Making the Most of Needle Exchanges
Syringe exchange programs are difficult to use, but in the absence of anything else, they are a godsend. In addition to this, exchanges can be very helpful as a part of a multi-faceted approach to acquiring syringes.
The Exchange Philosophy
The basic idea of syringe exchanges is that syringes are exchanged. These programs do not increase the number of "illegal" syringes on the street; they simply replace used syringes with new ones. Even with this restriction, people continue to make the argument that syringe exchange programs increase illegal injection drugs use (this is demonstrably false, however). Without this restriction of only allowing exchanges, it is doubtful that these programs would operate legally anywhere in the United States.
Increasing the User's Syringe Stock
Because of the philosophy of the exchanges, most take great care when counting the syringes that are input and output. Some programs are not so careful. These programs will often allow users to get a few more syringes than they are turning in. Often these programs simply take the client's word for how many syringes are being deposited. This is particularly true when the number is large (over 100).
Many exchanges request that syringes be banded together in groups of ten. If a few groups are nine, it is likely that they will be counted as ten--even at exchanges that are careful about counting. Over time, these minor errors will cause the user's total stock of syringes to grow, and the larger a user's stock, the more useful are exchanges.
Most exchanges offer a selection of syringes. Normally, they will offer large and small syringes. The large syringes have a barrel that holds one cubic centimeter (cc) of water. This is equivalent to a milliliter. The small syringes have a barrel that holds a half cc; occasionally one sees 0.3 cc syringes in addition to or in place of the half cc syringes. Most heroin users prefer the larger syringes because they ingest a larger solution volume. The smaller syringes are preferred by meth users who inject small volumes of solution (the idea with meth is that there is a one to one ratio of meth to water--heroin is not that soluble).
The other syringe option involves the size of the syringe needle. These normally range from 30 to 27 gauge. See the article Gauging Syringes in this HEROIN helper issue for more information about syringe sizes.
Most exchanges provide a lot of useful stuff besides syringes. These range from syringe cleaning kits to food. The people who run the exchanges really are modern day saints.
One such thing is a cleaning kit. A typical package is shown in the photos on the left. This package contains a lot more than just cleaning supplies. In addition to bleach, which all kits contain, this one contains purified water, a rubber tie, a package of cotton filters, an alcohol prep pad, antiseptic (benzalkonium chloride) towelette, and antibiotic ointment. In addition it has a clean cooker system which is an aluminum cap with a long twist-tie. The twist-tie is wrapped around the the cap and then the ends are twisted together to form the handle for the cooker. This can be seen in the bottom photo.
Also available are condoms which, in addition to their usefulness for sex, are helpful when hiding drugs.
Finally, and perhaps most important, the exchanges are usually an excellent source of drug related information. Most of this comes from the Harm Reduction Coalition. The HRC provides many small pamphlets in addition to their exceptional book Getting Off Right: A Safety Manual For Injection Drug Users. This book is required reading for users who inject.
In addition to this kind of general information, the exchanges usually have a thorough collection of local information. This includes information on other exchanges, detox programs, support groups for people with HIV and Hepatitis (and drug addiction, of course).
Needle exchanges are always free of charge. But if a user can pay for his syringes, he should. First, it supports the exchange. Second, in a sane world, he would be able to walk into a pharmacy and buy the syringes he needs--the syringes would not be free. So taking syringes for free is like begging. Some users may not have a problem with this--but most people beg only when necessary.
The retail price of a syringe in the United States is about 22¢. But this is for grade-A end consumer syringes. The syringes that exchanges distribute are of lower quality. As a result, paying 10¢ for each syringe is reasonable. And the exchange will be happy as well.