For Rural Drug Users, Finding Clean Needles Might Mean Looking in the Mail

As the opioid epidemic spread in recent years, more and more communities embraced syringe access programs that provide safe injection materials to people who use drugs. Also called needle exchanges, the concept has been proven to be a safe and effective way to reduce the spread of contagious diseases without increasing drug use. 

Still, there are only 320 syringe exchange programs in the U.S., according to the North American Syringe Exchange Network. In states like California, New Mexico, and Kentucky, which have dozens of them, clean needles can be easy to find. But in the 15 states where the programs are banned, getting safe injection supplies can be difficult.

In those places, and in rural areas where a syringe exchange may be hundreds of miles away, people who inject drugs may turn to different solution: ordering syringes online. NEXT Distro, a New York-based non-profit, is also trying to fill the gap as a free harm reduction platform that ships safe injection supplies like syringes, alcohol pads, tourniquets, gauze, sharps containers, and syringe clippers, to people across the country. 

“Everyone who uses drugs should have access to harm reduction supplies,” said Jamie Favaro, the founder of NEXT Distro. “If you live in a rural area, or you’re poor, you should have the same access to support and harm reduction. You can order syringes from online marketplaces like Amazon and people do that—people who have money.” 

Mailing harm reduction supplies isn’t a new concept, Favaro said. She got the idea after learning about the work of Tracey Helton, an activist who mails the overdose reversal drug naloxone to people who ask for it on Reddit forums about addiction and recovery.

In New York, NEXT Distro is one of 24 authorized syringe exchange programs, acting as a middleman between the state, which supplies the harm reduction materials, and the people who need them. Erin Hammond, a spokesperson for the New York Department of Health, said that 53 individuals have taken advantage of the service so far, with 41% of NEXT Distro supplies being sent to two upstate counties, Washington and St. Lawrence. 

“It is an imperative of the NYSDOH to reach people who inject drugs throughout all of New York, especially those in rural areas,” Hammond said. “It’s critical to supply individuals who are not currently accessing health services or do not have syringe exchange programs nearby with clean syringes and other supplies to reduce disease transmission.”

Favaro said that while her organization is based in New York, they ship safe injection supplies across the country, although NEXT Distro can’t disclose where those supplies end up out of concern that the users of their service might face criminal prosecution. “We receive a lot of requests from people who live in other states, especially those in the South where laws make getting safe supplies difficult. Our priority is expanding to those states.” 

Many of the states where the rate of hepatitis C infections is on the rise due to injection drug use—including states in the South and throughout the Great Plains—are those that lack places where people who use drugs can swap dirty needles for clean ones. Opponents of the programs often argue that needle exchanges make drugs easier to use and could attract crime to neighborhoods in which they’re established. 

Favaro said she’s shipped thousands of needles to one state where the need is so great, she can’t take on more demand. “There are so many places like that around the country,” she said. “It’s a Scott County waiting to happen.” 

Scott County, Indiana, was the location of a years-long HIV outbreak among people who inject drugs between 2011 and 2014, when 215 people became infected. In 2015, former Gov. Mike Pence declared a public health emergency, and a month later, the county created a temporary needle exchange program. 

A CDC investigation in 2016 into the Scott County crisis found that at least 220 other counties in the U.S. were at risk of HIV and hepatitis C outbreaks related to injection drug use. 

Favaro said needle exchanges and safe injection material programs are critical to preventing these types of outbreaks—and mailed supplies might be the only way to reach people in geographically isolated areas. NEXT Distro doesn’t require users to ship needles back.

NEXT Distro also works with harm reduction affiliates and state health department partners in 29 states to distribute free naloxone through the mail. Though naloxone is easier to obtain than safe injection materials, and can usually be purchased at most pharmacies, Favaro said getting it isn’t always easy. “We’re contacted by a lot of family and friends of people who use drugs who tell us how difficult it is to get naloxone,” she said. “They couldn't afford the copay, or lived an hour away from a pharmacy, or they couldn’t overcome the stigma of buying it in a small town.”

States supply their own naloxone, but use NEXT Distro’s digital infrastructure to ensure people have an easier way to obtain it. Packages include naloxone, a rescue breathing map, tips for overdose response, information about stigma and overdose aftercare, and instructions for how to report the use of the drug. All of the deliveries are geo-located, which provides valuable information to state health departments. “It can show the state where people are reporting low or no access to naloxone,” Favaro said. 

Favaro said she believes the best service is provided with in-person harm reduction, but an online model is a necessity for people who have no other option. While places like Reddit are an invaluable source of information, she noted that it can be difficult to sort out what advice is evidence-based and what isn’t. “It’s a minefield,” she said. “That’s why it’s so important to consolidate supplies and information in one anonymous, stigma-free place. Harm reduction programs are lifelines for people who use drugs, and an online model is our best option going forward to ensure that all Americans have access.”