Auto-disable syringes are not for needle programmes

As you may have seen in the media recently, the World Health Organisation (WHO) has launched new guidelines on medical injections and a global campaign to switch all medical and vaccination injections to syringes that cannot be used more than once. These "safety-engineered syringes" may, for example, include a weak spot in the plunger that causes it to break if the user attempts to pull back on the plunger after the injection. Others have a metal clip that blocks the plunger so it cannot be moved back, while in others the needle retracts into the syringe barrel at the end of the injection. Using these syringes in medical settings will, according to WHO, protect millions of people from becoming infected with HIV, hepatitis and other diseases through the re-use of unsterile equipment by doctors and medical staff, especially in the poorest health systems in the world. Their ambitious aim is that every country should have transitioned to these new syringes by 2020.

However, these recommendations and this campaign explicitly do not apply to needle and syringe programmes for people who inject drugs (the population most impacted by HIV, hepatitis and other diseases transmitted through contaminated injecting equipment). It has been demonstrated and proven on many occasions that these auto-disable syringes are unsuitable, ineffective and undesirable in these programmes – clients simply do not like them, they are often harder to use, and they cost more. For example, drug preparation and injection amongst people who inject drugs routinely involves more than one retraction or depression of the syringe plunger, making auto-disable syringes inappropriate. Several peer-reviewed studies have also documented the inadequacy of auto-disable syringes for people who inject drugs – see this informative briefing from the USA's Harm Reduction Coalition for more information.

As a result, and after intensive lobbying by the NNEF and other civil society partners around the world, the WHO guidelines (available here) include the clear exemption that health systems must set "policies and standards for procurement, use and safe disposal of disposable [i.e. not auto-disable] syringes in situations where they remain necessary as described above, including in syringe programmes for people who inject drugs". Similar disclaimers appear in the accompanying leaflet and press release – but this has not been picked up in the media reporting, such as the recent BBC article.

So in short, auto-disable or auto-retract syringes remain unsuitable for needle and syringe programmes. Of course, the message must continue to be that every syringe is intended to be single use, and programmes should continue to use low dead space syringes as before. But these new guidelines from WHO should not change the way that we work.

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