and syringe programs.

Iversen J et al. Reduction in HCV Incidence Among Injection Drug Users Attending Needle and Syringe Programs in Australia: A Linkage Study. Am J Pub Health 2013; 103/8: 1436-44 doi: 10.2105/AJPH.2012.301206

This tells that, as we would predict, that clean needles prevent disease. But more than that, it is an effective measure to capture used needles and syringes that are exchanged for new, thus reducing overall the scourge of discarded needles and associated disease transmission.

Elsewhere, there are obvious and deep rooted concerns about needles, and their association with drug abuse, danger of infection, crime and social disturbance. Any measures to capture those used needles by placement of sharps boxes receive widespread criticism though no alternatives are offered.

Refusal to provide safe injection facilities – a shooting gallery – and clean needles has prompted legal action by IVDUs who claim that refusal by British Columbia authorities to provide this service breaches their human rights by restricting access to the facilities necessary for effective health prevention measures. Since BC laws prohibit the promotion of drug culture this gets in the way of a controversial but nonetheless effective measure that in Vancouver has reduced the incidence of drug overdose and, though not cited, will have reduced infection rates also.

Needles finds in public toilets and playgrounds seem to be the most widespread concerns, though in these hot days as we rush to the beaches sharps uses will do likewise and there is a huge risk of sharps covered with a dusting of sand, particularly for those enjoying the sand, and worse, between their toes.

In Portales, New Mexico, IVDUs have left needles in a children’s playground with a sharps injury to a 6 year old.

In New South Wales, Australia, a somewhat different event occurred in a junior school. A young child brought to school a diabetic blood testing kit left behind in his home just days before when ambulance personnel left it there after attending his sister. You guessed it. He then proceeded to test all of his friends, with the same lancet!

Elsewhere, the risks are more personal, at least for a Gaffney, South Carolina  woman who was found to be hiding a syringe and needle loaded with crystal meth in her underwear. This seems to be a not uncommon hiding place and one that must be uncomfortable, and dangerous for police officers and emergency personnel dealing with such cases.

The greatest fear stems from the use of a needle as a weapon, and regrettably this seems to be increasing in frequency. Right now, West Midlands police are appealing for CCTV data that may help investigation of a Birmingham syringe stabbing.Police have released an image of a man they want to speak about a woman who was stabbed with a needle while on a night out in Birmingham.

Police have released a hopelessly blurred image of a man thought to be responsible for an attack on a 20-year-old woman. She had just left a Birmingham nightclub in the early hours of Sunday, June 23, when she was stabbed twice by a man using what appeared to be a hypodermic needle. The man then walked off.

The young woman was taken to hospital following the attack and, although she suffered only minor injuries, will have to have months of tests to ensure she has suffered no long-term effects. A trivial wound and, we must hope, a good outcome, but despite that months of anguish and anxiety, with a possibly profound and life-changing impact over the months and years ahead.

So we want to help? We would support the placement of sharps bins in hot spots and other likely locations? Or would we?

Well, not in Whitstable they don’t. There, a local shop owner is campaigning for better public loos in the town. Alexandra Schick, who  has run nursery shop Milestones in Harbour Street  since March, says in some toilets, mums are forced to change their babies’ nappies next to a bin for discarded drug needles.

It’s obviously a concern for mums, to see a sharps bin on the wall while changing baby, but if the alternative is to discover a discarded syringe and needle the concerns would be greatly magnified and understandably so.

Drug abuse is a fact of life. We cannot stop it, and must make of it what we can, minimising risks to IVDUs, police officers and others who might be inadvertently to discarded needles. “Supporting” drug users with clean injection facilities and capturing used injection tackle at exchange services are hugely effective methods for harm reduction. So too is the provision of secure sharps boxes in recognised hot spots. These interventions work, and work well. They protect us all, and we should support them wholeheartedly, not least with a realistic understanding that the alternatives are much, much worse.