SHOULD WE MOVE FROM SYRINGE EXCHANGE TO DISTRIBUTION?

Port-Au-Prince, Haiti, 2010: An American aid worker after a failed attempt to deliver desperately needed food to 700 Haitians. Photographer: Peter van Agtmael. Printed with permission of Magnum Photos.

Kerr et al.¹ recently reported findings indicating that syringe exchange programs (SEPs) can maximize their impact by removing restrictive policies. We would like to call attention to our study, which provides additional evidence linking SEP policy to increased syringe access and other positive outcomes. As part of a National Institute on Drug Abuse–funded study in Portland, Oregon, we pilot tested a program that trained secondary exchangers—methamphetamine injectors who frequent our SEP and regularly provide syringes to others—to deliver HIV risk reduction and other health promotion messages along with clean syringes. As part of this program, we also relaxed our established 1-for-1 exchange policy for this small group of peer educators, with favorable results.

Seventeen individuals were trained as peer educators during 3 training sessions; peers received an additional box of 200 syringes on top of usual SEP services at each training session. For 2 months after the training, those peer educators delivered health messages and clean syringes to methamphetamine injectors in the community. Sixteen peer educators (94%) completed baseline and 3-month follow-up evaluation interviews.

At follow-up interviews, 15 of 16 peer educators (94%) reported participation in SEP services at a training session. Of those, 13 (87%) said they received and distributed more syringes than they exchanged during the previous 2 months, including 7 who said they expanded their distribution networks.

Comparisons of baseline and follow-up data showed significant increases in the number of syringes peers reported distributing in the previous 2 months, from a median of 712.5 (range: 50–4800) at baseline to a median of 1500 (range: 200–9000) after the intervention (P = .03, Wilcoxon signed rank test). For very little cost (about $19 per 200 needles), peer educators approximately doubled the volume of syringes they distributed to other injectors, without necessitating the extra costs of staff, vans, or building rental.

Our study supplements growing evidence from larger jurisdictions suggesting that less restrictive syringe dispensation policies are associated with increased access to clean syringes and safer injection practices.^1–3 Currently, fewer than 1 in 10 SEPs in the United States report unlimited distribution program models.⁴ Transforming more US syringe exchange programs to such models will require changes in political acceptance, program design, and staffing, and may remain financially unrealistic for small jurisdictions, despite the recent removal of the ban on federal funding for SEPs.⁵ Meanwhile, providing extra syringes to SEP participants who report exchanging syringes within a social network appears to be an effective and inexpensive means of increasing access to clean syringes.