Harm reduction value of needle exchange and methadone maintenance:
Features studies which remind recovery-focused Britain of the harm reduction value of needle exchange and methadone maintenance services. First entry suggests these have curbed hepatitis C, an analysis based largely on the second entry, repeated here for convenience from an earlier bulletin. Australian analysts went further, calculating that needle exchanges will eventually save the health service money. Finally from Canada, a drastic way to demonstrate the value of a needle exchange – closing it.

1. Can needle and syringe programmes and opiate substitution therapy achieve substantial reductions in hepatitis C virus prevalence?
Vickerman P., Martin N., Turner K. et al. Addiction: 2012, 107, p. 1984–1995.
Among the messages of this simulation model for the UK and other countries is the resilience of hepatitis C in the face of considerable investment in methadone and needle exchange services, that these have nevertheless helped and need to be maintained and if possible expanded, but also that further measures are required to substantially curtail the virus.

2. The impact of needle and syringe provision and opiate substitution therapy on the incidence of hepatitis C virus in injecting drug users: pooling of UK evidence.
Turner K.M.E., Hutchinson S., Vickerman P. et al. Addiction: 2011, 106, p. 1978–1988.
Together studies recently conducted across the UK suggest that consistent participation in methadone maintenance treatment plus adequate access to fresh injecting equipment has prevented many hepatitis C infections, supporting calls for needle exchange to be expanded and methadone treatment sustained.

3. Estimating the cost-effectiveness of needle-syringe programs in Australia.
Kwon J.A., Anderson J., Kerr C.C. et al. AIDS: 2012, 26, in press.
Latest mathematical model from Australia probably broadly applicable also to the UK suggests that needle and syringe programmes have cost-effectively saved/improved lives, and in the long run save the health service money due to averted HIV and hepatitis C infections. But in both countries adequately curbing hepatitis C requires much more.

4. An examination of injection drug use trends in Victoria and Vancouver, BC after the closure of Victoria's only fixed-site needle and syringe programme.
Ivsins A., Chow C., Macdonald S. et al. International Journal of Drug Policy: 2012, 23(4), p. 338–340.
Until June 2008 Victoria in Canada had a comprehensive extended hours needle exchange at a fixed site in the city. Neighbourhood pressure led to closure, creating a natural experiment in the withdrawal of services. The result seemed to be more sharing of injecting equipment entailing a greater risk of infection.