The Quadrant Approach

While harm reduction programmes worldwide, like the needle exchange programme (NEP), have been effective in reducing the incidence of infections and associated drug harms, there remains a high residual risk of poor health and morbidity associated to the use of drugs by way of injection.

About the approach

The social environments in which people live, as well as their lifestyles and behaviours, are key drivers influencing the occurrence of illness and the state of wellbeing of populations and groups within them. This includes people who inject drugs.

The Quadrant Approach was a concept developed out of recognition that clean needles alone do not appear to be sufficient to motivate further major changes in risk behaviours. The Quadrant Approach consists of four public health principals. Each of these has been acknowledged before BUT this is the first time that they have been promoted together as a holistic approach to harm reduction for people who inject drugs in New Zealand. The Quadrant Approach resource has dual aims. It is for workforce up-skilling, and for generating a ‘talking point’ for health promotion activities (as a brief intervention package).

Workforce up-skilling

The workforce up-skilling aspect was drawn out of awareness that a wide scope of health and other professionals are interested and willing to invest in needle exchange and addiction related health services (i.e. the NEP, sexual health, A&E, general practice, pharmacy, community policing, AoD, NZ AIDS Foundation, NZ Prostitutes Collective and others).

The resource aims to provide those groups (the NEP and workforce partners) with the capacity to improve institutional knowledge and support development. Additionally, it aids in maintaining a level of consistency and quality across a sector whose workforce is continually changing.

Health Promotion (a brief intervention)

The continuation of the transmission of blood borne disease and poor health amongst people who inject drugs is in part a result of (i) poor hygiene including the non-use of sterile filters, and hand washing, (ii) a lack of knowledge around maintaining vein vitality and the care of wounds, (iii) a lack of education on what constitutes a healthy diet, and (iv) a lack of focus on sexual health and safe sex.

The resource focuses on the consistent reiteration of targeted health messages – key to successful health promotion and long-term change for people who inject drugs. These messages must filter out from trusted organisations like the NEP and workforce partners.

A personal touch….?

Communicating messages online, in particular, does not offer the assistance particularly needed for people with drug dependency or the myriad of other potential health issues presenting. The lack of personal contact may increase existing problems. Socially isolated people or groups that are participating in risky behaviours are less influenced by ‘anonymous services’ and are less likely therefore to improve social situations or alter threats to safety.

It is essential we continually identify the most effective elements of interventions and who is benefiting most from them. Concerted effort should be focused on evaluating not the number of people up-taking information and being retained in services, but rather the final outcome, for example, how many people significantly reduce their drug consumption, or stop using drugs in risky ways, and for how long they do so. Identifying and acknowledging the limitations of any intervention is important.

Supporting people who inject drugs to maintain social relationships and economic participation, also improves their social wellbeing and therefore their ability to contribute positively to society. People left at the margin remain those who also cost to the cohesiveness of society, and are the most difficult to maintain effective lines of transfer of information. Strategies based upon social inclusion may be key to moving the group as a whole upward and forward.

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