Keynoter at harm-reduction summit says syringe exchange programs need to partner with drug users to be truly successful

Nearly 500 people attended the 2019 Harm Reduction Summit on April 9 in Northern Kentucky.  (Photo by Melissa Patrick)
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By Melissa Patrick
Kentucky Health News

COVINGTON, Ky. – Syringe exchange programs must partner with drug users to have the most impact. That was one of many messages that resonated with the nearly 500 attendees of the state-sponsored 2019 Harm Reduction Summit in Northern Kentucky on April 9.

Jon Zibbell, a senior public-health scientist at RTI International, an independent, nonprofit research institute, was the keynote speaker. He& praised the state’s efforts for harm reduction, saying Kentucky is recognized across the nation as a leader on it.

At the same time, he stressed that there is room to do more in these programs to better meet the needs of the people they are supposed to serve. But first, he said, you have to ask the people who use drugs what their needs are.

“This population has insights and expertise that can help inform the planning, delivery and review of harm reduction services,” Zibbell said.

Harm reduction is the primary purpose of a syringe exchange. It not only passes out clean needles and syringes as a way to decrease the spread of HIV and hepatitis C, which are commonly shared by the sharing of needles among intravenous drug users; it also provides health screenings and vaccines, access to treatment, and a safe place for people to reach out for help.

The legislature authorized the exchanges in 2015, subject to approval of local governments. They have approved 52 exchanges, all but four operational. That said, about half of the 54 counties that are considered at high risk for HIV and hepatitis C outbreaks among IV drug users still don’t have one.

Latest, updated map of syringe exchanges and vulnerable counties (Click on it for a larger version)

Zibbell talked about the many challenges of helping drug users stay safe, including the influx of fentanyl into the market, which has created what he called “market unpredictability;” the use of multiple drugs among opioid users, which increases their risk for overdose; and the increase in the number of non-opioid drugs, like cocaine and methamphetamine, that also have fentanyl in them.

He said no one knows better than the drug users themselves the reality of these challenges, and that’s why we need to be talking to them about it.

Zibbell said much of the data used by harm-reduction programs comes from law enforcement, government data sets and mortality records, not the people on the streets who “have critical knowledge and expertise. . . . People that use drugs have an insight and a knowledge about drugs that we desperately need.”

He said the principles of harm reduction support his call for bringing drug users into the programs as consultants. One calls for drug users and those with a history of drug use to “routinely have a real voice in the creating of programs and policies designed to serve them.” Another says users are called to be the “primary agents of reducing the harms of their drug use,” and such programs should empower them to share information and support each other with strategies to do so.

Zibbell said working in partnership with people who use drugs helps a program better understand its clients and their needs, which will result in better outreach and service. Further, he said it will ensure the program is community-friendly, improves the “cultural competency” of the workers and reduces the stigma often associated with drug use.

“We need to know where the drugs are on the street, we need to know how people are injecting, we need to know if people are getting tested, if they’ve been vaccinated,” he said. “Having that connection to the population gives us that entry. ”

Takeisha Nunez, supervisor of the syringe exchange at the Louisville health department, also came with the message of partnering with drug users. Her focus was on African Americans, who she said have been slow to embrace them.

Nunez said African Americans’ historical mistrust of government and the medical system and said this mistrust has been an obstacle for them to participate in syringe exchanges, which in Louisville are primarily located in government buildings or medical centers.

In response to a Facebook question about why more African Americans don’t come to the Louisville exchange, one client replied: “They are afraid. I have shown them my card and everything, but they don’t believe that they won’t get arrested.”

Further, she said there is a lot of resentment about these programs. Another person on Facebook wrote, “Where was all this compassion when there was a crack era and you was locking up the black and brown people? No one was the angel of compassion for our community.”

Nunez said, “We have to figure out ways to break down those barriers.”