Needle and Syringe Programs are expected to encounter more frustrated clients and a real threat to the program’s success in preventing unsafe injecting practices.
Introduced in April, the South Korean-made Terumo equipment caused a storm of discontent among people who inject drugs.
The global medical-products manufacturer, founded in Japan, changed syringe models supplied to Australia after it shut down its US manufacturing plant earlier in the year. The US-made syringes had been well-favoured by those using them for well over a decade.
NSPs soon began receiving many complaints that the new syringes, made in South Korea, were unsatisfactory. The issues ranged from blunt and weak needles and difficult-to-use plungers, to overall quality of the product. Complaints around the new equipment causing bruising and vein damage were common.
One incident reported to an NSP indicated a needle tip had snapped off in the person’s arm, who then required surgery to remove it.
In Victoria, the Department of Health and Human Services (DHHS), frustrated and keen to resolve the issue, quickly tried to pursue other options soon after it became obvious that the problems arising from the new equipment were not simply an issue of people having a hard time getting used to a new product.
Terumo provided a Japanese-made product for a consumer feedback survey conducted by Penington Institute on behalf of DHHS. The survey, undertaken in consultation with five NSP sites in Melbourne, asked clients to rate the South Korean-made and Japanese-made Terumos, as well as a BD product used in other NSPs across Australia.
The results on about 5000 fits from 348 respondents to the survey clearly indicated a preference for the Japanese- made product. “It looked like we had a clear way forward with a product that was well received by clients and overcame many of the issues people were having with the South Korean version,” says John Ryan, CEO of Penington Institute.
“We’re all frustrated at the Terumo decision to end the supply of the US-made syringes and those frustrations have grown since Terumo decided not to supply a Japanese-made model,” Mr Ryan says.
Terumo says it had sought to introduce this “contingency option” manufactured in Japan, a product that had been going through user-acceptance trials. Only later it became apparent there would not be enough supply to meet demand. Terumo says a worldwide drop in demand for the US-made syringes followed a shift to pen technology for injecting insulin, which has become the preferred method of uptake for that purpose. “The decision to cease the manufacturing in the USA was a global business decision,” says the general manager of Terumo Australia, Ms Rebecca Cortiula.
Ms Cortiula says Terumo is working to ensure quality control procedures are maintained, with an additional inspection process during the manufacture of the South Korean insulin syringe. “We understand that some end-users still have a preference for alternatives, but the South Korean products are the only products we can currently supply.”
The Japanese-made Terumo syringes provided temporarily were well received among people who inject drugs. Ms Cortiula said the decision not to supply the Japanese syringes to the Australian market was about constraints in supply, not cost. “Had we been able to supply the Japanese syringes we would have offered that option, however we subsequently found out we cannot supply this product even at a higher selling price,” she says.
Ms Cortiula says the South Korean-made syringe meets the specifications of requirements for use by Australian NSPs. “However, the fact remains that they are not specifically designed to deal with excessive scar tissue from repeated use of the needle and intravenous drug injection.”
Craig Harvey, outreach worker (pharmacotherapy/NSP/ naloxone programs) for Barwon Health, says that when the complaints started, he thought it important consumer views be heard. He compiled a simple complaint form listing issues most frequently reported.
More than 160 responses came in when the forms were distributed to Barwon Health’s secondary NSPs.
“I contacted Terumo myself and explained the complaints and what we had been doing,” he says. “They said they wanted the complaints sent to DHHS.” He did so and also lodged a complaint with the Therapeutic Goods Administration.
Mr Harvey says some consumers were now “making do” with the new syringes while others said they would re-use older syringes. He says there is now a black market operating for old equipment.
When clients at Sydney’s Uniting Medically Supervised Injecting Centre started telling nursing unit staff about the effects of the new syringes in early May, the staff knew the fallout would be
considerable. Richard Sulovsky, Uniting’s health education officer, says clients said they would hoard old Terumos and sharpen old needles on matchboxes.
One of the big concerns at NSPs was that the change would lead to more needle sharing. In 2009, an Australian government assessment of needle and syringe programs found that about 32,050 HIV infections and more than 96,000 hepatitis C infections had been prevented between 2000-09 as a result of NSPs.
The upshot being that spending on NSPs was considered a crucial investment in avoiding the potentially vast costs of increased infection rates and medical treatment.
– Andrew Stephens