1. Harm Reduction 24/7: The supply of harm reduction materials via vending machines for drug users in North Rhine-Westphalia, Germany.
Prof. Dr. Daniel Deimel
Lisbon Addictions,

2. Declaration of conflicts “I have no conflicts of interest.”

3. Overview
German national drug strategy
Harm reduction measures for drug users in North Rhine-Westphalia
Needle and syringe vending machine programme in North Rhine-Westphalia
Harm Reduction 24/7: study design
Harm Reduction 24/7: first results
Outlook

4. German national drug strategy
The strategy aims to help individuals avoid or reduce their consumption of licit and illicit substances, as well as addictive behaviours.
Four pillars:
Prevention
Counselling, treatment and help in overcoming addiction
Harm reduction measures
Supply reduction.
EMCDDA: Germany. Country Drug Report 2017

5. Key facts: harm reduction measures in North Rhine-Westphalia
NRW: inhabitants.
10 drug consumption rooms
with 96 consumer places.
Local needle and syringe programmes.
110 syringe vending machines in public areas.
Heroin-assisted treatment.
Methadone maintenance programmes including psychosocial support.
Outreach work.
Emergency shelter.
Landesstelle Sucht, 2015; IT.NRW, 2011

6. Key facts: drug-related deaths
Germany: increase in drug-related deaths in past five years.
...but North Rhine-Westphalia: stable overall.
...but local differences in the cities of North Rhine-Westphalia.
Bundeskriminalamt (BKA), 2016

7. Key facts: drug-related harms
Results of the DRUCK-study (n = 2.077; RKI 2016)
Up to 54% of PWID were hepatitis C positive.
5-22% of PWID reported that they used needles and/or syringes from other PWIDs in the last 30 days.
32-44% of PWID reported that they used other injecting equipment (e.g., water, filters) from other PWIDs.
There is a lack of knowledge about the risks of HCV from using the same water or filter.
PWID are also a vulnerable group for HIV (RKI 2017)
RKI 2016; DOI: /rkipubl
RKI 2017; DOI: /EpiBull

8. Needle and syringe vending machine programme in North Rhine-Westphalia (NRW)
History – 1989:
On the background of the HIV epidemic, the first methadone maintenance programme and the syringe vending machine programme was established in North Rhine-Westphalia.
Aidshilfe NRW, 2012

9. Needle and syringe vending machine programme in NRW
project webpage:
Today: Locations of 110 needle and syringe vending machines
61 operators

10. Needle and syringe vending machine programme in NRW
Ministry of health NRW
NGO:
61 local drug counselling
and HIV organisations
political decision makers
financial support for programme coordination
financing of new vending machines
programme coordination / management
advising local operators
shipment of harm reduction materials
technical support
application of new machines by the local administration
filling the machines with new syringes and harm reduction materials
organise the disposal of used syringes
Meyer & Schmidt, 2011

11. NSP vending machines in NRW
Two types of vending machines are available.
Space for used needle/syringe disposal
The price for one machine is 850 €.

12. materials and prices The syringe vending machine programme in NRW
every package 0,50 €
1 Needle 12mm
1 Syringe
1 Filter
1 Needle 16mm
1 Syringe
1 Filter
1 Needle 20mm
1 Syringe
1 Filter
1 Needle 25mm
1 Syringe
1 Filter
1x skin creme
1x alcohol swab
1x vitamin C powder
1x saline
1x Stericup
1x alcohol swab
4x aluminium foil 1x alcohol swab
bombon & drinking straw
1 Condom
1 Lubricant
1 Condom

13. Harm reduction 24/7: study design
Systematic Review
Evidence of needle and syringe vending machine programmes.
(n = 60 papers)
Online questionnaire
Experience of
vending machine operators in NRW
(n = 36)
response rate: 59%
Online questionnaire
Experience and requirements of drug users with needle and syringe vending machines.
Starts from November 2017
first results

14. Harm reduction 24/7: first results
6,4%
6,0%
7,2%
Data from Aidshilfe NRW 2017

15. Harm reduction 24/7: first results
High rates in rural areas without harm reduction services.
Lower rates in urban areas with established harm reduction services.
Data from Aidshilfe NRW 2017

16. Harm reduction 24/7: first results

17. Harm reduction 24/7: first results
Groups n %
Heroin users 28
82,4
Cocaine users 15
44,1
Amphetamine/methamphetamine users 5
14,7
Anabolic users 1
2,9
Substituted heroin users
Unkonown / not stated 8
23,5
(n = 34; multiple answers were possible)

18. Before implementing a new vending machine:
Harm reduction 24/7: first results
Problems.
Before implementing a new vending machine:
24% of operators reported problems with local council, police and/or local residents.

19. Harm reduction 24/7: first results
Problem: Disposal of used needles/syringes:
Many are not taking needles/syringes back to machines for disposal.

20. Harm reduction 24/7: first results

21. Outlook:
Needle and syringe vending machines provide 24/7 access for needles/syringes and other harm reduction materials.
The programme in NRW has been successfully operating since 1989.
But there is a lack of comprehensive coverage for harm reduction materials especially in rural areas.
Targeted resources are needed for priority groups, e.g. MSM, refugees.
There are no needles and syringe programmes or provision of other harm reduction materials in prisons in NRW.

22. Thank you for your kind attention!
Contact
Prof. Dr. Daniel Deimel
Catholic University of Applied Sciences NRW
Department Aachen
Robert-Schuman-Str. 25
52066 Aachen
Collaborating partners