Tgk1946's Blog

Drug Policy Expert Committee (David Penington) reported in stages throughout 2000.

Re: Stage 1B. The implementation of a trial of safe injecting facilities.

My expertise is medical microbiology in public hospital pathology services. I have knowledge of infectious diseases, laboratory tests and information systems.

I assume the following criteria will apply to self-injecting facilities.

1. Administrators of the facility are acceptable to the taxpaying community.

2. Medical supervision ensures that injected substances are of pharmaceutical grade.

3. A robust accountability framework minimises risk and legislation limits liability.

4. They will be part of a broader healthcare program that includes a wide range of basic services.

5. Desperate and uncontrollable people will not be allowed to bypass the rules and gain access.

Infection risks
The participants will need to be registered, probably by GPs who are not connected with the facility, so that they can be tested for a wide range of blood-borne pathogens. Note that the list of pathogens will tend to increase and the costs of testing for them will also increase. A syringe containing blood is a potent weapon, real or perceived. It will be very important for the regulating authority to have confidence that the infectious status of every person on the premises is known. It will be totally unacceptable for the government to be seen to put “weapons” of unknown hazard in the hands of sociopathic people. The Committee should investigate the use of one-way (injecting only) syringes which cannot be used for drawing up blood.

Laboratory tests

Blood samples should be tested under the protection of anonymity, through the registration process, in a manner similar to that for HIV tests. There should not be a restriction on choice of laboratory to perform the tests, providing there are no costs to the client or requestor and the results are delivered to a central electronic database in agreed format.

An information system that is capable of handling the demands of such a program would have to be

• easy to use, with a simple graphical interface

• widely accessible to GPs (or chemists or newsagents or police stations) and users

• at least as secure as a banking system

• able to recognise individuals by sophisticated unique traits, such as voice, handprint, iris.

An independent contractor should establish the essential and desirable features of the electronic records system.

It may be possible to lease time on an existing database from a public hospital or laboratory, or from a private pathology company. However, a recent article in British Medical Journal (v319, 6 Nov 1999, p 1211) suggests that public hospital information systems in the UK are not capable of providing epidemiological data on blood-borne infections. It may be that Victorian hospitals are in a similar situation. Certainly, Victoria does not have a single coherent system for recording, reporting and analysing community acquired infections.