Evaluation of Nova Scotia’s Mainline Needle Exchange Program Soon to be Released

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Since the fall of 2015, the Atlantic Interdisciplinary Research Network for Social and Behavioural Issues in Hepatitis C and HIV/AIDS (AIRN) has been working with a steering group of stakeholders to conduct an evaluation of Mainline Needle Exchange. Mainline commissioned the evaluation in order to document program operations and impacts, as well as current and emerging needs. It also sought considerations and recommendations to increase the efficiency, positive impacts and outcomes of programming. The evaluation was informed by three key sources, including a review of key documents, an analysis of the program’s database, and key informant interviews with staff, clients and partners. While the results have not yet been released, some of the context and preliminary findings can be shared.

First established in 1992, Mainline is the only needle exchange program in mainland Nova Scotia. It is located in the heart of the North End of Halifax, in close physical proximity to a number of other services that clients access, including a Native Friendship Centre, a community-based methadone program, and a community health centre.  Sandwiched between two adjoining buildings, Mainline’s bright blue front makes it easily visible. In addition to their fixed-site, Mainline provides outreach services in a van beyond the Halifax downtown core and in other locations across the province.

Lived-experience of drug use and street life is the cornerstone of this peer-based program. The lived-experience of staff lends itself not only to their own credibility with clients, but also to clients’ hope for the future. In addition to drug use, Mainline’s clients often face multiple challenges, including poverty, unemployment, lack of stable housing, legal issues, poor physical health, and mental illness. Many have or are at risk for HIV, HCV and other STBBs. They experience stigma and discrimination, and tend to avoid access to traditional prevention and treatment health services.

There was unanimous support among those interviewed for the harm reduction work that Mainline does in the community. It is recognized as an innovator and at the forefront of virtually every harm reduction initiative introduced in Nova Scotia. The evaluation documents how Mainline has worked consistently over the years to improve the lives of vulnerable people in the province. It also provides evidence of its broader community impacts, including health and safety; knowledge, advocacy and community mobilization; as well as surveillance and research.

The report also discusses the organization’s various challenges, including funding and systemic barriers. Despite Mainline’s work, the demand and need for harm reduction services has increased markedly over the years, and continues to increase. The numbers of client contacts and needles distributed, for instance, have increased almost 10-fold since 2001, reaching an all-time high of almost one million needles last year. The lack of adequate and stable funding poses a tremendous challenge to their capacity and programming, and often necessitates limiting the supply of safer drug use/sex material available to clients. It also restricts their outreach to the various areas of the province.

In contrast to some of Canada’s larger centres (e.g. Toronto, Vancouver, and Montreal), Nova Scotia’s harm reduction landscape is very conservative. There are no supervised injection or smoking sites in the province, for example, or access to community detox. While needle distribution services are highly effective, this places barriers on the potential effectiveness of Mainline and Nova Scotia’s harm reduction efforts. The final section of the evaluation includes some points for consideration and recommendations for moving forward and sustainability. Stay tuned for more details.

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