Mail-based Syringe Access During COVID19: Brief Guide

MAIL-BASED SYRINGE ACCESS DURING COVID-19:

NEXT DISTRO

ABRIDGED GUIDE FOR SYRINGE ACCESS PROGRAMS

Given potential changes to in-person services, the purpose of this is to share some basic information for mail-based syringe access for those who may have the ability to implement this as an option for folks to continue receiving supplies.

L EG A L IT Y It is not illegal to mail syringes in the US. What puts syringes into a legal gray area is when they are paired with any type of ‘paraphernalia’ or drug user health education component.

Diabetic syringes are available through online marketplaces if folks have the means to purchase them. Amazon sells one box of EasyTouch (10 bags of 10 syringes each) for about $15. This is cheaper than most in-person pharmacy prices.

COST Depending on the amount of supplies in a package, it costs anywhere from $7-$20 to ship a box of harm reduction supplies via USPS. Bubble mailers are a less expensive option but they hold far fewer supplies. For very heavy packages, a USPS flat rate box is sometimes cheaper. More info on USPS pricing.

HOW TO ENROLL PARTICIPANTS & RECEIVE REQUESTS The main thing to keep in mind is that convenience is the enemy of privacy and security. Any time participant information is stored with names and addresses in an unsecure system (Google docs, for example), there is risk. It is important to inform participants of that risk.

Here are some things to consider for receiving order requests from participants: 1) Phone-in enrollment: make sure to double- and triple- check the address and confirm if there is an apartment or lot number.

2) Use

a Google Form for participants to enroll online. These enrollments automatically get sent to a Google Sheet (very similar to Microsoft Excel) where you can set up an email notification (Tools > Notification Rules) to alert you to when a new participant enrolls. a) Google Sheets integrating a third party service into your form will force you to agree to their service/company

having access to all pieces of your information. Beware of third party add-ons. b) Having the enrollment be anonymous with a ‘handle’ and then having an individual call in their address is an option.

3) Encourage participants to download and use the Signal app (available for Android phones, iPhones, and desktop computers - download Signal) for communication with you. We have outlined our privacy and security efforts, including the benefits of Signal, on our website.

ORDERING You will find that the ordering process is the most complicated piece. If you are able to dedicate one phone line to orders coming in and have someone who is doing the packing take the orders, that would be best. You can quickly learn how much fits in a box. Ordering is much easier when people know exactly what they want.

SUPPLIES Participants request supplies for themselves and often for their close networks as well. In general, NEXT asks users to request supplies for one month as a guideline. You will need to do what is right for your participants, capacity, and inventory.

HOW TO PACKAGE You can purchase cardboard boxes on Amazon for under $1/box. The shipping boxes we commonly use are (dimensions in inches): · 10 x 6 x 4 - fits 200 syringes · 10 x 8 x 7 - fits 460 syringes · 12 x 8 x 8 - fits 600 syringes

· 18 x 16 x 10 and larger - for mailing large amounts of supplies to community/peer distribution, or if sending large sharps containers

TIPS FOR MAXIMIZING SPACE IN A PACKAGE · Cookers and sharps containers take up a lot of space. Put supplies into sharps containers (they’re also great for protecting glassware/pipes) - remember the lids if they are separate from the container! · Take the 10-syringe bags and other supplies out of their original boxes to reduce their volume. · Consider limiting water/saline in packages for folks that have other non-ampule options. This reduces package weight and can help keep shipping prices low too.

Don’t put anyone’s name IN the box. Leave some room for deniability if at all possible, i.e., a roommate or parent opens the package.

HOW TO MAIL The United States Post Office is the least expensive and most reliable option for mailing. They also have strict privacy standards.

Let folks know that their full name is essential for mailing packages. You want people to think it is any other old boring package These are the things we’ve noticed may get a package flagged by security (which usually means a delay in shipping): · Missing or incomplete return address - if at all · No recipient name possible, use a return address and/or name that can not · Consider a nondescript return name and address if be traced back to your program. possible. We use “NHR” rather than “NEXT Harm · Only a first name, or obvious pseudonym of recipient. Reduction” and a P.O. Box return address.

TIPS ON THE MAILING PROCESS · Items to mail that are considered “hazardous” include batteries, perfume, and anything flammable. Don’t say your box has hand sanitizer or anything alcohol-based. Always check the NO option if you are asked if packages have anything hazardous. · If asked what you are mailing, you can say office supplies, first aid supplies, or something else innocuous. · Third party postage systems (such as pirateship.com) are convenient because you can purchase postage online and print from a printer (or thermal printer). However, using anything third party does create more risk if records are ever subpoenaed by a court. USPS.com has an online option but we have found it too clunky to use.

FINAL NOTES · Mail-based distribution can be very time consuming. We’ve learned that dedicated staff time needs to be set aside in order to sustain and grow distribution. · We’re continuing to build upon our resource page. Check it out at nextdistro.org/resources. (Thanks Kat Humphries!)

Please send us your resources to include.

CONTACT

Jamie Favaro | 917-828-0293 | jamie@nextdistro.org | naloxoneforall.org | nextdistro.org