IV. Choosing a Site or Sites

The following resources are available to find out more about specific regulations in your area: 1) Your local health department 2) Harm Reduction Coalition (HRC) 3) Temple University’s Project on Harm Reduction in the Health Care System 4) American Civil Liberties Union (ACLU)

Appendix A provides links to additional resources that point to background on the legal basis for syringe access in the United States, while Appendix C details specific strategies for legal justification of SAPs that have been successful.Also, if at all possible, it can be helpful to build relationships with some good, local criminal lawyers who support syringe access and with whom you can consult as needed.

All staff at the SAP must be trained and wellversed in legal issues related to the SAP. It is important for all staff to understand the legal rights of SAP participants as well as the overarching authorization or legal justification for the SAP to operate. In addition, any legal documents – such as waivers or authorizations – should be easily accessible to all staff in case of incidents with law enforcement. Staff and peers should receive proper SAP identification, indicating their affiliation with the program.

Regardless of the kind of protection offered under the law for SAP operation, it is crucial to engage with local law enforcement early in order to minimize any potential problems or confusion. Particularly in cases when there are recent changes to penal codes, law enforcement may not understand the protections for SAPs and their participants. In addition, given the vulnerability of drug users when it comes to law enforcement, it is the responsibility of the SAP to ensure that participants understand how they are protected, and any ways in which they may not be protected from prosecution. Module 4 will discuss negotiations with law enforcement in greater detail, however the more education and outreach that can be done to local law enforcement early on – including an outline of the legal authorization for your program as well as benefits of the SAP to officer and public safety – the better.

drug users can still be arrested for possessing hypodermic needles and syringes (clean or used), even if they can be legally purchased over-the-counter without a prescription or obtained legally from Saps. despite laws, regulations and legal precedents that protect Sap participants from prosecution for syringes obtained or being returned to Saps, arrests or additional charges (paraphernalia or drug possession for residue in syringes or cookers) are not uncommon.

it is always important to distinguish between the law of the land and the law as it plays in the street. that is to say – sometimes law enforcement make arrests, despite protections under the criminal or public health code – creating very real consequences for drug users.

cHOOSing A SiTe Or SiTeS

Site location

Choosing site location for conducting syringe access services – be it fixed, mobile or outreach sites – can be among the most important factors in the success of the program. Site location can inform whether IDUs will visit the site, how comfortable they feel once they get there, and, in some cases, the level of community resistance the SAP may face.

An SAP can have wonderful services and excellent staff; however, without IDUs it will not function. An inconvenient location, or one that is perceived as threatening in any way (ex. near a police station), could easily deter IDUs from visiting the program – even when they are interested in taking care of their health and using sterile injection equipment.

Beyond making it difficult for IDUs to access sterile injection equipment, improper site location can have other ramifications. In extreme cases, controversy around location choices can undermine overall support for syringe access, attract heightened scrutiny directed at program operations and participants, and jeopardize relationships with allies and other stakeholders.

When choosing a site, it is important to know as much as possible about the location. Certain locations can almost guarantee community opposition. For example, an SAP is likely to invite public opposition if it is too close to any place where children congregate, including: • Schools • Playgrounds • Children’s nurseries and day-care centers • Youth and after-school programs

In urban areas, restaurants with outside seating or shops with window displays may be concerned about drug users congregating in front of the program. Residential areas can also pose challenges – commonly known as NIMBYism (Not In My Back Yard). In general, it is important to keep in mind that IDUs are likely to gather and hang out in front of the program or across the street; it is the responsibility of the SAP to protect both participant safety and program viability from the program’s outset, which includes anticipating problems before they occur.

Of course, it is equally important to choose a site that will be convenient and accommodating to the IDU community. The good site is going to be one that makes transactions quick and easy so that, if need be, IDUs can continue with any other activities with as little disruption as possible. A good location will also be close to where IDUs live, work and/or obtain drugs. Ideally, it will be easy to find, but still somewhat discreet.

Proximity to public transportation, particularly in urban areas where it may be the primary mode of transport, is also an important factor. Using information gathered during needs assessment, look for a location that will be convenient to copping spots (places where people buy or “cop” drugs), but not so close that the program, its participants or anyone else may be compromised. A good question to ask in a needs assessment would be, “How far do you think you would be willing to walk for clean injection equipment?” Consider traffic patterns around a potential location – will drivers have a hard time parking? Will people on foot have an easy walk? Will the program be accessible to people with disabilities?

SAPs may also benefit from being near methadone programs, hospitals, welfare or public assistance offices, shelters, soup kitchens and/or other ASOs or CBOs.

fixed-Site considerations

Choosing a fixed site comes with unique considerations. When choosing a site, consider issues such as program growth, storage space and general feel. Programs that feel too “clinical” may be less appealing. In addition, consider the design and layout of your program – will it be able to fit desks, couches, chairs, etc?

The layout should also allow SAP staff to easily see what’s going on at all times - including where people are and that all participants are safe. Given the nature of working with drug injectors, it is important to be able to monitor for overdose as well as other safety issues at all times. On a related note, when choosing a fixed SAP site, the bathroom can be an important consideration. It is not uncommon for IDUs to be transient and/or homeless and a restroom can be an especially valuable resource. In many cities, public showers and restrooms for IDUs can be hard to come by. Keeping a biohazard disposal container in the bathroom can reduce the incidence of sharps or other biohazard material from being disposed of improperly. Finding a site with a shower can be of particular value, although it will also pose organizational challenges. Even bathrooms without showers will often be used for “bird baths” (i.e. showering in the sink), private time, changing clothes and other needs; because the bathroom can be such a valuable resource, it can be useful to monitor how long individual participants spend in the bathroom.