4091.0: Tuesday, October 23, 2001 - Board 7

Abstract #22315

Organizational issues in the implementation of a hospital-based syringe exchange program

Carmen L. Masson, PhD, San Francisco General Hospital, Department of Psychiatry, University of California, San Francisco, 1001 Potrero Avenue, Room 7G27, San Francisco, CA 94110, (415) 206-8404, masson@itsa.ucsf.edu, James L. Sorensen, PhD, Department of Psychiatry, University of California, San Francisco-San Francisco General Hospital, 1001 Potrero Ave, Building 20, Room 2117, San Francisco, CA 94110, David C. Perlman, MD, Department of Medicine, Beth Israel Medical Center, Milton and Carroll Petrie Division, First Avenue at 16th Street, New York, NY 10003, Nina Grossman, BA, San Francisco AIDS Foundation HIV Prevention Project, P.O Box 429018, San Francisco, CA 94142, Karl A. Sporer, MD, Department of Medicine, University of California, San Francisco, 1001 Potrero Avenue, 1E21, NH, San Francisco, CA 94110, and Don C. Des Jarlais, PhD, National Development and Research Institutes, Inc, Two World Trade Center, 16th floor, New York, NY 10048.

This paper describes organizational issues encountered in the design and implementation of a hospital-based syringe exchange program (SEP). HIV Prevention Project (HPP) legally operates a San Francisco community based SEP. Investigators collaborated with HPP in implementing an institutional-based SEP in the county hospital. The proposed introduction of a SEP into a hospital setting raised challenging ethical, legal/administrative, and logistical issues. Ethical issues raised included beliefs that: 1) SEPs encouraged individuals to continue using drugs and were unethical and inconsistent with a medical center's mission; 2) SEPs should not have research driven entry criteria; 3) SEP services should not be offered to individuals interested in enrolling in drug treatment; and 4) use of monetary research stipends within a hospital-based SEP is inappropriate. Legal/administrative issues included concerns about: 1) diversion of injection equipment to persons not enrolled in the program; 2) institutional liability regarding needle sticks; 3) encouragement of illegal activities that could subject individuals to criminal and legal consequences; 4) increases in petty crimes committed on hospital grounds; and 5) increases in discarded needles found on hospital grounds. Operational /logistical concerns identified included: 1)setting/location of the SEP; 2) protocol for hazardous waste disposal; and 3) potential impact on other hospital-based programs. Divergent philosophical views of key players were at the core of these issues; significant compromise was required to reach mutually agreed upon resolutions allowing the implementation of the program. This research effort provides both valuable information and guidance about how to integrate a community-based program into a traditional institutional setting.

Learning Objectives: At the conclusion of this session, the participant will be able to describe several organizational issues that must be considered in the design of syringe exchange programs.

Keywords: Syringe Exchange, Organizational Change

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 129th Annual Meeting of APHA