Définition

Dictionnaire des drogues et dépendances,Larousse, 2004.

Sold or provided for free kit, especially in pharmacies or in some associations and specialised centres, which purpose is to limit the risks of infectious contaminations within intravenous drug users.

The first generation of prevention kit (SteriboxTM) was conceived by a French doctor, Elliot Imbert in 1991, and experimented at Ivry-Sur-Seine (Val-de Marne). At that time, It was called “the little City Hall’s box”. It as progressively introduced to France between 1992 and 1994, the year of its marketing in pharmacy, at 5 francs. Each kit contained two 1mL syringes, two ampoules of sterile water, two alcohol cotton pads, a condom and an instruction for use leaflet. A box was given for used syringe diposal.

A second generation of kit (Steribox2TM) was launched in 1999, following an investigation conducted by Apothicom which had shown that sharing the spoon and the filter used to prepare the mix leaded to other microbe infections, non prevented by the first kit. That is the reason why two specific tools have been added in the SteriboxTM: Stericup, an sterile single-use aluminium containe, replacing the spoon, a cotton filter and a dry sterile pad aiming at preventing the use of bare thumb to press for local hemostasis after injection. This kit is sold to users for 1 euro.

A third generation of kit includes an innovating filtering device, directly fitting on the syringes (Sterifilt TM).

Prevention fits have been conceived and proposed within the context of harm reduction policy. Though, SteriboxTM packaging has always carried general prevention messages. Thanks to Steribox, troubles associated with intravenous use (HIV contamination, viral hepatitis, different infections, etc). This devise plays an important role in public health. However, the free sale of these kits to major people in pharmacies or their availability through vending machines (DistriboxTM, TotemTM) on public paths (tokens sold by pharmacists) were not originally consensual, as opposed to distribution by accredited associations dealing with drug users

    • A particular customer for the pharmacist : the drug user
    • Every day, the pharmacist meets people he knows as being drug users : requests of codeined products, pain killers or anxiolytics, presentation of false prescriptions.
    • Most of the time he recognises the profile of people who are concerned… but the dialogue is not that easy.Indeed, pharmacists may consider that drug users’ presence and purchases interfere with the daily management of the pharmacy and its other custumers.
    • Though, the contact between the pharmacist and the drug user is particular but is also unavoidable. Indeed, the pharmacist is the only healthcare professional who can provide him with the medicines the drug user needs.
    • Now, how to optimise this interaction, so as to make it satisfaying and beneficial in terms of public heath for both drug users and pharmacists ?
    • Information and prevention : the pharmacist’s public health mission
    • The pharmacist has got a key role in the fight against the AIDS epidemy by providing with prevention tools : condoms and syringes. The distribution of this material already holds a health message in itself, and makes its whole sense when it is accompanied by an informative dialogue. Syringes have been made more available since 1987, when their sale was authorised in pharmacies.
    • Besides, the pharmacist is often the first - and sometimes the only - healthcare professional the drug user meets in his addiction history. Indeed, drug users hardly go to other healthcare facilities, but they all go to pharmacies. They often get wrong ideas and beliefs by their peers about injection practices that lead them to high risk of contamination. Today, the first injection and the following ones are preceded by a syringe purchase in a pharmacy. That moment could be the opportunity of an important dialogue between the user and the pharmacist…
    • Prevention actions must be sustained…
      Since 1987, when the sale of syringes was legalized, injection material re-using, lending and borrowing are less frequent practices but have still not disappeared. The syringe is re-utilised 5 times in average. It is rarely disinfected, and viruses can stay alive up to one week in the needle. The liquid for drug dilution, the filter, the container for preparation before injection and the one for rincing after injection are often shared by several people.Besides, the risk of contamination by syringe sharing is much higher than by sexual realationship.
    • As a result, 15-20% of IV drug users have HIV, and over 60% have hepatitis B and C viruses. In France, since the beginning of the epidemic, more than 40,000 drug users have been contaminated by HIV. Moreover, in utero contamination of children whose mothers are IV drug users, and sexual partners’ contamination, are added risks. Among drug users, 80% have an active sexual life.
    • The risk of HIV contamination for drug users and their partners are 2000 fold higher than for the general population, while the use of condom is the same…

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If you ever encounter any problem with steribox : write the batch number down
and contact us ASAP at : infos@apothicom.org
Version Française USA