The definition of a rural area varies by government agency. For example, the US Census Bureau defines it differently than the Office of Management and Budget or the Federal Office of Rural Health Policy. However, if you live in a rural area, you usually define it by how far the drive is to a town center or facilities such as a health clinic or hospital. Commute time to a more densely populated area can require an hour or more drive with little to no public transit available. This poses unique challenges for syringe services programs in rural communities and an issue to consider in the siting of a facility. Below is a list of items to consider before establishing syringe services programs in rural areas.
Make it Accessible
The first rule of syringe services programs is that you must meet people where they are to build trust and encourage participants to return. Locations that are inconvenient (both in time and location) will be a disincentive to participate in the syringe services program. Keep in mind that people who inject drugs may have difficulty finding transportation to an established syringe services program, and public transportation is scarce in many rural areas. Engage the community first to find a location where most people in need of services congregate and consider what their mode of transportation is. Outreach workers can help get this type of information from people who inject drugs. In addition, find out if bus services are available in the area and whether the potential location for the syringe services program is on a bus line.
Communicate Early and Often
A concentration of community services in a specific area might spur local opposition to siting a facility. Be aware that the community may already feel burdened and not want another social service. Be sensitive to their concerns and seek to engage them in a constructive dialogue about how to mitigate these issues — before — identifying a location. Talk to people who represent the entirety of your local community. For example, include law enforcement, elected officials, business leaders, public health, medical community, people who inject drugs, individuals in recovery, the faith community, and families and friends of individuals with substance use disorders in any outreach efforts. Look for individual leaders in these sectors of the community first, try to gain their support and in turn they can be a trusted advocate for you. The Harm Reduction Action Center in Colorado may provide useful informatoin for communities facing opposition to siting syringe services programs.
Location, Location, Location
Find a location where people will feel comfortable going. A community clinic in one at risk county is in a prime location, however, since it is near a police station, there is a concern that people who inject drugs may not feel comfortable going to that facility. Again, talking to individuals who inject drugs or who are in recovery will help identify potential issues. People in rural areas may be particularly concerned with anonymity. Be cognizant of the facility’s entry point, is there a more discreet entrance where people can feel some privacy when they enter or exit. Alternatively, they may want to enter through the front door of a facility and mix in with other visitors to the facility. Explore assorted options such as mobile vans, co-locating with another facility, or providing needles through individual outreach workers.
Identify Potential Siting Challenges.
Before identifying a location, understand your local zoning ordinances, or consult with a local land use attorney. Some ordinances may preclude the siting of such a facility or may have restrictions on parking or hours. If you are seeking to establish a mobile unit, find out if the van can go to the same location every week at a set time. Knowing the answers to siting questions can help keep concerns from growing into full-blown opposition. Building support with local faith communities and law enforcement may help overcome concerns about syringe services programs. In fact, they may be your strongest allies. In addition, information about the public benefit of syringe services, to include a reduction in needle stick injuries, infectious diseases, and overdose deaths has been used in some communities facing zoning restrictions.
Identify Other Community Services
Syringe services program refer people to services such as drug treatment, birth control, enrollment in health care, housing referrals and other health care services. Before deciding on a location, determine whether these services exist in the area. To find local treatment availability, see SAMHSA ‘s treatment locator.
Some state laws require extensive record keeping to track the number of syringes that are distributed, the number of clients in the programs, etc. State law may also require that reports be provided to local governments or to the community. Determine up front how these data will be tracked, whether they will be shared and how to ensure confidentiality for participants.