Morgan Britton, Keene Serenity Center harm reduction coordinator and peer recovery support specialist, loads syringes, substance use literature, water bottles and various medical supplies into her car for the third and final syringe exchange of the week through the G.R.O.W. syringe service program, as she leaves the center Friday afternoon.
New syringes are among the many offerings for community members from the Keene Serenity Center’s G.R.O.W. syringe service program. Needle Disposal Cvs
An assortment of medical supplies in the Keene Serenity Center’s storage are packed up three times per week by Morgan Britton for the G.R.O.W syringe service program, and available for anyone who needs them at the center.
Morgan Britton, Keene Serenity Center harm reduction coordinator and peer recovery support specialist, loads supplies into her car Friday afternoon for the center's G.R.O.W. syringe service program, which provides the community with three opportunities for needle exchange per week.
Morgan Britton, Keene Serenity Center harm reduction coordinator and peer recovery support specialist, loads syringes, substance use literature, water bottles and various medical supplies into her car for the third and final syringe exchange of the week through the G.R.O.W. syringe service program, as she leaves the center Friday afternoon.
New syringes are among the many offerings for community members from the Keene Serenity Center’s G.R.O.W. syringe service program.
An assortment of medical supplies in the Keene Serenity Center’s storage are packed up three times per week by Morgan Britton for the G.R.O.W syringe service program, and available for anyone who needs them at the center.
Morgan Britton, Keene Serenity Center harm reduction coordinator and peer recovery support specialist, loads supplies into her car Friday afternoon for the center's G.R.O.W. syringe service program, which provides the community with three opportunities for needle exchange per week.
The Keene Serenity Center’s G.R.O.W. syringe service program typically sees between 200 and 300 people a year, making it the smallest program in the state, according to the program’s facilitator.
These services — sometimes known as needle exchanges — are most often associated with people who use drugs. But at the Serenity Center, which operates the only syringe service program in the Monadnock Region, a small but growing number of people are turning to the free service for a different purpose.
Seven of the program’s 74 new clients in the past five months identify as transgender, and at least half are using the program to safely access injection supplies specifically for gender-affirming hormone therapy (GAHT), according to Morgan Britton, the harm reduction coordinator and peer recovery support specialist for the nonprofit.
“The program is all through word of mouth,” she said. “And what we have been noticing is an increase in transgender and gender-diverse people utilizing the program in recent months.”
People who use drugs face intense stigma, which can be compounded when factors such as gender identity, financial and housing insecurity come into play. People who access GAHT also have experienced worsening treatment, particularly with the introduction of laws that restrict gender-affirming health care.
Decades of research, though, show that programs like G.R.O.W. help prevent drug-related deaths and the spread of infectious diseases, despite some local funding limitations. Now, providers like Britton say they’re also increasingly becoming lifelines for transgender people to access sterile injection supplies for GAHT, especially in rural areas like New Hampshire, where there are limited options.
Reusing syringes and needles can increase the risk of blood-borne illnesses and infections, according to the Centers for Disease Control and Prevention. Syringe services programs (SSPs) like G.R.O.W. are community-based programs that provide a range of services to promote sterile injection and reduce infectious disease transmission. There are currently 13 SSPs registered with the state health department, according to the N.H. Harm Reduction Coalition.
Research has shown SSPs can help reduce overall health care costs by preventing blood-borne infections, and make people who use drugs more likely to seek treatment. Studies dating back nearly 30 years have also found that SSPs do not contribute to increases in drug use or crime.
There are various ways to properly dispose of used “sharps” — medical waste with sharp points or edges that can puncture or cut skin — but most SSPs opt to incinerate them. This helps prevent accidental needle sticks to waste management workers because of improper disposal and reduce the amount of medical waste in landfills.
In addition to providing safe disposal, each syringe service program in the Granite State utilizes a harm reduction model. This approach aims to reduce the negative health and social impacts of substance use, including through the use of naloxone (Narcan) to reverse opioid overdoses. How these services are implemented, though, is different depending on community needs, according to Britton.
“Some people just need to use [our program] once, they’ve fallen on some hard times financially or they’re traveling from out of town and need somewhere to access supplies for their injection medications,” she said. “Others we see pretty regularly, at least once a week.”
The G.R.O.W. program, like similar services throughout the country, keeps the identities of participants essentially anonymous. No form of identification is required. Instead, participants are given an SSP card with a series of letters and numbers unique to them. That card is then shown at any SSP in the state to receive a syringe exchange kit.
G.R.O.W. distributes kits containing water capsules, alcohol wipes, rubber ties for tourniquets, new cookers and cotton balls for sterile injections, fentanyl test strips, and 30 syringes with needles.
The acronym G.R.O.W, which stands for Guerrilla Relief Outreach Worker, was inspired by the origins of most SSPs in the country, according to Britton. People in recovery used to work “in the shadows,” she said, to help others safely dispose of used sharps and secure sterile injection equipment before SSPs were legalized in New Hampshire in 2017.
The program operates primarily on a one-for-one exchange for their syringe kits, where someone must “bring something to get something,” according to Britton. But no one will be turned away, she said, if they ask for a syringe kit but don’t have any syringes to exchange.
“It will just spark a bit more conversation between you and me, like if someone has been regularly participating in the program but hasn’t brought me any syringes in a while, I just want to talk to them more about it,” she said. “What are the barriers in place right now that are preventing them from doing that, and how can I help?”
G.R.O.W. also gives people access to first-aid kids, at-home HIV tests, condoms, Narcan and personal care items. They don’t need to bring in syringes to access those supplies.
“If you don’t need everything that’s in a [syringe exchange] kit, like let’s say someone just really needs alcohol wipes or fentanyl test strips, we’re happy to give you just those things,” Britton said. “We have people from all walks of life come see us for all sorts of reasons. We’re here for everybody.”
Societal stigma against injection drug use can present barriers to accessing necessary health care for people who use drugs. In a 2019 study, a majority of the participants who use drugs felt they needed to delay access to health care or not disclose their drug use to avoid being treated poorly by a health care provider.
This negative perception only worsens for those in the LGBTQ+ community, those living with HIV and for people of color. The CDC released a report in 2018 that found gay and bisexual men who use substances often have trouble with maintaining treatment for HIV and inconsistently access HIV services due to stigma.
One of Britton’s close friends is transgender and is currently accessing GAHT. She’s seen first-hand through supporting him with his hormone injections the difficulty that comes with accessing the correct injection supplies at a pharmacy.
“What we’ve been noticing is that people will go to the doctor, get their prescription filled and then they either don’t get enough supplies or they get the wrong size needle or syringe,” Britton said.
If someone doesn’t have health insurance, the cost of a package of 10 syringes over-the-counter in Keene is about $10.
While most people who are prescribed injection-based GAHT do either weekly or biweekly injections, the cost of new supplies on top of paying for medication — which can cost about $120 a month without insurance — can present a barrier to their prescribed dose of GAHT.
Having access to free injection supplies can reduce the chances of someone needing to reuse syringes, according to Britton.
“Imagine how infuriating it can be to feel like you have to reuse a syringe or needle just for your basic health needs,” she said. “That shouldn’t happen to anybody.”
A program based in Eugene, Ore., has been successful in combining the traditional SSP model with access to sterile injection supplies specifically for GAHT.
HIV Alliance started its SSP in 2016 to aid in preventing the spread of infectious disease, and now provides its services in seven different counties in Oregon, according to its website. The group then partnered in 2017 with TransPonder, a local education and advocacy nonprofit that serves gender-diverse people, to launch a monthly exchange program.
Programs like this one, Britton said, can help advocate for more inclusive SSPs practices.
“This past Keene Pride, we passed out about 240 Narcan kits,” she said, referring to the second annual pride festival in September. “We’re just so happy to see more people utilizing this program, keeping themselves and others safe.”
Funding limitations and environmental impacts
Despite these sorts of community benefits, SSPs in New Hampshire are somewhat limited by funding requirements. With restrictions on how funding for SSPs can be spent and where it comes from, G.R.O.W. is forced to rely on grants and donations to remain sustainable.
As of 2017, SSPs in New Hampshire must be “self-funded,” meaning they cannot receive state money. Aside from clear language that federal funds cannot be spent on syringes, it’s still unclear to recovery advocates how federal dollars can be spent on SSPs due to the state law, according to Serenity Center Executive Director Sam Lake.
“Everything has kind of a hidden state or federal funding tag on it,” he said. “We have to be really careful as to what goes where, which more often than not can put us into a bit of a pickle when making sure programs like our [SSP] can keep on functioning.”
The G.R.O.W. program recently received funding from the nonprofit N.H. Harm Reduction Coalition to sign a contract with Stericycle, a medical waste management company based out of Haverhill, Mass., to try and reduce the environmental impacts of syringe disposal.
Proper disposal of medical sharps can help prevent injury and illness to family members and waste handlers and reduce pollution to the environment, according to the state environmental services department. The state says that household-generated sharps can be disposed of with the rest of your trash as long as the sharps are put into a puncture-resistant container, such as a plastic laundry detergent bottle, that is labeled as a medical sharps container and taped shut.
Between July 1, 2020, and June 30, 2021, almost 1.2 million sterile syringes were distributed and 885,000 used syringes were collected throughout all of the SSPs in New Hampshire, according to the most recent data from the state’s department of health and human services. In 2023, G.R.O.W. distributed more than 44,400 syringes and collected about 37,700. Those thousands of syringes could have landed in town landfills if it wasn’t for New Hampshire SSPs.
“We’re coming from a time where a lot of people were throwing syringes in dumpsters, putting them in coffee cans and saying it is secure, when it’s not,” Lake said.
“If you call us and need help with disposing of a syringe, even if it’s a single syringe, we’re going to do everything we can to help you out.”
James Rinker is The Sentinel’s digital community engagement journalist. He can be reached at jrinker@keenesentinel.com, or at (603) 355-8569. Follow them on Twitter @JamesRinkerKS Funding for the Monadnock Region Health Reporting Lab comes from several sources, including The Sentinel and several local businesses and private donors. We continue to seek additional support. The newsroom maintains full editorial control over all content produced by the lab.
If you or a loved one are struggling with substance use, there are local resources that can help. If you need immediate support, call 2-1-1.
The Keene Serenity Center at 24 Vernon St. in Keene is open Monday through Friday 9 a.m. to 5 p.m. Call (603) 283-5015 for more information.
Call or text (603) 903-4049 to find out how to become a member of the G.R.O.W. syringe service program through the Keene Serenity Center.
The Doorway through the Cheshire Medical Center at 24 Railroad St. in Keene is open Monday through Friday 8 a.m. to 5 p.m. Call 2-1-1 for assistance.
Live Free Recovery Services in Keene offers both residential and outpatient treatment options as well as medication-assisted treatment. Call (888) 705-3759 for more information.
ANew Behavioral Health in Keene offers medication-assisted treatment. Call 866-534-ANEW or visit anewbh.com/how-we-can-help/recovery-support.
Reality Check in Jaffrey is open Monday through Friday, 8 a.m. to 4 p.m., and provides drug & alcohol treatment counseling and support finding residential treatment in New Hampshire. Call (603) 532-9888 for assistance. They also have a list of support groups at realitychecknow.org/help-resources.
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Health Solutions Reporter Olivia Belanger keeps readers informed on issues like mental health, the opioid crisis and the COVID-19 pandemic. Before joining The Sentinel’s staff, Olivia spent a year as the health, nonprofit and education reporter for the Watertown Daily Times in Watertown, N.Y. A 2018 graduate of Keene State College, Olivia decided to move back to the area in the summer of 2019 to tell the unique stories of the Monadnock Region. The Bartlett native now lives in Keene with her fiancé, Ryan, and their Bernese mountain dog, Koa.
Contact Olivia at obelanger@keenesentinel.com
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