A lot of people seem to believe that if they allow a needle exchange program to operate in their community that they will see huge increases in the number of used syringes discarded on their streets as well as increases in drug use and in drug related harms in their communities. However, the research shows us that just the opposite is the case. Needle exchange programs not only benefit individual drug users by helping to prevent the transmission of blood borne diseases such as HIV and Hepatitis C, they also benefit the communities in which they operate by keeping discarded, used syringes off the streets, giving homeless or unstably housed drug users alternatives to street involvement, and serving as a gateway to engage difficult-to-reach individuals in services such as mental health and substance use counseling, housing, and case management. Many of the older and well established syringe exchange programs such as the Lower East Side Harm Reduction Center in New York City now function as one stop shops for harm reduction services providing mental health services, substance use services, and much more onsite. Now let's look at some of the evidence.

A recent study which compared Miami, where there is no needle exchange program, with San Francisco, which has numerous needle exchange programs, found that there were eight times more discarded used syringes on the streets of Miami even though Miami has only half as many injection drug users as San Francisco. This is essentially a sixteen-fold difference. Some people say that syringe exchange "enables" drug users and encourages them to use drugs; however, research by WHO clearly demonstrates that needle exchange programs do not increase drug use.

Syringe exchange programs typically deliver syringes via storefront programs, peer delivery programs, and outreach programs. Peer delivery and outreach are ways to get clean syringes out to drug users who are not willing to come into the storefront to get them or who may not know that the storefront exists. Outreach often consists of setting up a table or walking about and making contact with people who might be able to benefit from harm reduction services. Peer delivery workers are usually former or current drug users who have connections with a large network of injectors who are unwilling to come into the storefront to obtain clean needles, so the peer delivery workers bring the needles to them.

Peer delivery and outreach work are also very important in that they can provide former and current drug users with the opportunity to work as HIV prevention workers. When one becomes involved in peer delivery one now has a new identity as an AIDS prevention worker which can bring great amounts of pride and satisfaction with it and lead to a transformation which can help people to leave their problematic drug use behind them. Moreover, peer delivery and outreach workers build up job skills and a resume which can allow them to move on and get regular paying jobs as HIV prevention workers.

Because of the fact that needle exchange programs do not attempt to force people to change in ways which they do not choose for themselves, these programs are often very successful in engaging hard-to-reach individuals in services which they have traditionally refused to receive from other agencies. Injection drug users are often treated as despised pariahs by traditional social service agencies; it can be extremely powerful to offer these people a clean syringe for no other motivation than that we wish to save their lives.

Syringe exchange programs frequently provide mental health services to drug users with mental health issues in the form of harm reduction psychotherapy. Although most mental health services refuse to work with active drug users, research and clinical experience from people such as Dr. Patt Denning and Dr. Andrew Tatarsky have demonstrated clearly that active drug users are capable of working on mental health issues and often fare best when working on mental health issues and substance use issues simultaneously. Working on both issues at the same time often leads to a reduction of both mental health symptomatology and a reduction in problematic drug use. Syringe exchange programs are often the only resource in the community where active drug users can access harm reduction psychotherapy services. Syringe exchange programs are also often the only resource in the community which is capable of engaging these populations in mental health services. And finally, many individuals who have overcome their addictions choose to continue receiving their mental health services at syringe exchange programs because these were the only programs which treated them with respect and human dignity when they were active users.

Many needle exchange programs have a drop-in space which allows homeless and unstably housed former and current drug users to get inside off the streets and get warm in the winter or cool in the summer and to have a cup of coffee or a bite to eat. Many needle exchange programs also have fully development case management services which can help to place individuals in permanent housing who have traditionally shunned the shelter system.

Finally, opioid overdose poisonings have now become a huge issue in the US; the CDC tells us that the annual number of opioid overdose fatalities now exceeds the annual number of automobile traffic fatalities. It is becoming more and more common for syringe exchange programs to provide training in overdose prevention and reversal and to provide overdose reversal kits containing naloxone, also known as Narcan, which is the only drug which can save a life by reversing an opioid overdose.

So bringing a syringe exchange program into your local community can have all of the following benefits:

  • It can reduce the number of discarded syringes on your streets to a fraction of the current number.
  • It can help engage drug users in mental health or substance use treatments even if they have a history of refusing such treatments.
  • It can create opportunities for homeless or unstably housed drug users to get off the streets by providing them with a drop in space or connecting them to the shelter system or to housing.
  • It can provide mentally ill drug users with harm reduction psychotherapy which they are unlikely to be able to access in traditional mental health settings.
  • It can save the lives of people who overdose on opioids.

So what are you waiting for? Get a syringe exchange program started in your local community now!

Overcoming Addiction

Healing through harm reduction
Kenneth Anderson, MA

Kenneth Anderson, M.A., is the founder of Harm Reduction for Alcohol and the author of How to Change Your Drinking: A Harm Reduction Guide to Alcohol.

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