John Hirst
Hennepin County Public Health, Minnesota
At Hennepin County’s Public Health Clinic, the Red Door, harm reduction plays an important role in providing services. We understand how the complexities of life such as poverty, class, racism, past trauma, sex-based discrimination, and other social inequalities can affect an individual’s ability to adequately deal with drug use and STI prevention. For these reasons we meet patients privately in a welcoming and safe space to understand the challenges that are impacting their health and well-being. We acknowledge that there is not a one-size-fits-all solution. For example, some patients are struggling on a daily basis, some are focused on maintaining, and others are taking steps forward. Red Door provides information, services, and referrals that are tailored to the individual’s needs to empower them to reduce their risk of acquiring HIV/STIs during sex and drug use and improve their overall health.
Syringe exchange and naloxone: applying the harm reduction model to drug use
The overdose death of actor Philip Seymour Hoffman captured the attention of Minneapolis city officials and residents in 2014. Suddenly the local media reported heroin overdoses on a daily basis which brought increased attention to the heroin epidemic in Hennepin County. In response to this growing concern, Red Door’s prevention outreach team started researching the problem and discovered that between 2013 and 2014, Hennepin County experienced 262 heroin-related deaths.
The prevention program leveraged internal expertise, and met with county commissioners, community members, treatment facility residents, community based organizations, and current heroin users to identify the strategy that would work best to prevent the spread of HIV, HCV, and overdose deaths in the community resulting from the opioid abuse epidemic. With the feedback we received, Red Door created a free Syringe Exchange Program and has started distributing Naloxone (Narcan), an opiate antidote that reverses an overdose, in the clinic.
The syringe exchange program started in August 2015 and is accessible during all clinic hours. The program has knowledgeable non-judgmental staff to assist patients, and provides clean syringes and works (cottons, cookers, and tourniquets), Naloxone, chemical and mental health referrals, and HIV/STI testing. Any staff member at Red Door can help including Outreach and front desk staff or nurse practitioners who see clients during STI testing. Red Door continues to adapt as staff learn more about the patients’ needs. We originally only offered one size of syringe but soon discovered that other sizes were preferred as well. With such information Red Door now offers two of the most common sized syringes used for heroin and meth injection in the metro area. Patients are able to access the exchange quickly and without giving identifying information. When accessing the exchange, patients are given a choice between two sizes of syringes, cookers, cottons, tourniquets, alcohol preps, and Naloxone. Information is provided to every patient on topics such as abscess care, using clean syringes, works, and Naloxone, and referrals to mental health providers and medication assisted therapy providers are made. Depending on what the patient is injecting, they may want a few items or all the items available. Staff assisting the patient are also available to answer questions, make referrals, or preform STI testing.
In addition to providing clean syringes and works the Red Door also offers disposal services for used needles. Patients can dispose of used syringes in discreet disposal bins that are located in the men’s and women’s restrooms or people can give used syringes to staff during their visit. Patients are offered 10 syringes in two sizes. Should a patient dispose of used needles during their visit they are given the same number of syringes disposed of plus an additional 10. For example, if a patient disposes of 30 syringes they are given 40 new syringes in return. The maximum amount a patient is able to access at one time is 200 syringes. Patients are encouraged to return for more syringes when needed. Since opening, 5,410 syringes have been distributed.
Naloxone is also available for free. People who use needles for drugs, as well as family members or friends of users, are able to access Naloxone in the event a person experiences an opiate overdose. Each Naloxone package contains two syringes (larger than syringes given for drug use), two doses of Naloxone, two alcohol preps, and two band aids. Patients are also educated on how to administer Naloxone by staff and a pamphlet with instructions. Since opening, 217 Naloxone packets have been distributed. During an exchange, patients will share their experiences with Naloxone. One patient who provides secondary exchanges used Naloxone twice to prevent overdose deaths. Another patient’s partner used Naloxone to prevent her overdose.
Red Door’s harm reduction efforts have helped patients use condoms effectively, get treated for STIs, reduce their risk of acquiring HIV with PrEP/PEP, prevent HIV/HCV transmission by using clean syringes, and prevent overdose deaths with Naloxone. New patients come the Red Door to access the syringe exchange and are introduced the services that Red Door and Hennepin County provides. Prevention work is difficult but by understanding the challenges our patients are facing, we are able to improve a person’s health and well-being, even if it means just making small changes.
