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Although needle and syringe programmes in Western nations are superficially similar, they are a response to and reflection of the time, place and circumstances of their conception and evolution and therefore distinctively different from each other. A Needle and Syringe Exchange Programme (NSEP) was established in New Zealand in the late 1980s, shortly after the implementation of needle and syringe programmes in some Australian states. New Zealand’s NSEP is unusual in several key respects, notably the fact that drug user groups operate peer-based needle exchanges under contract to the government, and its principle of full cost recovery for needle and syringe provision. This paper seeks to describe the context in which needle and syringe exchange was established in New Zealand and explain how it has affected the programme’s evolution. [Copyright &y& Elsevier]

Aims: To compare the policy positions of health and medical organisations across Australia, New Zealand, and the UK as they relate to sale and supply of nicotine vaping products (NVPs) and evaluate factors that have informed the differences in policy recommendations among these countries.Methods: We used mixed methods to analyse data from position or policy statements published by health and medical organisations regarding NVPs (n = 30) and consultation documents submitted to government committees regarding policy options for the regulation of NVPs (n = 26). Quality assessment of included documents was conducted using the six-item Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Text and Opinion Papers, and findings were presented narratively. Qualitative data were coded using NVivo 12 software and analysed using thematic analysis.Results: An overwhelming majority of health bodies, charities and government agencies in the UK and New Zealand portrayed NVPs as a life-saving harm reduction tool. In contrast, concerns about addicting non-smoking youth to nicotine, a perceived lack of clear and convincing evidence of safety and efficacy and the potential to undermine tobacco control progress continues to define attitudes and recommendations towards NVPs among Australian health and medical organisations. Although the profoundly divided views among stakeholders seem to arise from empirical uncertainties and disagreements over the level and credibility of evidence, the source of most of these disagreements can be traced back to the fundamental and irreconcilable differences in the framing of the NVP debate, and varied tolerability of risk trade-offs associated with NVPs.Conclusion: Progress in resolving the controversy surrounding NVP policy requires stakeholders to be frame-reflective and engage in a meaningful dialogue of risk trade-offs, as well as both intended and unintended consequences of proposed policies. [ABSTRACT FROM AUTHOR]