Harm Reduction Efforts for Illicit IV Drug Users

Illicit drug use through the intravenous route introduces pathogens into the body via shared needles and a lack of sterile preparation and injection techniques. The number of blood-borne infections like hepatitis C and Human Immunodeficiency Virus (HIV) continues to rise with persistent drug use, thus nurses attention should address various methods of harm reduction. Because nurses are educators providing the skills for open and honest communication, they are most effective in reaching out to the drug using community promoting safe injection practices thereby decreasing the spread of infectious disease. Addressing essential nursing strategies, such as collaborating with the government to gain financial support for supervised injecting centers, promoting legal syringe access through syringe exchange programs, as well as offering educational programs at the injection rooms within health care facilities are necessary harm reduction efforts that contribute to saving lives.
“Approximately one-third of HIV cases in the United States is associated with the practice of sharing of injection equipment and is preventable through the once-only use of syringes, needles, and other injection equipment. Injection drug use is also the principal mode of hepatitis C transmission” (Stancliff, 2003 para. 1). Variables responsible for the transmission of lethal diseases among IV drug users relates to equipment sharing between users, a deficit in disease knowledge, as well as a lack of awareness of health services offered. Additionally, the population abusing illicit drugs is more likely to participate in unsafe sexual practices, which contributes to the transmission of infectious agents. All of these factors are preventable by providing education and supplies. This emphasizes why it is crucial that nurses address such issues with specific strategies. According to Bradley-Springer (1998), “If patients fail to practice prevention, providers must offer preventative care to reduce danger of infection among themselves and to continually educate patients” (page 17).
One nursing strategy is to join forces with the government to encourage financial support for supervised injecting facilities. The only supervised injecting center operating in North America offers “heroin addicts a medically supervised injecting site” (Jones, 2006, page 859). At the Insite clinic, nurses and doctors are present to provide general health care including sterile syringes, as well as medical interventions if users overdose (Jones, 2006). Nurses must help the government understand that the tremendous cost to the health care system for tertiary care far exceeds the cost for primary care. Gaining government support will aid in the expansion of supervised injecting facilities in more locations. If additional centers existed, nurses would be able to communicate with more IV drug users spreading the word on disease transmission along with preventing second time use of syringes by providing sterile equipment. Nurses working at these centers believe in “harm minimization” and feel that in the long term, they are “educating users to stop the spread of disease and help them get off drugs” (Buckis, 2005, page 24).
Sterile syringes are not only provided at supervised injecting facilities, they are offered at syringe exchange programs as well, which is the second nursing strategy that should be addressed. “Several studies have shown that when given access to sterile syringes, drug users readily make use of them, reducing their high-risk behavior and rates of disease transmission” (Edlin, 2006, para. 14). Promoting legal access to syringes enhances drug users’ adherence to using sterile equipment, thus decreasing transmission rates. According to Edlin (2006), “substantial progress can be made if existing knowledge and resources are to bear” to the community (page 1). Nurses are great candidates for educating the public about syringe exchange programs, due to their effective communication skills and knowledge of what the program offers. The education of the public will contribute to a “significant decrease in needle reuse” thanks to the availability of “clean needles and persistent prevention messages offered at syringe exchange programs” (Cowlitz County Health Department, 2007, page 3).
In addition to offering sterilized injection equipment in places like supervised injecting facilities and syringe exchange programs, another strategy to reduce harm is to offer educational programs at injection rooms within health care facilities. A short history review on infectious disease as well as a “teaching plan for sterilization of needles and syringes with the underlying message of health and the invitation for rehabilitation” should be the focus of these classes (Edwards, 2006, page 257). Offering such classes within the health care facility would make them easily accessible to the public, which would increase the attendance rate; thus more effectively spreading the message on disease and drugs.
Because some IV drug users will continue to use illicit drugs, the problem will never be solved entirely. However, implementation of several nursing strategies such as government collaboration for financial support, promotion of legal syringe access via syringe exchange programs, and offering educational programs within the health care facility are essential in reducing the problem and are “lifesaving interventions” (Edlin, 2006, para. 1). The existence of the programs mentioned above directly relate to decreasing numbers of infectious disease transmission by intravenous drug use. The goal of these programs is wellness promotion; therefore nurses must strive to promote harm reduction to those in need, because expecting people to quit would be unrealistic. Intervention #1:
Nurses must collaborate with the government to gain financial support for supervised injection centers.
Disadvantage #1:
Financial support from the government as well as obtaining a permit to operate is needed to establish new supervised injection centers. This in itself creates a barrier for these centers because attaining governmental support is a challenge. Many of its members argue that “it’s morally wrong to aid illegal drug addiction” (Jones, 2006, page 175). A prominent supervised injection facility in Vancouver, Canada called Insight, barely received a permit extension to continue operation of their experiment. Finally, a “deferring decision was made on Insite pending more research” (Jones, 2006, page 178). The Canadian Conservative government is not confident that safe injection sites contribute to lowering drug use, fighting addiction, and inhibiting spread of infectious disease at this time thus keeping them from fully supporting these services. “Evidenced-based practice is being compromised by the politicization of science, and efforts by corporations and lobby groups undermine research that threatens profits or offends moral positions” (Kerr, 2008, page 964). Politics affect supervised injection centers greatly, for the government is the deciding factor as to whether these facilities stay open or not. Their hesitancy of supporting supervised injection centers hinders the existence of new ones as well as the continuation of those in existence.
Disadvantage #2:
Nurses possess effective communication techniques to persuade others, though convincing an entire conservative government is a challenge. The feelings these critics posses are strong and the evidence based research proving center’s effectiveness are limited. Governmental critics say “this approach is too accepting of drug use and that it does not make sense to make heroin illegal and than set up healthcare facilities where people can inject it” (Buckis, 2005, page 24). Because critics feel so strongly about their concerns for this controversial subject, convincing them to change their minds is difficult. Nurses are faced with a great challenge, for the Canadian government is not the only critics opposing supervised injection facilities. They are supported by other agencies and governments as well who oppose such facilities. The International Narcotics Control Board has looked down upon countries implementing supervised injecting facilities. The United States “has maintained a ban on federal funding” of related services as well (Kerr, 2008, page 964). Nurses have yet to gain support from those opposing the facilities, which is keeping more from existing.
Intervention #2:
Nurses must promote legal syringe access through syringe exchange programs.
Disadvantage #1:
There are internal factors that exist within an intravenous drug user that create barriers to adherence of sterile technique. Many intravenous drug users are uneducated about how syringe exchange programs operate, so they prefer to stay away. Syringe exchange programs require “no appointment or identification; relying on exchange of used syringes for sterile ones is an integral part of the service” (Stancliff, 2003 para. 9). Lacking knowledge of syringe exchange program’s requirements along with concerns for privacy and confidentiality, keep a client from taking advantage of these services. The “social stigma and embarrassment surrounding drug use” also play a major role in keeping someone from obtaining sterile equipment from syringe exchange programs (Bradley-Springer, 1998, page 17). The reason for their visit to the facility is obvious, which can be a problem for those who posses strong feelings of keeping their habit a secret.
Disadvantage #2:
Along with existing internal barriers that prevent adherence to sterile technique, external barriers, or environmental factors exist as well. A primary drawback to syringe exchange programs is “their lack of accessibility; there are approximately 130 exchanges in the entire United States” (Stancliff, 2003, para. 9). Additionally, because of syringe exchange programs policies of needle exchange, intravenous users are obligated to “carry and return medical waste containing drug residue that may put them at risk of arrest” (Stancliff, 2003, para 9). And because only 130 centers exist, the distance one must travel might be too risky for intravenous drug users, outweighing the benefit of access to sterile equipment.
References
Bradley-Springer, L. Prevention: The original adherence issue. Journal of the Association of Nurses in AIDS Care. (1998) 9(3) 17-18 Retrieved April 27, 2007 from Expanded Academic ASAP Database.
Buckis, C. (2005) High and dry: Controversy has plagued Sydney’s supervised injecting center for heroin users. But the nurses who run the place say they are simply saving lives. Nursing Standard. 20(10) 24-26. Retrieved April 09, 2007 from Expanded Academic ASAP Database.
Edlin, B. R. (2006) Prevention and treatment of Hepatitis C in injection Drug users. Pub Med Central Retrieved January 13, 2008, from .
Edwards, K. (2006) A new role for pediatric nurses: Teaching teen drug users how to sterilize their equipment for prevention of infectious disease; a course outline. Pediatric Nursing. 33(1) 257-263 Retrieved from April 09, 2007 from Expanded Academic ASAP database.
Jones, D. (2006, October 10) Injection site gets 16-month extension. Canadian Medical Association Journal – JAMC. 175(8), 859 Retrieved from January 13 2008 from .
Kerr, T. & Wood E. (2008, March 25) Misrepresentation of science undermines HIV prevention. Canadian Medical Association Journal. 178(7), 964. Retrieved from April 29, 2008 from Proquest database.
Stancliff, S., Agins, B., Rich, J. D & Burris, S. (2003) Syringe access for the prevention of blood borne infections among injection drug users. BMC Public Health. 3 Retrieved January 13, 2008, from .
The 2005 annual report of Cowlitz County’s syringe exchange program. Cowlitz County Health Department. (2005) Retrieved September 25, 2007 from .