“I Feel Safe Here”: Participants Identify Key Components of Syringe Access Programs

Overview: Syringe access programs (SAPs) provide an array of supplies and services to people who inject drugs. This project surveyed 28 injection drug users about their experiences with SAPs in a large city. Through this work, participants prioritized the supplies they most frequently need and the services they most often utilize.Proposal text: Within North America, approximately 1.78 million to 2.38 million individuals are injection drug users. Along with the risk of overdose, the risk of infection associated with injection drug use is high. The myriad harmful outcomes are often difficult to address as people who inject drugs (PWID)
are often disconnected from care. However, where available, PWID are often engaged in syringe access programs (SAPs) that offer assistance in avoiding these harms. Empirically-based research is unambiguous that SAPs can reduce the health consequences of injection drug use, including: reducing injection-related risk behaviors, HIV transmission, and Hepatitis transmission. Despite overwhelming evidence to support the efficacy of SAPs, a ban on the use of federal funding to purchase syringes persists, crippling a vital source of health information and services for those who need it. While the evidence has been established, and basic program definitions exist, there is considerable variation in the drug injection equipment and services that individual programs provide. When emerging outbreaks occur in areas devoid of services, communities often grapple with how to create a program to address the need. The research literature lacks sufficient discussion of the optimal structure, necessary elements, or procedures for success. Such work is a logical next step, and the focus of this project.

This qualitative project engaged active PWID who access SAPs about what they need and value most in an SAP. Key research questions included:

1) What services do PWID find most useful in a syringe access program?
2) What do PWID cite as necessary components of a syringe access program?
3) What materials or equipment do PWID need the most?

The aim of these questions was to produce outcomes that inform developing programs, particularly in a context of limited public health funding – to identify services, components and materials of greatest need to program participants. The 28 participants agreed on several points. First, easy access to syringes is the most critical component of an SAP, both in terms of service delivery and actual equipment. Other prioritized equipment needs included alcohol pads and cookers. Alcohol pads are used to disinfect the skin prior to injection, in order to avoid common bacterial infections, which is something participants often cited as a concern.In terms of services, additional priorities accompanied syringe exchange, including medical services. Participants described unmet medical care needs and the desire to have these addressed at the SAP. Finally, respondents frequently cited overdose education / naloxone distribution as a critical service when identifying the three most important services they have utilized at the SAP.