For the past several years there has been a move a foot to initiate a Needle Exchange in the Miramichi area. Thanks to the tireless work of invested community members, we are now on the cusp of opening one. My last blog about the Needle Exchange explained ‘How We Do’ or how we operate, but focused less upon why we operate. Since I have been spending some time lately talking about the virtues of Needle Exchanges, I have decided to make “why we do” the topic of this week’s blog.
The primary focus of a Needle Exchange is to reduce the spread of HIV and Hepatitis among Injection Drug Users (IDUs). In my last blog about the Needle Exchange I explained that in 1999 the Fredericton Police Force asked the community to start some form of initiative to address the high amount of needles being left in public, and so the Fredericton Needle Exchange was born. At this time Needle Exchanges were just barely making their way onto the scene, and were misunderstood by many. Today, Needle Exchanges have gained some notoriety and even if someone objects to the notion of an exchange, it is hard to dispute the positive impact they have on a community and on public health.
I will let Elizabeth Pisani explain the scientific rational for Needle Exchanges as well as condom distribution as it relates to HIV transmission. She’s just great!
“If there are two things that make human beings a little bit irrational they are: erections, and addictions.”
Despite the overwhelming evidence in favour of Needle Exchanges, people who object to them still exist, and can prevent such initiates from being implemented in their communities. I’m sure you can imagine the types of rebuttals one might hear regarding the Needle Exchange, “It encourages drug use”, “I don’t want that around my kids”, “They got themselves into it, why should we help them?” and so on.
Let’s examine those quotes. First, evidence tells us that Needle Exchanges do NOT encourage drug use, and trust me, people have tried to prove the contrary. Second, I can appreciate the instinct to protect ones children from harm, which is one reason why I support Needle Exchange so much. Needle Exchanges foster community, which results in fewer needles being left around the city, and a general increased respect for people. Third, true, you cannot help someone who is not willing to help themselves, but when they are ready, their connection with Needle Exchange Staff can help them on their way to helping themselves.
People who have addictions may not simply be chemically addicted to their drug of choice, whether it be the more outlawed crystal meth or cocaine, or the more legalized tobacco or alcohol, they may also have a physiological dependency to it. It can be an external coping mechanism, because their internal one isn’t working. Obviously, needing a coping mechanism isn’t the only reason people use, but it is one. And for anyone, their habit, their coping mechanism, is probably more important than legal consequences, it’s a pretty huge part of a person’s life.
As stated by Dr. Robert Strang “Looking at illegal drugs based solely on a criminal justice approach has failed.”, however, if we look at addiction from a Medical Model, rather than a Criminal Justice Model we would see that there are programs available for people who are ready to try to stop using. These programs offer detoxification for the chemical dependency, and counseling for the psychological dependency. The key word here is “ready”. The person has to be ready to make that change in their life, no one can force it. The person needs to reevaluate their consequences verse reward structure.
This is where Needle Exchanges come in. Needle Exchanges operate on a philosophy of Harm Reduction, which put very simply is reducing the amount of harm associated with a particular situation. Harm Reduction does not seek to eliminate the core behaviour, or punish those who engage in it. It just seeks to make it safer. Let’s take driving a car for example. Driving a car can be a dangerous thing to do, accidents are not uncommon. Seatbelts are (for the most part) found in cars, and the people who wear them are practicing harm reduction. Harm reduction doesn’t try to stop people from driving in cars, it just tries to make it safer, offering an option for people to chose. It’s the same for Injection Drug Use: the behaviour exists, and for those who are trying to stop that behaviour, there are services available. But, for those who are not ready to stop using, Needle Exchanges make it possible for them to at least help avoid contracting HIV, Hepatitis, or any number of infections.
What’s interesting about Needle Exchanges, or at least what I have noticed with mine, is that it’s because it’s not our role to stop our clients from using, that they feel comfortable coming in not only the first time, but time and time. For many, it’s the only safe space that they have, the only place they have to feel human. Needle Exchanges do not operate solely for clients, but also for their families and friends. It is not uncommon to have parents, friends, or loved ones come in to pick up clean supplies, because they are trying to keep someone else safe. We offer a place for anyone to be able to talk openly about their or someone else’s habit, without being criticized, or belittled. Once that happens, once that line of communication is open, it may be easier to have open and honest conversations about other difficult topics.
A significant number of my clients ask me about Addiction Services. When this topic is broached, it is very important to ensure that information is delivered in a way that is unbiased. It is very important to give all the relevant information without leaning to one side or the other. If someone makes the decision to seek treatment, one needs to be encouraging, but too much, because if the client relapses, which is a part of recovery, they need to feel safe coming back to the needle exchange, but at the same time we need to make the transition as straightforward as possible. I even have a contact with Addiction Services who will actually come down and do intakes in my office, for those who are not ready to walk upstairs, anything to make it easier for them, when they’re ready.
I’m usually the last person my client sees before they walk upstairs to Addiction Services to check-in for detox. They come in to drop off their injection kit, things like tourniquets, spoons, used needles, extra needles, filters, and alcohol swabs, and off they go. No one forced them to seek Addiction Services. If and when they are ready, they will seek it on their own, and it’s such a good feeling to help them, help themselves. Deterring people from drug use isn’t nearly as effective as encouraging them to seek treatment. Some people will seek services when they are ready, and some people will never seek them. Criminalizing those who would eventually seek services is redundant, and criminalizing those who will never, is a waste of time and resources.