Syringe exchange—All outreach workers should carry unused syringes as well as equipment for the safe collection and disposal of used syringes (e.g. gloves and sharps containers).

–Distribution—During engagement, each person engaged will be offered unused syringes and injection equipment. Each person should also be offered a description or informational material on safer injection practices. Outreach teams should consider a ‘needs-based’ model of syringe distribution in which an outreach worker determines a person’s needs based on the frequency of injection and access to syringes when the mobile team is not present (for example, if a person injects five times daily and the team anticipates coming back to the area in three days, ideally at least 15 syringes are distributed to the individual). Examples of other syringe distribution policies are strict 1:1 exchange, which is discouraged based on less efficacy in preventing transmission of HIV and HCV, or “1:1 plus.” Which strategy a program uses depends on several factors.

–Collection—Outreach workers should also actively collect used syringes. Outreach workers should always be on the lookout for improperly discarded syringes on the street and collect any they see, always using safety equipment and syringe pick-up strategies that minimize risk of a needlestick. Outreach workers might also consider carrying small, portable individual biohazard containers to give to program participants

–Secondary exchange—As key individuals are identified as central to a network/community of PWUD, the outreach team should consider supplying larger quantities of unused syringes and other harm reduction supplies than typically advised by protocol so the individual can distribute the resources to their own contacts and also bring back syringes for the team to discard.

Naloxone—All outreach workers should carry naloxone kits on their person. Workers should all be trained in naloxone administration and be prepared to administer naloxone if they encounter people exhibiting signs of opioid overdose. In the event of naloxone administration, always call 911.

–Distribution—Naloxone should be offered during every encounter with PWUD. Distribution amounts should be agreed upon prior to outreach sessions based on supply and client circumstances. Each interested contact should receive no fewer than one naloxone kit, supply permitting. For some people, it may be feasible for the clinician to prescribe naloxone to be paid for by their health insurance and filled at a nearby pharmacy