Health departments can be a natural ally given their common interest in reducing the spread of infectious disease and promoting greater public health. The support of health departments can build the credibility of the SAP and garner support from neighbors, the community at-large and law enforcement. However, it may be necessary to educate health departments about the benefits of SAPs, provide scientific evidence supporting their implementation, and describe challenges that can be imposed by certain regulation strategies. A supportive and engaged health department can validate SAPs as important tools in promoting community health and potentially provide the legal basis for operation. Health departments can allocate valuable funding toward syringe access services. In addition, they can provide numerous resources to the SAP such as access to testing services, vaccination, healthcare referrals and other service linkages. Health departments that are on board with the SAP may also be able to coordinate provision of syringes as well as disposal of biohazard and sharps. There can also be challenges when collaborating with health departments. Perhaps the biggest challenges will be related to the bureaucracy that can be tied to governmental systems. Health departments may have strict reporting and regulation requirements that, while often valuable, can also be very time-consuming and inefficient. Some policies imposed by health departments may be hard to reconcile with SAP participants (i.e. policies around exchange vs. distribution, limits to the number of syringes that can be exchanged and/or limits on secondary exchange). SAPs may feel a certain loss of autonomy under health department regulation. However, the benefits of collaboration, including the impact on project sustainability often outweigh the drawbacks. The following principles foster successful collaboration between SAPs and health departments: • Clear understanding of expectations from both parties • Open lines of communication • Reporting SAP achievements, challenges, noteworthy incidents and ongoing needs in a timely manner • Commitment to mutual support and flexibility • Willingness to listen to and learn from each other
RELA TI O N S H I PS WIT H LA W ENFO RCEMEN T SAPs are responsible for negotiating and communicating with law enforcement to protect their program operations and their participants. Without proper education, law enforcement officers may target SAPs and their participants. This diminishes the effectiveness of the program and places participants at increased risk of prosecution. If people are targeted and arrested at or near the SAP, participants may lose trust and therefore be less willing to access services. Poor interactions with law enforcement can have a number of negative consequences for participants. Fear of law enforcement may keep IDUs from: • Visiting the SAP • Returning used syringes • Collecting a sufficient number of syringes • Calling 911 in cases of overdose • Properly disposing of used syringes • Practicing safer injection and overdose prevention strategies A great number of the cases that law enforcement deals with involve drug use on some level. Law enforcement officials are unlikely to have a complete understanding of harm reduction, HIV and HCV transmission, and may also lack information on laws around syringe possession and related public health provisions. Many police officers have fears of accidental needle stick and drug users in general, often expressed in the form of hostility. Nonetheless, as harm reduction teaches, it is important to meet law enforcement where they’re at. It is important to acknowledge the frustration and helplessness that law enforcement officers can experience as a result of the cyclical nature of drug use and their interactions with drug users. Ongoing and persistent education, training and proactive communication are key to building understanding and avoiding problems. -64-
