Outreach Exchange

For most of us when we think of a needle exchange we picture either a pharmacy exchange where someone is given pins and very little else (including information in a lot of cases) or a static site exchange where someone is given a fuller intervention in a nice warm building.

But for services that run street outreach there are other options. This article is about an exchange we did with a heroin injector and the advantages it had both to the user and to the service.

So a bit of outline on the service I currently work in: equipment wise we have a history of very limited equipment in our city, this is mainly due to poor funding and little understanding of the advantages of needle exchange as a gateway to services from the Drug Action Team. A result of this and of the poor facilities we have means that most non steroid users just access pharmacy exchanges. But recently we took advantage of an underspend to order in a wealth of equipment.

We have been running night-time outreach for around 5 months, and it’s mainly been just a chat and a coffee for rough sleepers. This week though we came across one of my previous clients and during the chat he mentioned that he had dropped out of prescribing a couple of weeks ago and was talking about it in a very ‘ohh well its done’ way, even when I explained that it should be no problem to get him re-scripted.

I asked him how much heroin he was using and he said £30 - £40 a day injected. Because he is rough sleeping he had very little access to hand washing facilities, so I offered him some hand cleaning gels and explained that there was enough gel to wash his hands and most of an arm ready for injection. We also gave him 10 amps of 2ml water and a water snapper (plus explained how to use them).

I explained to him that we also had “Nevershare” pins and sterile cookers back at the office but that we only had standard 1mls with us; he took 10 of these and a bin as well.

We arranged that he would come back into the service to see me the next day that I was in work to let me know how he found the equipment (remember that most of this equipment is not available in our city).

Next Session

He did come into the service again to get more equipment including 3 different colours of Nevershare pins because he uses with two friends.· He also asked for different colour snappers so he wouldn’t mix these either.

I asked how he had found the equipment and he said it was fantastic, he said his friends loved it as well and that they would be coming in to collect some themselves, including one of them who had been telling us on outreach he was just drinking.

I asked if he wanted me to look into prescribing, which he did. I also agreed to organise hep testing and vaccination for the same time as his prescribing appointment.

Advantages

The obvious advantages to the user are we have reduced his virus risks, got him back into treatment and re-engaged him with the service. As a result his risk profile for overdose is also reduced.

The advantages to the service are that we re-engaged a hard to reach (homeless) client, but more than this we have more evidence now for the usefulness of our outreach work and of the engagement advantages you get from a well stocked exchange. Hopefully this can in some way be used to help convince funders that we need to stock more than just pins, swabs and citric.

Related Links

The Nevershare pins and alcohol gels that where given out are available from Exchange Supplies. Click here .