Province won't pay to patch negligent needle program. Ontario won’t fund expanded dirty needle cleanup in Ottawa:

Ottawa city Coun. Diane Holmes argued that since Ontario requires the City of Ottawa to make sure drug users have clean needles, the province should cover the costs of cleaning them up from city parks and sidewalks after they have been used and discarded.

The province may require the city to provide drug users with clean needles (WTF?), but it is the city program that has decided to distribute these needles without requiring the drug users to return their used needles. Those needles have to go somewhere, and they do: strewn about the streets, parks, lawns, and alleys of the neighborhood.

See, the objective of the needle-exchange program is to prevent reuse of the needles by drug users because those needles, once used, potentially spread disease to anyone pricked by them. Ideally, the program would require that the drug users return the potentially infected needle in order to get a new needle. The used needles could then be safely disposed of.

However, as it turns out, the drug users are not all that interested in or for whatever reason able to return the used needles. When that is made a requirement of the service, the drug users don't bother to ask for new, clean needles. The program distributes less clean needles, failing to fulfill its mandate, since it appears that the metric being used to measure performance is the number of clean needles distributed.

So, in order to keep the distribution of clean needles high, the restriction is lifted. Clean needles go out, and those used needles, so dangerous to the health of drug users, where do they go? Who cares! Not the people running this program.

The needle exchange program is facilitating the reach of the dangerous, used needles beyond the scope of drug users and into the larger community. In other words, they are increasing the number of people who are at risk of becoming infected by a used needle.

To fix the program, all the funding bodies need to do is count instead the ratio of user needles collected by the program to clean needles given out by the program. The closer the ratio is to 1, the more successful the program. If the ratio drops below some level, the program is considered a failure and looses its funding.

How to determine that cut-off ratio? Its a question of risk. What is the probability of someone in the neighborhood (including the drug users) being pricked by a used needle? Almost 100%, once you include the drug users. What is the probablility of that person being infected by the used needle? That I'm not sure of, but it isn't zero (nor is close to 100%). What is the impact of becoming infected with HIV, for example? Big impact.

So the program should require people to bring back used needles in order to get a clean one. I'm glad to see that I'm not the only person who is thinking along these lines:

Chris Grinham of Safer Ottawa, who helped collect a number of discarded needles and crackpipes from local streets and stairwells Wednesday, said he agrees with city councillors who think Ottawa should require addicts to turn in a dirty needle in order to get a clean one at the city's needle exchanges.

Right now, needles are collected and distributed separately.

"If the addict has to bring them back, then that needle's not sitting there anymore," Grinham said.

The city's medical officer of health has said requiring one-for-one exchange will discourage addicts from using the clean needle program and increase the spread of disease.

Hopefully the powers that be will eventually require the program to take in a used needle for every one that it gives out. Oh, wait: that policy is already in place!

The City of Ottawa has run a needle exchange program since 1991. The official policy states that needles are to be exchanged on a one-for-one basis, drug users will be encouraged to bring used needles back when they receive new ones and they will be told about other locations where needles can be returned or exchanged. (emphasis mine)

I give up.