Syringe/needle exchange

[SiwanRN]

Hi all! I am a public health nurse whose health department is about to start a syringe access/needle exchange program for intravenous drug users in our area. The intent of the program is to provide a harm reduction approach to IV drug use. Program participants can bring in their used works and needles for safe disposal (keep those neeedles off the sidewalks!) and exchange them for sterile things. We will also be providing HIV and Hep C testing along with active referrals to mental health providers, rehabs, and other substance abuse treatment services to participants ready to stop using. We will provide Narcan training too (some pharmacies in our area will provide Narcan on standing orders without rx to people who ask for it). I know it isn't quite the same as traditional addictions nursing, but I am curious if any of you have ever worked in a place that provided services like that and what your experiences were like. I've read stories from lay people who have worked in syringe access/harm reduction, but I am having trouble finding nursing perspectives. Thanks for your stories if you've got em!

[Bowie21]

This is my dream job! SiwanRN, I've been volunteering at a needle exchange in the south for a few years. I'm about ready to finish my accelerated BSN and am finding it really difficult to find public health jobs down here. Am probably relocating up to the DC area to find a public health job. It's so tough to be in an area where public health nursing would make such a positive difference, but it is not invested in or supported.

[NuggetsHuman, BSN, RN]

There are some really great programs that can be learned about by researching harm reduction info.

I was just at a workshop yesterday in NYC about changing perceptions of self and systems for addiction. One of the programs I found fascinating was a program that was able to recruit active IV drug users to run the needle exchange as a way to help expand their identities beyond "user" to "harm reduction advocate", which then provided an entry-point to think and talk about making life bigger than IV drug use. I was fascinated.

[NuggetsHuman, BSN, RN]

You might also find some really receptive programs willing to share their startup stories with you. Two I know are Prevention Point here in Philly, and People's Harm Reduction Alliance in Seattle.

[PixieRN1]

Thank you everyone for your responses thus far! To answer a previous question asked of me, I am in the United States. It's probably going to take awhile for our program to get off the ground because there really isn't any advertising (yay, politics), but some other syringe access programs in the area will start referring to us soon for their clients who live in our area but travel a long way to get to these other programs. Ultimately it's not a competition, just an additional tool in the toolbox to address the problems of rising drug overdoses and HIV/Hep C rates in my area.

I also want to point out a bonus to these programs, other than disease transmission; sepsis and general infection reduction.

When addicts are so into their addiction, sometimes they don't take the time to even try to disinfect their used needles...they are too focused on the next fix ...some just give a cursory rinse with tap water and that's it. Many addicts end up in the hospital septic or with endocarditis.

Sure, it may be related to the compounds they are injecting being unsterile. But it could be because they rinse the needle and syringe with tap water after the injection and that syringe/needle just sits marinating in that unsterile water mixed with blood and residual drug before the next hit.

Needle exchanges help with that type of infection prevention as well.

[SiwanRN]

It's neat to see this old thread of mine still getting attention. For any other nurses out there searching for nursing perspectives in syringe exchanges, here's mine now that our syringe exchange program has been up and running for a few years now:

As a previous poster said, it is definitely a "community in desperate need of kindness." So true. Just think about what and who is stigmatized in our culture - teen pregnancy, commercial sex work, and injection drug use are right up there with people given the most side-eye or on the lowest rung of the social ladder. Knowing that, for many of our participants we may be the only people in their world that treat them like human beings. They are so grateful for a friendly face and someone asking how their day is going when probably for our more indigent participants, everyone else they encounter looks at them like the dog poo they scraped off their shoes.

In addition to all the other ways syringe exchanges make a difference with reduced HIV/Hep C rates, reduced sepsis and abscess rates, reduced number of used needles lying around in parks for kids to step on.... making that human connection with some people who inject drugs can often be the first step towards their recovery. I've seen a fair number of our participants warm up to us and then tell us when they are ready to go to substance abuse treatment and rehab, and then accept our warm referral handoffs because they've built up a trusting relationship with us.

On the other hand, I've certainly learned the importance of establishing and maintaining professional boundaries a bit better working with this population. Certainly we all learn in nursing school about this, but not having worked in psych before it's definitely honed those skills for me now. Consistency between all staff operating the syringe exchange is very important.

Giving someone positive HIV or positive Hepatitis C results never gets any easier, no matter how many times I do it.

One of my more challenging experiences has been working with 18 or 19 year olds who come to the program and tell me they've been injecting since 13 or 14. A person wonders what kinds of experiences they had growing up that made them want to self medicate by injecting at such a young age. It also feels strange to correct poor injection technique for someone who is injecting drugs not prescribed by their physician, but remembering that if I don't, abscesses and sepsis will likely follow helps to motivate me giving that education.

All in all, it's been more rewarding than challenging though, and certainly an eye-opening experience to learn about lives of others I'd probably never be exposed to otherwise.