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Appendix C: Needs-Based Distribution Concerns

Responding to Common Concerns to Needs-Based Syringe Distribution Policies

CONCERN

Distribution will increase the number of syringes in the community without removing used syringes from circulation.

RESPONSE
  • Emphasize disposal options and education campaigns that are available at the SAP.
  • Explain that participants will still be encouraged to return used syringes, and emphasize that if a participant does not have enough syringes to return, they are at much higher risk to become infected with HCV or HIV, which has an impact on community health. The better we are able to prevent the ongoing transmission of HIV and HCV, the fewer contaminated syringes there will be in the community.
  • One research study found that after investigating syringe return rates in three US cities – Oakland, Chicago and Hartford – that returns were highest (nearly 90%) in the city with the most liberal policy (Chicago) and lowest (only 50%) in the city with the most restrictive policy (Hartford).
  • Create a system wherein community members can report any improperly discarded syringes to the SAP, and someone will retrieve the syringes for proper disposal.
  • Conduct needle clean-ups in the community on a regular basis, and/or as necessary.
  • Emphasize that the SAP is a community intervention, and that the program as a whole is invested in, and cares about the health of the entire community – drug users and non-drug users alike.
  • Explain the many reasons why people may not be able to return used equipment in such a way that will meet their ongoing injection needs, and connect this to ongoing risk for infectious disease transmission.
CONCERN

By providing more syringes, people will use more drugs.

RESPONSE
  • Cite scientific research concluding that SAPs do not increase levels of drug use, and instead result in increased referrals and linkages to drug treatment.
  • Pragmatically emphasize HCV and HIV infection rates in the community as evidence that people will and are using drugs currently, and with an insufficient quantity of sterile injection equipment.
  • Create a system for making and tracking referrals to local treatment centers and methadone programs.
  • Appeal to allies in local drug treatment and throughout the community to back your efforts in support of a wide range of responses to drug use issues in the community.
CONCERN

Needs-based distribution will encourage non-injectors to transition to injection.

RESPONSE
  • There is no evidence that SAPs increase injection initiation.
  • Cite research showing that HCV incidence rates are higher among newer injectors. On average, upwards of 60% of injection drug users will test HCV antibody positive within the first 7 years of injection.
  • Emphasize that if a person has decided to inject, there are benefits to being connected to services early on, whether to learn proper injection techniques and avoid infection, overdose, etc., but also for treatment referrals if/when the person is ready
CONCERN

People may obtain more syringes with the intention of selling them.

RESPONSE
  • While it is true that some people may obtain sterile syringes as a means of selling them, it is unlikely that this will prove to be a viable source of income, especially if the SAP is providing enough free supplies to meet IDU needs.
  • People are less likely to purchase syringes on the street if they are able to get them for free from the exchange.
  • Even if they are being sold on the street, sterile syringes are still getting into the hands of the people who need them.
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