The interaction of oral substitution and needle and syringe exchange practiced in the five city project has accommodated people who are engaging in risk behaviour without needing to label them as something they are not. That is, labeling some one an 'injecting drug user', may in fact subvert the apparently 'natural' process of exiting from injecting drug use. Assessing a person for participation in a substitution programme or needle and syringe exchange programme is complicated by what period of a person's life they contact the service.

The services have often identified the high-risk group in terms of 'risk of injecting drug use' (which includes the period before a person has any experience in injecting drug use) in order to provide accessible and effective services to the communities with whom they worked. There is a need for more experience and research in this approach to the prevention of HIV transmission in areas where injecting drug use is not the predominant form of drug use.