Prevention in Focus

Fall 2016 

Views from the front lines: Bleach as a harm reduction strategy for people who inject drugs

We spoke to three service providers to find their views and insights on how they approach the use of bleach to rinse needles and syringes with their clients who inject drugs:

  • Laura Shaver, President of the British Columbia Association for People on Methadone, and Vancouver Area Network of Drug Users (VANDU) Board Member
  • Hepatitis C Treatment Nurse, northern Ontario
  • Glen, client and advocate, HIV/AIDS Regional Services (HARS), Kingston, Ontario

Laura Shaver

Do you and/or your clients or peers ever use bleach to clean needles and syringes? Why or why not?

No. Because here at VANDU you bring in your used needles, they go into a sharps container and you can get new ones. So there is no need to use bleach. Bleach is really not safe. It really doesn’t eliminate anything.

Here in Vancouver you can access needles. Lots of other places don’t have access. I moved from Kelowna which is a couple hours away and it is absolutely the dark ages there. In Kelowna, people can’t pick up harm reduction supplies and so they are finding used needles and they use them. When I got to Vancouver I couldn’t believe that there were places for me to go.

Here at VANDU it’s harm reduction – we are not promoting drug use. What we are doing is promoting best practices for people that are already using. People are always going to use drugs. What we need to do is find ways for them to be able to do it safer.

Do your clients or peers ever ask you about using bleach to clean needles and syringes? What advice do you give them if they do?

It’s not very often, but I would really advise them not to use it. I advise people to try and have clean supplies. As a very last option if you cannot access clean supplies, yes, you could use bleach and be very thorough with it. But I don’t even like to give advice to use bleach in those scenarios. Because you never know if it’s going to kill anything anyway.

That’s why it’s so important to be able to have harm reduction places to go to so that people can have access to clean needles and they don’t have to try and use bleach to clean them. It’s 2016, there is no reason for people not to have access to clean needles.

What are the most important ways to support someone to stay safe when using injection drugs, even if they don’t have access to places where they can get clean needles and syringes?

Every 12 hours we are losing somebody to an opiate overdose. The best way to prevent overdose is to never use alone. Make sure that when you are with a partner that you have access to a naloxone kit. Health providers need to make naloxone accessible to everybody. There needs to be naloxone kits on every third light pole here in the downtown east side.

I try to make sure that I have some harm reduction supplies on me even if I’m not using them so that I can give them out to people that don’t have clean supplies. I advise people to always try to carry more than they need – especially if they know somewhere they get clean supplies is going to be closed. Places that carry clean supplies need to make sure that opening and closing times are posted and that there are places listed so that people know where else they can go to get supplies.

If you already know that you have HIV or Hep C, it’s also important to take care of yourself. Make sure to take the medications and make sure to be careful when discarding needles and equipment and do it safely.

I want people to know that drug users are people. I am a current drug user myself. VANDU is an association of current or former drug users. We are advocating for people to have access to clean needles in areas where they don’t. We have travelled all over B.C. to places like Kelowna, Nelson and Kamloops to talk about harm reduction and advocate for it.

Drug users need to be involved in all points of creation. They need to be involved in everything from the beginning – from the ideas, to the programs to the outcomes. In certain places you can’t access clean needles or education on drug use best practices, so how do we change that? Organize drug users to fight for those places. When you can organize, its big.

If we don’t fight for it, then who is going to?

Hepatitis C Treatment Nurse

Do you and/or your clients or peers ever use bleach to clean needles and syringes? Why or why not?

I work as the hepatitis C treatment nurse in northern Ontario and we partner with a large number of communities across the region to deliver our programs. Yes, some clients are using bleach either because there isn’t a needle exchange program in their community or because the stigma around accessing needles and syringes is extremely high.

I would say about 40 to 45 percent of our communities have needle distribution services. There are a lot of confidentiality and privacy issues as people don’t want to go into the nursing stations on reserve and be seen getting needles. I can provide education that the literature doesn’t support using bleach, but I understand that from a client’s point of view that might be the only alternative.

If the issue is about stigma then we really need to find a safe space to provide needle distribution that is anonymous and where people can feel comfortable going. That is something that we are working on with the community partners. If the issue is that a community does not have a needle distribution program, then our hepatitis C team has been working pretty hard to have discussions within the community, including Chief and Council, together with healthcare professionals, about harm reduction and the need for a needle distribution program.

Do your clients or peers ever ask you about using bleach to clean needles and syringes? What advice do you give them if they do?

I used to struggle with that question a lot since I understand that many people cannot access clean needles. So we started having conversations internally with our own managers about what is the best and safest thing to do. It wasn’t until we sat down with the members in our program that we finalized the approach we are taking. The approach is to get people access to clean needles and syringes. The organizational response has been to push for needle exchanges. Conversations about bleach worry me; it gives people a false sense of security and we need to be consistent with our messages. I reinforce the fact that bleach is not effective and instead we try to find alternative ways of getting clean needles to clients.

For needle exchanges requested directly from clients, I put supplies in a non-descript bag and I distribute them outside of the nursing station in ways that work for people. I work with community partners and meet the client wherever they are – whether it’s in a school or at a treatment program. We are trying to set up safer sites outside of the nursing station.

In some communities, one person is willing to access clean needles from the nursing station and distribute them. They can act as the hub and distribute to others in ways that feel safer for people. Some people will go to the larger neighbouring communities to get a bunch of needles from the local public health unit and go back to their communities and distribute them. There are a lot of different ways that people have been distributing clean needles, and because our needle distribution program started two years ago, we are working with what is actually happening on the ground and exploring how we can support the existing sources of clean needles in communities. We are willing to do whatever it is humanly possible to do.

Ultimately, we do need to address the stigma around drug use because that is what makes accessing clean needles so difficult. We hear about stigma in the communities, but there is a lot of stigma coming from outside the communities from healthcare professionals. We deal with nurses that come from outside of the community who are absolutely against harm reduction strategies.

I was in one community and we were doing a presentation in the treatment program and someone interrupted me and said, we think the nurses are judging us. I explained if that is what’s happening, let us know because maybe we can address that since nobody has a right to discriminate against you. You hear that a lot, it is like someone is finally coming and talking about things that they have kept bottled inside for so long, such as issues related to abuse, residential schools, grief and trauma. It is much more far reaching than harm reduction. It is community wellness and fostering an independence that you see more in B.C where tribal councils run every aspect of programming themselves and provide culturally specific, trauma-informed and client-centred harm reduction type programming.

What are the most important ways to support someone to stay safe when using injection drugs, even if they don’t have access to places where they can get clean needles and syringes?

Our approach is to work with people and be creative to get them access to clean needles. If we were working in Toronto we would be advocating for clean needles, so there is no reason why we can’t work with people on getting clean needles into these communities.

In terms of supporting people and keeping them safe, it is also important to provide culturally safe, trauma-informed care and to have a long-term commitment to clients. The hepatitis C program I work for is meant to be run through the provincial Ministry of Health – which funds 15 hepatitis C teams across the province. That’s just the way it is in the north – everything relies on funding. That is what I think some communities are waiting to see, they are waiting to see if this program will expand and receive longer-term funding before they throw their all into developing harm reduction programming.  

There should be no difference in programming or resources – we need to get the best programming available up here. Supporting clients to stay safe and healthy also involves addressing the social determinants of health. When you are living in inadequate housing and you don’t have access to clean water, clean needles might just not be your first priority. Food is so expensive in the north. It is difficult talking with people about staying healthy when they have hepatitis C and they don’t have access to food, clean water or a safe bed. There are so many issues related to the social determinants of health, as well as colonialism, the impact of residential schools,  stigma, trauma, grief – all those issues come into play when you are talking about supporting the community. Things go far beyond access to clean needles and syringes.

Glen

Do you and/or your clients or peers ever use bleach to clean needles and syringes? Why or why not?

Yes. Personally I started using bleach in the late eighties. That’s when I first started hearing little bits about HIV. My understanding at that time was that if you used bleach properly, it would kill the virus. That was still in the time when syringes were very hard to get. I am 60 now and I started using when I was very young.  I went through a period in the late sixties through the seventies and the eighties, where sometimes it was harder to get a syringe than it was to buy heroin. In the early years of the HIV epidemic, they hadn’t really made the decision to unlock the syringe drawer, you know. So, it was especially important to clean the syringes.

In terms of the current situation, until the time I left prison in 2014, using bleach was just automatic inside because you can’t get new needles. That’s what people did. On the inside it’s in the culture and that’s what you do. Of course, the actual workings of it can be different. I have seen situations where the bleach disappears really quickly though. There are limited amounts of it. If you are not on the hierarchy list, you might not get your bleach. What happens then, is that you need to go knocking on cell doors to get your bleach. If you are a person who doesn’t know anybody and it you don’t occupy a space that demands that people respect you enough to satisfy your request, then you might not get bleach. But culturally, bleach is the way to go. All of the institutions I was in had bleach programs. It is SUPPOSED to be available for everybody.

On the inside, people want to keep themselves safe. That’s why people go through the complication of getting bleach. Using bleach is a bump in the road to acquiring your fix and then getting hidden away somewhere to do it. First of all you have to get your dope, then you have to find a syringe, then you have to find some bleach. It’s the things you have to do before you can use your dope. There are people who won’t do that. But most people do.

Do your clients or peers ever ask you about using bleach to clean needles and syringes? What advice do you give them if they do?

It’s such an established part of the beliefs and culture in prison now, that there isn’t much of a conversation about it anymore. The only conversation you hear around bleach on the inside is, do we have any?

As far as the article on bleach goes, it surprised me at first but then I realized that the article is not a big change from this perspective. The article is not saying that bleach doesn’t work, it’s saying that given the parameters of specific situations, it may not be an effective strategy.

People really need to be careful about this kind of information because in Canadian penitentiaries there isn’t much in the way of harm reduction. The one thing we do have is bleach. It would be different if there was scientific evidence that bleach doesn’t kill the virus in the lab. But it does kill the virus. I think that if the word gets out that bleach is not effective, it will spread very quickly. That could be dangerous in certain settings where bleach is the only strategy and is likely preventing some transmissions. We need to be really careful about messaging this information so that people don’t just stop doing the one thing they can do to try and keep themselves and others safe. 

Bleach may not be an effective strategy but it does work in the lab so people deserve to know that information and make their own choices. If bleach is the only thing you have, even if we are hoping to get needles and syringes in prison, then it’s worthwhile for people to know that it can be effective under certain circumstances.

What are the most important ways to support someone to stay safe when using injection drugs, even if they don’t have access to places where they can get clean needles and syringes?

Wow, that’s a big question. Other than unrealistic things, like don’t use?  If you have a habit and you are using, what do you do to stay safe? Well, really, if you are on the inside and you don’t have bleach, then you don’t have any tools at all. That’s it.

With drug use and addiction, there isn’t a huge change in prison or in the community. It’s just the ‘more of’ in prison – more police, more careful, more chances of being busted. So what happens then is you’re quicker to use, you’re quicker to shrug off any kind of safer practices because they all take time and they all increase the chances of being busted.

It’s absolutely critical to provide harm reduction and harm reduction equals needle exchange or needle supply programs. Explaining that bleach is not an effective harm reduction tool is a great strategy for lighting a fire under the people that have their hands on the lock. It’s a great strategy to present this information to the harm reduction nay sayers. But how fast is it going to work and what are we going to do in the meantime? Harm reduction is needed whatever way you look at it, and it equals needle and syringe exchange programs, but in the meantime, what are we going to do? And bleach seems like the only thing to do in certain situations.

Related article

For more detailed information on the use of bleach to rinse needles and syringes, see Bleach: Should it be recommended to disinfect needles and syringes?

Resource

Harm reduction behind bars: Prison-based needle and syringe programs