Threat or opportunity? Secondary exchange in a setting with widespread availability of needles

Where authorized access to needles and syringes from exchanges and pharmacies is limited, secondary exchange (SE) can provide an important source of sterile injecting equipment. Interventions can be developed to use SE to facilitate needle and syringe exchange programs to reach a wider population of drug injectors. Yet in a context such as Western Australia, where needles and syringes are available to drug injectors from many authorized sources, the added benefit of SE is unknown. This review of data and literature conducted in October 2003 shows potential benefits but also concerns about undermining vulnerable public and political support for authorized needle provision schemes that has been nurtured and supported over a number of years.