Shot in the Dark

Program Description

Shot in the Dark is a collective group of volunteers with lived experience committed to the health equity of people who inject drugs in Maricopa County, Arizona. Through the framework of harm reduction and empowerment, we provide thousands of participants with life-saving equipment each week to prevent overdose, HIV, Hepatitis C, and isolation. We have no paid staff, no government funding, and a lot of dedication. We partner with local organizations to ensure this stigmatized community receives healthcare, testing, naloxone, and other referrals.

Creativity

In a state where syringe access is rarely supported and Good Samaritan Overdose response laws do not exist, we have always viewed our ability to overcome challenges as a strength of our organization. Despite unclear state laws, we have built successful partnerships with law enforcement. Unlike other syringe exchange programs, we meet our participants in convenient areas to ensure our program is low barrier. All of the materials we hand out – syringes, harm reduction kits, naloxone, condoms, and referrals – are free. We also deliver supplies to people with different abilities that prevent them from leaving their homes and we engage with local officials regularly to advocate for change.

Leadership

Shot in the Dark (SITD) is a unique program, but our state’s circumstances are not. Many states are facing the same legislative battle to support syringe access and policy has not caught up with the evidence-based model of harm reduction. Utilizing this model in rural Arizona and beyond is a goal of SITD. Our program is run as a collective with an underlying mutual aid model. This means our participants and volunteers are not mutually exclusive; participants keep the program running in a variety of ways (making kits, sharing information with the community, advocacy work, and encouraging local businesses to carry naloxone). We have supported secondary exchanges and provided technical assistance to anyone interested in creating their own program. All of our actions are transparent and our volunteer manual is available to anyone. We keep an open model in the hope that others start their own programs.

Sustainability

Shot in the Dark has operated for over five years, but contact information has only been publicly published for two years. Since that time, we have seen a huge increase in demand. Our closest partner is Sonoran Prevention Works, a harm reduction organization that focuses on legislation change and naloxone distribution. They rely on us to distribute naloxone to those who need it most, and we receive naloxone and technical assistance from them. We have existing partnerships with the Aids United Foundation, which recently renewed our 2-year grant application. We receive funding from the Komer Family Foundation and Elizabeth Taylor AIDS Foundation. Many community members donate their services to us; we provide free HIV testing through Ebony House, and work with medical professionals to provide wound care. Terros Behavioral Health provides bleach kits, and Community Medical Services has partnered with us to ensure people have 24/7 access to MAT.

Replicability

Our model of community-based syringe access can be applied to an array of communities, especially those where health disparities are already a known issue. Even in areas where syringe access programs exist, barriers to getting clean equipment are still pervasive with limited hours, restraints due to public funding, and a lack of delivery as an option. Small, grassroots organizations like SITD can fill in the gap of our social safety net that is only growing larger in the wake of the opioid epidemic. The unique part of SITD is that it is participant driven. This challenges traditional models of helping and is truly innovative. Institutions can adopt this model to further research, increase access to services, and prevent overdose deaths in rural areas.

Results/Outcomes

Outcomes for prevention programs are difficult to tabulate. However, we do keep track of our demographics, syringes distributed, referrals to different healthcare agencies, and overdose reversals reported. In 2017 we distributed 1,485,424 syringes, had over 45,827 interactions with clients, and had 2,201 overdose reversals reported to us, which are 2,201 lives saved in a single year, from an all-volunteer organization with no state funding. In 2017, we made 2,387 referrals to treatment, testing, and healthcare. We also regularly collect participant surveys and conduct focus groups as needed to improve our services.