Community Retrieval/Syringe Collection It is important for the SAP to respond to community concerns regarding the improper disposal of used injecting equipment. In addition to educating participants and providing resources to increase proper disposal, SAPs may also consider engaging in pro-active syringe clean-up efforts in the community. This can be done by organizing crews of SAP staff and/or volunteers to go into community areas that may have higher rates of discarded injection equipment and conducting “needle sweeps”. Of course, any member of a clean-up team must be trained on proper handling and disposal of RMW and tools such as tongs, sharps containers and puncture-proof gloves must be made available to workers. In some cases, when there is a clear and necessary advantage, these “sweeps” can be made public through the use of media outlets as a way to attract positive attention to the SAP and increase support. However, any time media is contacted and involved in SAP activities it is essential to weigh the potential for negative consequences against any possible gains. Also, it is imperative to make every effort to protect confidentiality of SAP participants. Another strategy for assisting the community in improper syringe disposal is to develop a resource whereby the SAP can respond directly to specific community concerns. For example, the SAP can institute a hotline for community members to call and report any incidents of improperly disposed syringes. The SAP can then dispatch trained staff to retrieve and dispose of the sharps. Advocating for the use of syringe disposal kiosks in areas where IDUs are likely to access them – parks, public bathrooms, pharmacies, etc – can also be very useful.
O VER D O S E P REVENT ION When working with injection drug users, it is imperative to address overdose (OD) prevention and response. Overdose poses a significant health risk to drug users and is the second-leading cause of accidental death in the US, just behind automobile accidents. SAPs are in a unique position to address OD prevention and response so that should overdose occur, it is not fatal. Comprehensive training on overdose prevention, recognition and response should be a requirement for all staff and should also be made available to SAP participants. Programs will also benefit from having specific protocols in case of an OD at the program. OD Prevention and Response In order to comprehensively address overdose, an SAP should: 1) Train all staff and volunteers on OD prevention, recognition and response. a. Training should include the use of naloxone (Narcan), a drug used to reverse the effects of opiate overdose, and if possible, staff should receive prescriptions to be able to legally carry it. Although naloxone is not technically defined as a controlled substance by the federal or state law, it is currently a prescription drug in the United Sates that is subject to the general laws and regulations that oversee all prescriptions in regular medical practice. Therefore, it is possible for someone to face prosecution if they are in possession of, or use, naloxone without a prescription. Further, in some states, naloxone can only be prescribed to people who use drugs. Hiring drug users as staff would ensure that naloxone is still available on site in case of emergency. b. Anyone who works or volunteers at an SAP, including front-line staff, administrators, executive directors, cleaning staff, etc, should receive comprehensive OD prevention, recognition and response training. 2) Address overdose with participants through training on prevention, recognition and response, as well as with ongoing education campaigns. a. Ideally, the SAP will be able to make naloxone (Narcan) available to participants. b. For assistance instituting an overdose prevention program, please contact HRC’s S.K.O.O.P. (Skills and -44-
