How Mailing Syringes to Drug Users Helps — The Merits of Mail-Based Supply Distribution

People like San Francisco’s Tracey Helton and organizations like New York City’s NEXT Distro have long distributed syringes, naloxone, and other harm reduction supplies via mail.

Mail-based supply distribution (MBSD) is so very helpful for people who live in areas where there isn’t much, if any, access to harm reduction supplies, drug-related education, or drug user health support. Although MBSD isn’t an equal substitution for in-person syringe services programs and other resources that help drug users like me, they’re unarguably the next-best alternative.

I regularly distribute supplies like these from mail-based supply distributors to fellow drug users and dealers here across rural Northwest Tennessee in an underground, unfortunately-illegal, grassroots fashion. Here, syringe access is nonexistent and finding naloxone is like pulling teeth.

Here are some insights on MBSD that I’ve gathered during my time as a harm reductionist.

Drug Users Often Lack Access to Necessary Supplies

Across West Tennessee, there are only two syringe services programs (SSP) overseen by the Volunteer State. Both of them are in Memphis, which is in the far southwestern extreme of Tennessee. No matter where you’re at in Northwest Tennessee, a nine-county area home to 254,000 people, Memphis is at least a solid 90-minute drive away, rendering legal syringe access essentially impossible.

Pharmacies can legally sell syringes, though pharmacists routinely turn down customers without prescriptions for syringes. The only access we have to syringes here in rural West Tennessee is the black market.

Here, there’s an objective, pervasive lack of access to supplies like syringes.

Even in areas where there is syringe access, many drug users get left behind for reasons like not having reliable transportation, having to work during program operation hours, not wanting others to know about their drug use, and fearing incarceration because they have outstanding warrants for their arrest.

Mail-based supply distribution circumvents these barriers and many others — though, just to be clear, MBSD isn’t a panacea.

At Least Here, We’re Trained to Exercise Discretion in Everything We Do

As drug users, we’ve been trained to avoid new people or things that seem too good to be true. In my own efforts to distribute syringes, naloxone, and other supplies to people who use drugs, I’ve been turned down countless times by people who simply don’t trust me.

The people of rural West Tennessee aren’t used having access to syringes, let alone getting free syringes — we’re used to buying them illegally from other users, family members, or dealers — which has made reaching out to people who use drugs and could stand to benefit from what I do difficult. As you might imagine, many here aren’t comfortable with the idea of receiving syringes through the mail, either.

In full disclosure, I’ve tried to turn people on to mail-based supply distributors, many of which offer supplies for free, but nobody’s taken me up on this offer. Once syringe access expands and rural Tennessean drug users become familiar with it, I know they’ll slowly come to trust such opportunities as legitimate.

Even if we did have open access to syringes here in rural Northwest Tennessee, the most vulnerable drug users likely wouldn’t be able to visit syringe services programs’ outlets or be comfortable with showing up in person. MBSD would help reach some of these people, assuming they’re housed or otherwise have an address to accept mail at.

Last thing — there will be a transitory period following the expansion of syringe services programs here in rural Northwest Tennessee in which drug users will slowly come to accept such resources as legitimate. Abruptly shaking us out of our discretionary habits, which, again, are so prevalent here in rural Tennessee, isn’t possible. During this period, I predict that some people who stand to benefit from access to syringes and other harm reduction supplies may only be comfortable participating in supply distribution programs if they can receive supplies via mail.

MBSD may prove useful during this transition. Maybe not.

Well-Served Drug Users Are More Likely to Support Harm Reduction Than Those We Haven’t Helped

It doesn’t take much thought to reason that a well-served drug user is more likely to aid in harm reduction than an underserved counterpart.

This is just an anecdote, but I only became active in harm reduction after I was given syringes, naloxone, and other supplies — they came by way of mail, too. We don’t have much access to things like that here.

Although you could, in theory, purchase syringes from pharmacies, pharmacists rarely sell syringes without prescriptions here in rural Tennessee — I’ve heard pharmacists are more lenient in cities, such as Memphis or Nashville — this rarely happens. Those who have tried to buy syringes without prescriptions usually don’t bother after a few tries, anyway.

One more anecdote — I’ve only been able to welcome aboard other drug users or dealers as secondary distributors after giving them supplies myself.

If We Drug Users Demonstrate Responsibility, We Stand to Gain More Support

Despite research that shows otherwise, most Americans — at least this is true for rural Tennesseans — don’t support expanding syringe access.

Many people think opening up syringe access simply enables injection drug users. While I understand this reasoning, the fact that regular injection drug users by the boatload who only have black-market syringe access suggests this idea falls short.

Let’s face it — often-problematic drug users like me have often lived up to the stereotype of “junkie” or “druggie.” I know this is true for me. And I’ve been around so many others who fit the bill, too.

If we drug users can prove ourselves responsible in handling syringes given to us, views toward improving syringe availability may brighten.

Of course, I’m sure syringe access will be portrayed negatively by local news agencies if syringe litter becomes prevalent or complaints arise even if most of us are, in fact, responsible with the supplies we receive. Still, we stand to improve our overarching reputation as drug users through proving responsibility. But this is something we should strive for, anyway.

For the record, if I wasn’t already clear, I’ve made myself — and all drug users, by extension — look bad countless times before. And, even though I try to act more responsibly now, I still find myself giving drug users a bad name from time to time.

Is it reasonable to expect everyone who uses drugs to act responsibly? No. Actively making drug users like me aware of this responsibility will, inevitably, encourage at least some of us to shape up.

Mail-Based Distribution Can Promote Safety During Pandemics

Times of pandemic don’t rear their ugly heads very often, to be fair, but MBSD reliably reduces pathogen transmission.

Although this is a very real benefit, I feel it’s auxiliary to other points expressed herein. Despite this, I think we harm reductionists could benefit from making the public aware of this benefit before the ongoing novel coronavirus pandemic slows down. Maybe not — admittedly, I’m not well-versed in communications or public relations.

Providing Opportunities to People as Potential Secondary Distributors Gives Them Purpose

I know a handful of people, one currently-incarcerated dealer and a few active drug users, who are willing to distribute the supplies I provide to others who use drugs.

The dealer, of course, was motivated by the prospect of selling syringes or increasing sales by offering supplies customers might not have access to. However, the others, I believe, are motivated by the prospect of helping others.

Long-term, often-problematic drug users like me often have less to live for than the general population. We are also less likely to actively pursue passions and hobbies. We lose interest in things we used to like.

Activating current drug users as secondary supply distributors gives them purpose, which can very well lead to outcomes like ceasing or decreasing drug use, securing gainful employment, or enrolling in college or trade school. Put simply, by giving people purpose, we improve their quality of life.

Just to be clear, I don’t think MBSD should be solely reserved for people interested in community distribution. Mailed harm reduction supply access certainly got me engaged in secondary distribution and harm reduction in general, though I think I’d have been less likely to seek out supplies if the senders considered me responsible for further distributing them.

In my time distributing supplies to other drug users and, less commonly, dealers, I’ve found that most recipients haven’t been interested in distributing syringes, naloxone, and company themselves. I do think, however, that people who seek out supplies from mail-based distributors are more likely to engage in secondary distribution than their counterparts.

They Help Kickstart Harm Reduction Efforts in Underserved Areas

I live in Northwest Tennessee. The closest syringe services programs are each two-and-a-half hours away. Syringes currently aren’t available anywhere else, as pharmacists — the only other legal source here — don’t usually sell syringes to people without prescriptions despite being legally able to do so.

I’ve only ever received harm reduction supplies from out-of-state, mail-based sources. These suppliers effectively advanced efforts to improve the treatment of people who use drugs by activating me as a harm reductionist, whether or not they had this in mind.

Mail-based distribution can inspire recipients to support future harm reduction-positive measures in grassroots form or, as in my case, encourage them to actively practice harm reduction in a tangible, hands-on manner (i.e., distributing supplies, educating others about safer practices in drug use).

One of the major challenges that American harm reductionists face, in my opinion, is expanding resources that help drug users to rural areas. MBSD is one of our most valuable resources in doing just this.

Tying Everything Together

MBSD isn’t just for reaching people in underserved areas. I think mailing syringes, naloxone, and company to people in areas where there aren’t currently any available resources is an effective way to reduce HIV and hepatitis C transmission, prevent injection drug users from potentially harming themselves by using worn-out syringes or other supplies, and connect people in active addiction with much-needed resources.

I also think health departments and state-sanctioned syringe services programs (SSP) can find utility in mailing supplies to areas that aren’t currently served. Mailing things isn’t free, plus, governments that allow SSPs to operate often require them to dispose of participants’ used syringes — mail-based distribution doesn’t lend itself to direct used syringe disposal by such programs.

Like all things in life, mail-based distribution isn’t problem-free. The altruistic distributors who send syringes and other supplies out of state often worry about legal action being taken against them. Some funding sources might not allow organizations to send supplies to out-of-state recipients, either, potentially resulting in loss of funding. There may be other issues, such as safety concerns.

All considered, mail-based supply distribution is a great thing—and something we need more of.