Organizational Issues in the Implementation of a Hospital-Based Syringe Exchange Program

Abstract

Little published information exists to guide health care institutions in establishing syringe exchange program (SEP) services. To address this gap, this article discusses organizational issues encountered in the implementation of a hospital-based SEP in San Francisco, California (USA). Investigators collaborated with a community organization in implementing a county hospital-based SEP. SEP services integrated into a public hospital presented unique challenges directly related to their status as a health care institution. In the course of introducing SEP services into a hospital setting as part of a clinical trial, various ethical, legal, and logistical issues were raised. Based on these experiences, this paper provides guidance on how to integrate an SEP into a traditional health care institution.

RÉSUMÉ

La Problématique Organisationelle lors de l’Éxécution d’un Programme d’Échange de Seringue en Milieu Hospitalier

Le grand défi d’un programme d’échange de matériel d’injection pour une institution de santé comporte des questions éthiques, légales et logistiques surtout dans un contexte de recherche clinique. Il y peu de ressources qui aident ces institutions de santé à établir un tel programme. Cet article décrit la problèmatique au niveau de l’organisation et de l’éxécution d’un programme d’échange de matériel d’injection en milieu hospitalier à San Francisco, Californie. Les chercheurs ont mis en place ce programme en collaboration avec une organisation communautaire. Cet article nous fournit un guide afin d’établir un tel programme en milieu hospitalier.

Mots clés: échange de seringue, utilisation de drogues injectables, organisationel, hôpital

RESUMEN

Temas Relacionados a la Organización de la Implementación de un Programa de Intercambio de Jeringas en un Hospital

Existe escasa información publicada sobre como guiar a las instituciones de cuidado de la salud a establecer programas de servicios de intercambio de jeringas (SEP). Para enmendar esta carencia de información en la literatura, este artículo describe asuntos a nivel organizacional que se encontraron cuando se implementó SEP en un hospital en San Francisco, California (EE.UU.). Los investigadores colaboraron con una organización comunitaria con el propósito de implementar SEP en un hospital del condado. El integrar servicios de SEP en un hospital público presentó retos particulares que tienen que ver directamente con ser una institución de cuidado de la salud. Durante el curso de incorporar los servicios de SEP en el contexto de un hospital como parte de un estudio clínico, varios temas de índole ética, legal y de logística salieron a relucir. Basados en estas experiencias, este artículo brinda una guía de como integrar SEP en una institución tradicional de cuidado de la salud.

Palabras claves: intercambio de jeringas, HIV, uso de droga mediante inyección, organizacional, hospital

Keywords :

• syringe exchange
• HIV
• injection drug use
• organizational
• hospital

THE AUTHORS

Carmen L. Masson, Ph.D., is an Associate Adjunct Professor in the Department of Psychiatry at the University of California, San Francisco (UCSF) at San Francisco General Hospital. She teaches in the Postdoctoral Traineeship in Drug Abuse Treatment and Services Research at UCSF and is the Director of Training for the California-Arizona Node of the National Institute on Drug Abuse Clinical Trials Network. Her research program investigates interventions designed to improve access and delivery of prevention and health care services for drug using populations. Currently, with support from the National Institute on Drug Abuse, she is studying a model of HIV and hepatitis care coordination in the methadone treatment setting.

James L. Sorensen, Ph.D., is a California drug abuse researcher, teacher, and clinical administrator. He serves as Professor of Psychiatry at the University of California, San Francisco and Medical Staff Member at San Francisco General Hospital. Dr. Sorensen's work in drug dependence research began 25 years ago, directing an investigation of heroin detoxification. With support from the National Institute on Drug Abuse, NIMH, and American Foundation for AIDS Research Dr. Sorensen has developed and evaluated numerous innovative treatment approaches, including a Community Network approach to drug treatment, family therapy, small−group HIV education with drug users, case management approaches, and interventions to improve medication compliance of drug abusers with HIV/AIDS. Dr. Sorensen has authored 200 professional publications, including several recent studies of AIDS and drug abuse. Currently he is investigating how well patients on methadone maintenance fare in a therapeutic community setting and leading a collaboration of California and Arizona programs participating in multi-site studies in the NIDA Clinical Trials Network. He is first author of A Family Like Yours: Breaking the Patterns of Drug Abuse (Harper and Row, 1987) and Preventing AIDS in Drug Users and Their Sexual Partners (Guilford Press, 1991). Dr. Sorensen also is senior editor of Drug Abuse Treatment Through Collaboration: Practice And Research Partnerships that Work (American Psychological Association, 2003), which advocates for creating practitioner-researcher partnerships to improve the effectiveness of drug abuse treatment.

Nina Grossman, B.A., is currently the Community Liaison for Tibotec Therapeutics. Ms. Grossman began her work in HIV and substance use 15 years ago as an intern for the Marin AIDS Project. She was then hired on to coordinate the Peer Education Program at San Quentin State Prison. She then moved to Centerforce to continue her work with HIV-positive inmates at the prison. While working at Centerforce, Ms. Grossman was involved in many research projects with the Center for AIDS Prevention Studies and was an author of “Reducing Post-Release Behavior Among Seropoitive Prisoners”. Ms. Grossman joined the staff of the San Francisco AIDS Foundation in 1999 as the Director of the HIV Prevention Project. Her main responsibility was to coordinate operations for the needle exchange program and to build better relationships with the community and the San Francisco Police Department.

Karl A. Sporer, MD, FACEP, FACP, is a Clinical Professor at the University of California San Francisco School of Medicine and is a practicing emergency physician at San Francisco General Hospital for the past 16 years. His research interests and publications have included the topic of heroin overdose, its treatment and prevention, as well as on a variety of Club Drugs such as GHB and Ecstasy. He is a member of the board of directors of the California Chapter of the American College of Emergency Physicians. Dr. Sporer has served as the Medical Director of the Emergency Medical Services for San Mateo County for the past 7 years and is currently the Medical Director for the San Francisco Fire Department.

Don C. Des Jarlais, Ph.D., is Director of Research for the Baron Edmond de Rothschild Chemical Dependency Institute at Beth Israel Medical Center, a Research Fellow with the National Development and Research Institutes, Inc., and Professor of Epidemiology with the Department of Epidemiology and Population Health of Albert Einstein College of Medicine in New York. He began his research on AIDS in 1982. As a leader in the fields of AIDS and injecting drug use research, Dr. Des Jarlais has published extensively on these topics in journals such as, the New England Journal of Medicine, the Journal of the American Medical Association, Science and Nature. He serves as a consultant to various institutions, including the Centers for Disease Control and Prevention, the National Institute on Drug Abuse, the National Academy of Sciences, and the World Health Organization. He is a former commissioner of the National Commission on Acquired Immune Deficiency Syndrome (AIDS). Dr. Des Jarlais is currently working on research studies in 20 different countries, and has accumulated over three million frequent flier miles doing AIDS research.

David Perlman, M.D., is Director of the Infectious Diseases Core in the Center for Drug Use and HIV Research at NDRI, Inc.; Director, AIDS Inpatient Unit at Beth Israel Medical Center; and Professor of Medicine at the Albert Einstein College of Medicine (all in New York). His primary research and clinical interests are in the infectious complications of drug use and HIV/AIDS, and in tuberculosis prevention and treatment. He has written over 50 articles on these topics and has authored or coauthored several book chapters, summary statements, and guidelines; the primary focus of his publications has been treatment of HIV/AIDS and tuberculosis coinfection, behavioral interventions for HIV, HBV, and TB screening and prevention, and syringe exchange. He is a member of several professional societies such as the American College of Physicians, Infectious Diseases Society of America, the College on Problems of Drug Dependence and the International Society of Travel Medicine.

Notes

1 Treatment can be briefly and usefully defined as a planned, goal directed change process, which is bounded culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual-help based (AA, NA, etc.) and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users- of whatever types- which aren't also used with non-substance users. In the West, with the relatively new ideology of “harm reduction” as well as a consideration of quality of life there are now a new set of goals in addition to those derived from/associated with the older tradition of abstinence driven models. Editor's note.