Syringe Exchange Delivery Models via the National Harm Reduction Coalition

Fixed Site Exchanges – The exchange is located in a building. This could be a storefront, an office, or other similar space.

Strengths:

♦Shelter from street-based activities/safe space.

♦Room for other services such as medical care, referrals, psychosocial.

♦Out of view of local residents, businesses

♦Privacy for exchange participants.

Limitations:

♦Participants have to come to you.

♦Limited hours of operation.

♦Higher overhead and upkeep.

Mobile/Street Based Vehicle based exchange – The exchange is conducted via a van or RV that drives to exchange sites and neighborhoods.

Strengths:

♦Flexibility if the drug scene or neighborhood changes.

♦Easier negotiations with larger community if they know you are not a permanent fixture.

♦Informal and low threshold if actually on the sidewalk or in a park.

♦Reaches harder to reach IDUs who may not have transportation or feel comfortable walking into a fixed site exchange

Limitations:

♦Harder to deliver ancillary services than with a fixed site.

♦Van involves higher overhead because of insurance, upkeep, driver, etc.

Home Delivery or Peer-Based Exchange -  Participants call a phone number to arrange delivery of services, which can be done in their home or at another agreed upon site. Can happen on a regular schedule, or by appointment via cell phone. 

Strengths:

♦Safer for participants.

♦Peer knowledge of drugs, drug use, and the local drug scene.

♦Increases access to new syringes for socially isolated injectors who do not access services such as syringe exchange.

Limitations:

♦Can involve a lot of driving, resulting in high overhead.

♦ Harder to offer wrap around services such as HIV testing, wound care, referrals, etc 

Integrated syringe exchange - An organization adds syringe exchange into their ongoing services.

Strengths:

♦Pre-existing organizational infrastructure and client base.

♦Multiple ways of getting syringes to participants, depending on the type of services provided by the agency.

♦May offset operational and human resource costs

Limitations:

♦Staff may be  resistant to new programs & new ideas, especially if the agency follows a traditional abstinence approach.

♦Cost of training and supervision of peers.

♦Possible conflicting identities as peer worker and IDU community member.