Syringe Trade & Education Program of TN: Chattanooga CARES Provides Syringe Exchange Services

Why offer syringe trade?

It is common for injection drug users (IDUs) to share needles, syringes, and other injection equipment. 40% of new IDUs share needles. The one-time use of syringes is the most effective way to limit the transmission of HIV among IDUs, with research showing that HIV infection rates are decreased by 80%. STEP TN provides a way for injection drug users who continue to inject to safely dispose used needles and syringes and to obtain sterile needles, syringes, and supplies at no cost. STEP TN also provides prevention and care services that can help injection drug users reduce their risks of becoming infected or transmitting HIV, Hepatitis C, or other bloodborne diseases.

Is syringe trade legal?

Yes. In May 2017, the State of Tennessee enacted Senate Bill No. 806. This bill allows for any nongovernmental organization to establish and operate a needle and hypodermic syringe exchange program. The law was created to address the opioid crisis by reducing the spread of human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), viral hepatitis, and other bloodborne diseases in this state.

How does SSPs work?

People are encouraged to bring in their dirty syringes, but this is not required. Many users collect syringes in detergent containers and bring the container to a syringe exchange site when it is full. Some individuals dispose of syringes in public bathrooms that have needle collection boxes. Some may have had their equipment confiscated and don’t have any syringes to exchange. Injection drug users often are fearful of getting caught with dirty needles by police.

Staff also offer interested participants condoms, and testing for HIV and hepatitis C. Staff provide information and referrals for addiction treatment, mental health services, and other resources. Only adults are served with this program.

What are the benefits of SSPs?

Based on existing evidence, the U.S. Surgeon General has determined that SSPs, when part of a comprehensive prevention strategy, can play a critical role in preventing HIV among persons who inject drugs (PWID); can facilitate entry into drug treatment and medical services; and do not increase the unsafe illegal injection of drugs. These programs have also been associated with reduced risk for infection with hepatitis C virus (HCV).

Many SSPs offer other infection prevention materials (e.g., alcohol swabs, vials of sterile water), condoms, and services, such as education on safer injection practices and wound care; overdose prevention; referral to substance use disorder treatment programs including medication-assisted treatment; and counseling and testing for HIV and viral hepatitis. SSPs also provide linkages to other critical services and programs, including screening, care, and treatment for HIV and viral hepatitis, HIV pre- and post-exposure prophylaxis (PrEP), prevention of mother-to-child transmission, hepatitis A and hepatitis B vaccination, screening for other sexually transmitted diseases and tuberculosis, partner services, and other medical, social, and mental health services. SSPs also protect the public and first responders by providing safe needle disposal and by reducing the number of people living with HIV and HCV infections who could transmit those infections to others.

Do SSPs increase drug use in a community?

No. Based on existing evidence, the U.S. Surgeon General has determined that SSPs, when part of a comprehensive HIV prevention strategy, do not increase the illegal use of drugs by injection. The opportunity to expand HIV and viral hepatitis prevention services through SSPs will support communities in their efforts to identify and prevent new infections. SSPs are an effective public health intervention that can reduce the transmission of HIV and facilitate entry into drug treatment and medical services, without increasing illegal injection of drugs. SSPs often provide other services important to improving the health of persons who inject drugs, including referrals to substance use disorder and mental health services, physical health care, social services, overdose prevention and recovery support services. Studies also show that SSPs protect the public and first responders by providing safe needle disposal.

Can participants receive immunity?

Public Chapter No. 413 Senate Bill No. 806(c)(1) It is an exception to the application of title 39, chapter 17, part 4, if an employee, volunteer, or participant of a program established pursuant to this section possesses any of the following:

(A) Needles, hypodermic syringes, or other injection supplies obtained from or returned to a program established pursuant to this section; or

(B) Residual amounts of a controlled substance contained in a used needle, used hypodermic syringe, or used injection supplies obtained from or returned to a program established pursuant to this section.

(2)(A) The exception provided in this subsection (C) shall apply only if the person claiming the exception provides written verification that a needle, syringe, or other injection supplies were obtained from a needle and hypodermic syringe exchange program established pursuant to this section.

For a participant in the program, this exception shall only apply to possession when the participant is engaged in the exchange or in transit to or from the exchange.

What services are SSPs required to provide?

Syringe exchange programs operating in Tennessee are required to provide the following:

1. Disposal of used needles and hypodermic syringes

2. Needles, hypodermic syringes, and other injection supplies at no cost and in quantities sufficient to ensure that needles, hypodermic syringes, and other injection supplies are not shared or reused

3. Reasonable and adequate security of program sites, equipment, and personnel. (Written plans for security shall be provided to the police and sheriff’s offices with jurisdiction in the program location and shall be updated annually)

4. Educational materials on all of the following: Overdose prevention; the prevention of HIV, AIDS, and viral hepatitis transmission; drug abuse prevention; treatment for mental illness, including treatment referrals; treatment for substance abuse, including referrals for medication assisted treatment

5. Access to naloxone kits or referrals to programs that provide access to naloxone

6. For each individual requesting services, personal consultations from a program employee or volunteer concerning mental health or addiction treatment as appropriate

Programs should also provide written verification to all participants that they have received syringes and other injection supplies from the exchange

How many needles can a participant receive?

Needles, hypodermic syringes, and other injection supplies will be provided to STEP TN participants at no cost and in quantities based on a one-for-one exchange model to ensure that needles, hypodermic syringes, and other injection supplies are not shared. A one-for-one exchange model provides participants to receive the exact same number of sterile syringes that the participant brings in for disposal. Participants cannot get sterile syringes if they do not bring in any used syringes for disposal.

https://www.chattanoogacares.org/steptn/