I volunteered at my college town Needle Exchange on Monday nights my sophomore year of college.  I thought it would be useful to recount my very basic experience with this program, in the hopes of raising awareness about the existence of such efforts and to promote more widespread acceptance of the benefits of such a facility.  The clinic I worked at opened in the mid-’90s, with support from the mayor, city council, Chief of Police, and area health and human service providers. Needle Exchange sites are legal in the United States if the state in which it is located does not have a law requiring prescription to buy a hypodermic needle, or if a formal vote of approval is given by a local elected body. In many communities, the sale and possession of non-prescription sterile syringes is illegal, making it difficult for injection-drug users to obtain properly sanitized needles. 

The sharing of contaminated syringes and other injection equipment (“works”) is a dangerously significant factor in the spread of HIV and other blood-borne diseases, such as Hepatitis B and C. The lack of educational materials available to IV drug users and the strict laws limiting needle possession and clean needle distribution suggest that the government considers drug users unworthy of protection from HIV. Even after a syringe is washed out with water, traces of blood may remain undetected, placing the next user at risk for infection. The availability of sterile needles, in exchange for used syringes, can greatly reduce this risk factor. Needle Exchange Programs are finally becoming more accepted on a national level, but government funding is still short.

One of the reasons given by the government for this since the late 1980s is that the CDC believed, or claimed to believe, that allowing intravenous drug users access to sterilized syringes would not prevent people from sharing in usage.   According to studies conducted in 1997, research has shown that needle exchange does not amplify usage among addicts and does not increase the quantity of discarded syringes.  In fact, the cost of providing drug users with safe syringe exchange programs is far cheaper than treating people infected with HIV as a result of drug use. 

I enjoyed working at the Needle Exchange and I have absolute faith in its effectiveness. The atmosphere was very relaxed and the work was minimal. If it was a slow night, I went through old newspapers, clipping articles about the Needle Exchange, drug use, women’s health issues, the police department, government policies, and anything else that might pertain to the clinic. The articles went into scrapbooks, informal archives of the clinic. When new participants came in, I would take some basic information from them about their drug use, and assign them a code based on their mother’s name and their birthdate. For regular participants, I would take their code and fill out a simple form to document the exchange, asking how many needles they were bringing in, where they got their needles, if they shared needles or works, and if they cleaned their needles or “popped” their skin. I would also offer them a free HIV test and information on detox programs, if they were interested. The Exchange offers a wide variety of literature and pamphlets on Hepatitis, HIV, women’s health, and rehabilitation, including a review of local and neighboring detox programs, rated by intravenous drug users. The Exchange also helps state residents to access primary health care.

For the actual exchange, participants would drop their used needles into a sharps container, and I would give them whatever size syringes they requested, plus one extra. There was a food pantry, which I would unlock if the participant needed food. They were allowed to take one of any item, sometimes more, depending on how many people they were feeding in their family. They could also take any supplies they wanted besides syringes, including cookers, twist-ties, bleach kits, water vials, cotton, condoms (male and female), lubricant, vitamin E, tourniquets, band-aids, and sterile wipes. At the end of the night, I would count the stock and record how many of what item had been given out, and replace the supply for the next day.

I like organizing and restocking and I was really interested in how the works were used. I asked one of my co-workers, a heroin user, to give me a demonstration of how to safely inject. She showed me how to clean the needle properly, how to use the cooker, the water, and the cotton. I wanted to be able to instruct participants on safe injection practices, how to reduce scar tissue, and how to utilize the services that the Exchange offered. Many local residents whom I knew came into the clinic, which I had expected, and I had worried that it might be awkward. Fortunately, volunteers, staff members, and participants in the program were very friendly and open. The staff did not discuss individuals by name, as a rule, but basically, everyone knew each other and I knew most of the heroin users in town. I was surprised at how comfortable I was in the setting. 

I think that this is what struck me most about the Exchange; without having to be covert and coded about drug use, communication lines opened up easily in the non-judgmental atmosphere. The information and the resources were available and there was no shame or secretiveness, just a respect for privacy.  The exchange policy helps reduce the number of contaminated needles circulating, part of the philosophy of harm reduction. I think that the Needle Exchange Program is exceptionally important, the most realistic, accessible, and effective response to drug use that I know of. If this program and others like it were to be established around the country, I believe that the rate of HIV infection and other infections resulting from intravenous drug use would change dramatically.