Syringe exchange an interview with samuel macmaster by Emily Sandberg Gold

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Syringe Exchange: An Interview With Samuel MacMaster Lori K. Holleran Steiker

School of Social Work , University of Texas at Austin Published online: 11 Oct 2008.

To cite this article: Lori K. Holleran Steiker (2008) Syringe Exchange: An Interview With Samuel MacMaster , Journal of Social Work Practice in the Addictions, 8:3, 412-416, DOI: 10.1080/15332560802224642 To link to this article: http://dx.doi.org/10.1080/15332560802224642

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Syringe Exchange: An Interview With Samuel MacMaster Interview conducted by Lori K. Holleran Steiker

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Holleran Steiker: To begin with, what are your general beliefs about syringe exchange? MacMaster: I have two strong beliefs about programs that exchange syringes with injection drug users. First, and most importantly, syringe exchange programs save lives by eliminating the mechanism by which individuals contract HIV/AIDS (the shared syringe). The lives saved are not only those of injection drug users, but also their sexual partners and children, and members of the community. I also strongly believe that we really need to look at a continuum of health and social services for active drug users, with one component being syringe exchange. Syringe Lori K. Holleran Steiker, ACSW, PhD, is an Associate Professor in the School of Social Work at the University of Texas at Austin currently studying culturally grounded substance abuse prevention with high-risk youth through a NIDA K01 grant. Samuel MacMaster, PhD, is an Associate Professor in the College of Social Work at the University of Tennessee. His research interests center on the intersection of substance use and HIV/AIDS. Address correspondence to: Lori K. Holleran Steiker, School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd., Austin, TX 78746, USA. (E-mail: lorikay@mail.utexas.edu).

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exchange has always provided a conduit to drug treatment and other social services by providing opportunities for active injection drug users to connect with low threshold services provided in a nonjudgmental manner. It’s just good social work. Syringe exchange provides opportunities for meeting an individual where they are (actively using substances) in their environment with what they need, rather than waiting for the individual to meet our expectations (a desire to remain abstinent). This approach works, and most syringe exchange programs provide an array of social services and all work closely with abstinence-based drug treatment programs to provide access to lifelong recovery. I think we really minimize the importance of these other services when we focus solely on the syringe exchange component. Holleran Steiker: I am aware that there is research and literature supporting syringe exchange, but that there is still some resistance against such programs. Can you flesh this debate out, explaining the challenges to moving forward as well as the benefits and historical successes? MacMaster: The lack of support for syringe exchange is based, at best, on oversimplified assumptions about addiction, and at worst, the dehumanization of injection drug users. Quite simply, despite the mountains of evidence (i.e., 10 large-scale multisite federally funded studies and numerous smaller single-site studies) there remains a severe discomfort among many individuals with the concept and act of exchanging clean and used syringes with active injection drug users (MacMaster & Womack, 2002). This is often rationalized as a desire not to enable, or support, an individual’s use with the assumption that if they are left on their own they will eventually become in touch with the pain of the consequences of their use and seek drug treatment services. While this view may be helpful for family members of well-resourced substance users, it becomes less appropriate for professionals interacting with injection drug users. Most individuals involved with syringe exchange programs are very in touch with the pain of their use, and a nonjudgmental, noncoercive approach is often welcomed. We need to really provide love to people before we can effectively enforce tough love. We know syringe sharing is a direct link to HIV infection and syringe exchange eliminates this risk. If we do assume that it is enabling, then we are simply prolonging the window of opportunity for recovery, for as a good friend of mine says, “Dead addicts don’t recover.” At worst, however, the lack of support is really an outgrowth of the lack of compassion for active

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substance users. It is difficult for anyone to interact with participants in syringe exchange programs and not be confronted by the pain of the stark realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination, and other social inequalities that affect both the vulnerability to the consequences of drug use and the capacity for effectively dealing with addiction. I believe that the lack of support is really a denial of these issues. We (as a society) are somehow bound to a consistent message on drug use, that all drug use is “bad” and all drug users are “bad,” and that help is only extended to those who want to be “good.” This simplistic morality is killing our communities and its members. I often ask students, “What would you want for a child, or other loved one, who developed a substance use problem?” The answer is rarely a prison sentence and the elimination of all assistance. Most individuals would seek the highest level of health care and make all attempts to access substance abuse treatment services for their family member. I think we owe all members of our larger family, our community and society, this same treatment. We simply need to take the judgment out of the equation. Holleran Steiker: Will you tell some anecdotes as illustrations of your successes and/or challenges with syringe exchange programs and harm reduction in general? MacMaster: I am currently working with my colleagues Kenneth Vail and Lyle Cooper to expand a syringe exchange program in Washington DC, Prevention Works. I think Washington, DC provides examples of many of the sorrows and hopes of syringe exchange across the country. There is currently a ban on the use of federal funds to support syringe exchange, and nationally most syringe exchange is supported by small private donations. In many of the cities and states confronted with the highest HIV rates among injection drug users, state and/or city funds have been utilized to support syringe exchange programs. The District of Columbia, however, has been specifically prohibited by a rider to the annual federal budget to use local tax dollars to support syringe exchange. Because of the colony-like status of the District, their budget must be approved by Congress. This rider has been annually included by Congressmen from the Midwest who are uncomfortable with the idea of sending an inconsistent message on drug use to the youth in their districts, and has passed each year under the present administration. Washington, DC has seen a rising increase in HIV among injection drug users over the

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past 10 years and the city now has one of the highest HIV rates in the nation. After many years of consistent political pressure, this year the rider was not included and the program has the resources to expand to a full continuum of services. This illustrates the ability and struggles of individuals to continue to provide services in difficult political environments and that their perseverance over time paid off. Holleran Steiker: It is my understanding that attitudes about such programs differ internationally. How has syringe exchange fared in other countries? What is your vision for syringe exchange in the United States? MacMaster: Many other countries are able to develop drug policies without the judgment that is handicapping our ability to be effective here in the United States. Australia, for example, was able to institute syringe exchange as soon as the HIV/AIDS epidemic developed. Their HIV rates among injection drug users are almost nil. The Netherlands not only instituted syringe exchange, but coupled all of their drug policies with treatment on demand. The lack of substance abuse treatment access really impacts our ability as a nation to effectively deal with drug addiction in this country. My vision is that our country will do the following: (a) reduce the level of judgment; (b) become more honest with ourselves—people use mind- and mood-altering chemicals, they always have—and ask, “What will we do as a society to reduce the harm of that reality?”; (c) provide drug treatment on demand, which is a lot cheaper and more effective than warehousing drug users in prisons; and finally (d) provide federal funding for syringe exchange so that it becomes a portion of the continuum of services to active drug users throughout the country. Holleran Steiker: What recommendations can you make to social workers who want to support or champion syringe exchange programs? MacMaster: For all social workers, I implore you to think critically about your own views of substance use and substance users. Ask yourself how have you, as an individual, contributed to the demonization of active drug users? For those with an interest in syringe exchange, contact a local program and volunteer. Syringe exchange programs universally lack resources and depend on volunteers to assist them in all areas. Finally, advocate for change. The example in DC is but one instance of a small group of dedicated people with the willingness to make a stand to change policy and improve the lives of others.

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Holleran Steiker: Where can readers turn to learn more about this important issue?

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MacMaster: I address the concept of harm reduction in several recent articles, including one written specifically for social workers. I have referenced them below. Holleran Steiker: Thank you so much for sharing your time and expertise, Dr. MacMaster. Can our readers contact you if they would like to learn more? If so, what is the best way to reach you? MacMaster: Readers are welcome to e-mail me at smacmast@utk.edu or they can call and speak to me at (615) 782–6150. They may also want to connect with the North American Syringe Exchange Network (www.nasen.org), the Harm Reduction Coalition (www.harmreduction.org), or the International Harm Reduction Association (www.ihra.net). Information about Prevention Works can be accessed at www.preventionworksdc.org.

REFERENCES MacMaster, S. A. (2004). Harm reduction: A new perspective on substance abuse services. Social Work, 49, 356–363. MacMaster, S. A., & Chesire, J. D. (2001). Perspectives on the other: Accounting for differences between drug policies in the Netherlands and the United States. Journal of Applied Social Sciences, 25, 31–44. MacMaster, S. A., & Vail, K. V. (2002). Demystifying the injection drug user: Willingness to be involved in traditional drug treatment services among injection drug users involved in a needle exchange program. Journal of Psychoactive Drugs, 34(3), 1–13. MacMaster, S. A., & Womack, B. G. (2002). Preventing HIV transmission among injection drug users: A brief history of syringe exchange programs. Journal of HIV/ AIDS and Social Services, 1(1), 95–112.