A Veteran allowed a friend to use their syringe to add drugs to his own clean syringe last summer. As a result, the Veteran was hospitalized for sepsis, caused by injection drug use and diagnosed with hepatitis C.
The Veteran’s VA Syringe Services Program (SSP) team acted fast to rapidly start him on hepatitis C treatment and to make sure he had clean syringes.
He then enrolled in a substance use domiciliary and hasn’t used drugs for two months. Now, the Veteran is working on obtaining a license to become a truck driver. Mentally and physically, he says he feels better now than in decades.
VA is working on bringing critical harm reduction practices – which are designed to lessen the negative consequences of drug use – to our medical centers.
Harm reduction includes SSPs. These programs, where legally allowed, provide clean syringes and equipment to people who inject drugs. They also provide critical services like infectious disease testing, naloxone prescribing and linkage to mental health services.
Increase the likelihood of substance use treatment
SSPs don’t increase illegal drug use or increase the crime rate in the geographic area where they are located. But they do increase the likelihood of entry into substance use disorder treatment by five-fold, reduce the incidence of new HIV and hepatitis C infections by 50%, and prevent overdose deaths.
SSPs are fairly new to VA and are being added to new sites all the time. Currently, there are VA-SSPs in
- Danville, Illinois
- San Francisco
- Puget Sound (Seattle and Tacoma)
- Chicago (Hines VA Medical Center)
We talked to Beth Dinges (Danville) and Minh Ho and Jacqueline Byrd (Orlando) to hear more about their work.
Syringes and naloxone integrated into VA’s comprehensive care
What are your VA Syringe Services Programs like?
At Danville, our program started when a Veteran asked for clean syringes to protect himself and others. Our VA site is in a rural community with no access to sterile syringes and naloxone (medication used to prevent overdose) from community programs, so we knew we needed to provide this service at VA.
We provide syringes and naloxone access that is directly integrated into VA’s comprehensive care, including addiction and medical treatment, all under one roof.
Orlando is the 4th largest VA in terms of Veterans served, and in a state that ranked number one in HIV and seventh in hepatitis C diagnosis. In 2019, we started the RIS4E program to offer Veterans comprehensive testing, such as HIV, hepatitis and sexually transmitted infections, and access to sterile syringes.
We developed a multidisciplinary team approach with physicians, pharmacists, nursing and social workers to administer vaccines, HIV Pre-Exposure Prophylaxis (PrEP). We provide referral to smoking and alcohol cessation, social work services, clean injection technique education, and substance use program services.
What do you wish the people knew about VA-SSPs and harm reduction?
We see re-infection with hepatitis C as well as hospital admissions for skin, bloodstream, bone and heart valve infections caused by injection drug use. For patients who use drugs, accessing sterile equipment is a step in the right direction. We wish more people recognized that people who use drugs are members of our family, neighborhood and community.
If we have simple and effective tools to protect people from infection and overdose, we should provide them. It really comes down to treating others like you would want to be treated. That’s what we are aiming to do in Danville and Orlando. We understand the difficulty of asking for syringes due to stigma, so when a new Veteran joins, we thank them and appreciate their courage for reaching out.
We adapt our programs based on Veterans’ feedback and we deliver care through a respectful, non-judgmental, non-condemning and non-confrontational method with emphasis on personal responsibility, offering treatment and harm reduction.
What has been the reaction to these programs?
Veterans have been appreciative and surprised by the many items we offer to keep them safe. One of our Orlando-area Veterans indicated after the first SSP visit that “it was a real wakeup call” and stated we were one of the reasons he was seeking recovery. He reports he hasn’t injected drugs for three weeks and “getting a sponsor for the first time in my life.”
Like Orlando, feedback from Veterans in Danville has been positive. There’s a lot more to do to improve how we treat and care for Veterans who use drugs. This is a step in the right direction.
If you are interested in accessing syringe services, naloxone or substance use services from VA, please talk to your provider about what is available locally. Information on safer drug use is available at https://www.hiv.va.gov/patient/ssp.asp.