Relaunched Tweaker site tightens ties to substance-use support group
What began as a campaign exploring STI transmission is now an international resource for drug-use safety. SFAF’s Jen Hecht shares the importance of accessible sexual health information and the evolution of drug language.
Since its inception 22 years ago, tweaker.org has been a resource for people seeking tips on using crystal meth more safely. After a design update this spring, the site is now configured to better serve the community.
In 1997, STOP AIDS Project surveyed some of San Francisco’s gay male community about issues around HIV and crystal meth was identified as a large driver for transmission. Thus, a social marketing campaign was born to address how meth affects sexual health and overall wellbeing.
The ad campaign appeared around San Francisco and tweaker.org was launched that summer, continuing for two years before its funding was canceled, leaving a static and dormant web address.
Stonewall Project, a harm reduction counseling group for gay, bisexual, queer and trans men interested in changing their relationship to drugs and alcohol, resurrected tweaker.org in 2001 as an additional outreach tool. Then, a decade after its debut, tweaker.org became part of San Francisco AIDS Foundation along with the Stonewall Project.
Jen Hecht, senior director of program strategy and evaluation at SFAF, has over 20 years of experience in public health with a focus on HIV and STIs. Now overseeing the relaunch of tweaker.org, which was updated this year to incorporate new mobile technologies and easier site navigation, Hecht spoke about the importance of access to sexual health information and the evolution of drug language.
How is tweaker.org different from other websites that offer harm reduction tips?
Jen Hecht: The fact that it’s not coming from an abstinence-only focus is huge. [The language is] non-judgemental and it’s in a tone that’s for the person who’s using. People have struggles that they’re facing and being able to learn how to really deal with them is essential.
What are the goals of tweaker.org?
The number one focus is to make sure people have access to accurate information. Secondly, and almost as important, is that people have access to communities of other users and peers, and feel that they’re not being judged. This site has been around for a lot of years and there has been a lot of activity with people supporting each other with information they’ve learned from their own experience.
Why is tweaker.org important to you?
It’s important because there are lots of people who are using and want to be able to use safely. [They] want to be able to take care of their friends, family, or partners who are using. They can be on their phone on the street and access that information. They don’t have to walk into a service provider or into a place that has a name on the front of the building that they might not feel comfortable with or be judged for. There’s any number of different scenarios where someone might not be in a position to walk into a treatment space, and that is completely fine, but they should still be able to access the information.
How have you seen drug language evolve over time?
There are terms that evolve and terms that, over time, acquire a certain stigma or negative association that we then want to move away from. While we’re based in San Francisco and a lot of the tweaker.org language is influenced by that, the website itself is accessed by people around the world. We recognize that regionally these things can be very different and that language may not be as on-point in other parts of the country or the world, but hopefully it’s at least clear.
How does tweaker.org intersect with the harm reduction values of the foundation?
We want to make sure people feel safe and welcomed into the [digital] space, and that they can get the information they want and not feel judgement.
In this new relaunch, we tightened the connection to Stonewall Project who runs tweaker.org. They have so much knowledge and expertise to share. We’re trying to make it easier for people who want to get support to be able to find it; there’s no pressure around it. The door’s open if that’s what you want, and if it’s not, here’s some information that will hopefully make using as safe, joyful and pleasurable as possible.
Try it! Access the relaunched tweaker.org from your mobile device for tips on using crystal meth more safely.
San Francisco AIDS Foundation promotes health, wellness and social justice for communities most impacted by HIV through sexual health and substance use services, advocacy, and community partnerships. Each year more than 21,000 people rely on SFAF programs and services, and millions more access SFAF health information online.
Bill allowing San Francisco to pilot overdose prevention programs preventing deaths from opioids passed both houses of State Legislature, vetoed by California governor.
San Francisco AIDS Foundation expresses its disappointment that California Governor Jerry Brown vetoed Assembly Bill 186. AB 186 passed both houses of the State Legislature and would have allowed San Francisco to pilot overdose prevention programs to prevent deaths from opioid overdose. Twelve Californians die every day of accidental drug overdose, which is the leading cause of death of people under age 50 in the U.S.
“Governor Brown’s decision to veto AB 186 is irresponsible and puts countless lives at risk,” said Joe Hollendoner, San Francisco AIDS Foundation CEO. “The suggestion that this policy is too much carrot and not enough stick implies that substance use treatment should be punitive rather than compassionate and based in best practice.”
“California’s next Governor,” Hollendoner continued, “must support the creation of overdose prevention centers and other public health interventions that will effectively address the HIV and opioid epidemics in California. San Francisco AIDS Foundation is committed to continuing to work with Mayor Breed and our community partners to make overdose prevention centers a reality for San Francisco.”
Overdose prevention programs are designated sites where people can bring pre-obtained drugs and use under expert supervision. In 120 sites that exist around the world, zero overdose deaths have occurred. A site in Vancouver saw 30 percent of their clients enter treatment for substance use disorders.
22,500 people in San Francisco inject drugs and 70 percent of them have active hepatitis C. Overdose prevention programs are proven to reduce hepatitis C and HIV transmission. Reducing risks associated with drug use and providing access to treatment makes entire communities safer and healthier. In 2017, research conducted by Amos Irwin and colleagues found that a single overdose prevention site could save San Francisco $3.5 million in reduced health care costs.[1]
[1] Irwin, A., Jozaghi, E., Bluthenthal, R. N., & Kral, A. H. (2017). A Cost-Benefit Analysis of a Potential Supervised Injection Facility in San Francisco, California, USA. Journal of Drug Issues, 47(2), 164-184. doi:10.1177/0022042616679829
San Francisco AIDS Foundation promotes health, wellness and social justice for communities most impacted by HIV through sexual health and substance use services, advocacy, and community partnerships. Each year more than 21,000 people rely on SFAF programs and services, and millions more access SFAF health information online.
Public injection drug use in San Francisco is not a new issue, but it’s one that’s reaching new levels of concern by public health agencies, business owners and the general public alike. If you have spent time walking the city, you have likely seen the tell-tale signs of public drug use—improperly discarded syringes or drug use paraphernalia—if not people injecting or using drugs outright.
It’s not that people who use injection drugs enjoy doing so in public—more often than not people use in public simply because they have nowhere else to go.
San Francisco Mayor London Breed speaks about overdose prevention sites at a community event (Photo: San Francisco AIDS Foundation)
“Continuing with the status quo and just hoping that things will get better is not an option. Substance abuse is not simply going away because we don’t want to see it,” said San Francisco Mayor London Breed at a press conference in August.Pending the Governor’s approval of AB 186, San Francisco may soon be able to open overdose prevention facilities where people who inject drugs can do so in a clean, sterile environment away from the public eye and under supervision of trained professionals. How will these facilities change the landscape?
Fortunately, we don’t have to guess. San Francisco benefits from rigorous research on overdose prevention sites that have been operating across Europe and in Canada for many years. Numerous studies have shared the positive impact that overdose prevention facilities have on cities (not to mention disease transmission rates, the health of drug uses and rates of overdose).
Overdose prevention facilities decrease public injecting
Studies of Insite, an overdose prevention/safe injection facility (SIF) that opened in Vancouver in 2003, show that public injection significantly decreased in the area surrounding the facility after it opened.
A volunteer for the Glide overdose prevention facility demonstration, Safer Inside, shows harm reduction supplies that would be provided to visitors at an overdose prevention site. (Photo: San Francisco AIDS Foundation)
In a study conducted in the six weeks before the facility opened through the 12 weeks after opening, researchers measured public injection drug use, publicly discarded syringes, injection-related litter and suspected drug deals in the 10-block radius surrounding Insite. Specifically, ethnographers walked through pre-determined areas at set times to count instances of each during the study.
With more than 500 people visiting the facility after its opening, the researchers said it was “not surprising” that public injection significantly decreased in the weeks after Insite opened. During data collection times, the mean number of people injecting in public areas near the SIF every day fell from 4.3 before Insite opened to 2.4 in the weeks after opening.
“A commonly reported reason for public drug use is the lack of an alternative place to inject,” the authors said. “[People who inject drugs] who go to safer injecting facilities are often homeless or marginally housed.”
A long-term study of an overdose prevention facility’s impact in Australia found that residents and business owners noticed a similar impact on public injection.
An example of what an overdose prevention facility set up might look like, by Glide. (Photo: San Francisco AIDS Foundation)
In Kings Cross, Sydney, telephone surveys were conducted with local business owners and residents before and in the years following the opening of an overdose prevention facility. There was a 50% decrease in the number of residents who reported observing public injecting in the past month from 2000 (before the site opened) to 2010. Similarly, the percentage of business owners who reported seeing public injection in the previous month declined from 61% before the facility opened to 22% ten years later.
This same study found that a majority (92%) of clients surveyed agreed with a statement that the facility “helped [them] to reduce injecting in public places.”
Overdose prevention facilities decrease improperly discarded syringes and injection litter in public spaces
Syringe access programs in San Francisco help ensure that people who use injection drugs have access to the supplies they need. Syringe access sites are also the top disposers of used injection equipment. But, used injection equipment too often winds up on sidewalks and in other public spaces. The good news is that overdose prevention facilities give people a convenient place to dispose of used injection equipment, which significantly reduces the amount of syringes and injection litter that wind up on the street.
Currently, San Francisco AIDS Foundation staff conduct regular sweeps to pick up improperly discarded syringes. Overdose prevention sites reduce the amount of public injection and the amount of improperly discarded syringes. (Photo: San Francisco AIDS Foundation)
In Vancouver, researchers studying the impact of Insite found that the amount of improperly discarded syringes and injection litter decreased dramatically after the site opened. In the 10-block radius around the facility, publicly discarded syringes and injection-related litter dropped by about 50% in the 12 weeks after opening compared to the six weeks before opening: The mean number of discarded syringes dropped from 11.5 to 5.4, and the amount of injection litter from 601 to 310 (which were both statistically significant reductions).
Reports from people who use overdose prevention facilities support these findings. A study in Copenhagen found that people who used an overdose prevention facility reported significant changes in syringe disposal practices after they started using the facility. The percent of people surveyed who reported returning needles to the needle exchange or overdose prevention facility increased from 34% to 88%, and a large percentage of people surveyed (62%) reported that their syringe disposal practices changed from “not always disposing safely” to “always disposing safely.”
“Establishment of the [overdose prevention] facility has resulted in measurable improvements in public order,” said Evan Wood, MD, PhD and colleagues in an article describing Insite’s impact on the community. “This in turn may improve the livability of communities and benefit tourism while reducing community concerns stemming from public drug use and discarded syringes.”
Overdose prevention facilities do not increase drug-related crime or drug dealing
One oftentimes cited concern about overdose prevention facilities is that they will increase drug dealing, drug-related crime or other criminal activity in the area. Studies of crime data in areas before and after the opening of overdose prevention facilities refute this assumption—showing that these facilities do not lead to increases in drug dealing or other neighborhood crimes.
In Vancouver, a group of researchers analyzed Vancouver police data of the year prior to and the year after InSite’s opening. Rates of drug trafficking, assaults and robbery in the Downtown Eastside neighborhood remained steady and rates of vehicle break-ins and theft declined.
“Our overall findings suggest that the [overdose prevention facility] was not associated with a marked increase in drug-related criminal activity,” said Evan Wood, MD, PhD and colleagues.
A similar study of crime data from Kings Cross, in Sydney, found that rates of robbery, theft and drug dealing did not increase in the nine years after the overdose prevention facility opened. In fact, rates of robbery and theft fell dramatically in the neighborhood (similar to trends across Sydney). Rates of dealing cocaine, narcotics and amphetamines remained stable from 2001 to 2010.
“Overall, these analyses show no evidence that the [overdose prevention facility] has had a negative impact on property crime or incidents of drug dealing or possession in Kings Cross,” said Jacqueline Fitzgerald and colleagues.
An overdose prevention facility could save San Francisco millions
The researchers used existing data from overdose prevention facilities around the world to estimate how many HIV and hepatitis C infections, overdose deaths, and skin and soft tissue infections could be averted with a single San Francisco overdose prevention site. They also estimated the impact a site could have on the number of people entering substance use treatment. These averted infections and benefits to health for people who inject drugs would provide a net savings of $3.5 million every year.
“Our cost-benefit analysis supports the establishment of an [overdose prevention facility] in San Francisco, as we find that it would significantly reduce costs associated with health care, emergency services, and crime,” the authors said.
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