title: Students as effective harm reductionists and needle exchange organizers.
abstract: Needle exchange programs are safe, highly effective programs for promoting health among people who inject drugs. However, they remain poorly funded, and often illegal, in many places worldwide due to fear and stigma surrounding drug use. Continued advocacy, education, and implementation of new needle exchanges are thus essential to improve public health and reduce structural inequality.
  
  
  
  We argue that students, and especially professional and graduate students, have the potential to play an important role in advancing harm reduction. Students benefit from the respect given to the professions they are training to enter, which gives them leverage to navigate the political hurdles often faced by needle exchange organizers, especially in areas that presently lack services. In addition, due to their relative simplicity, needle exchanges do not require much of the licensing, clinical knowledge, and infrastructure associated with more traditional student programs, such as student-run free medical clinics. Students are capable of learning harm reduction cultural approaches and techniques if they remain humble, open-minded, and seek the help of the harm reduction community. Consequently, students can generate tremendous benefits to their community without performing beyond their appropriate clinical limitations. Students benefit from organizing needle exchanges by gaining applied experience in advocacy, organization-building, and political finesse. Working in a needle exchange significantly helps erode stigma against multiple marginalized populations. Students in health-related professions additionally learn clinically-relevant knowledge that is often lacking from their formal training, such as an understanding of structural violence and inequality, root causes of substance use, client-centered approaches to health services, and interacting with clients as peers, rather than through the standard hierarchical medical interaction.
  
  
  
  We therefore encourage students to learn about and consider organizing needle exchanges during their training. Our experience is that students can be successful in developing sustainable programs which benefit their clients, the broader harm reduction movement, and themselves alike.
authors.affiliation: UC Irvine School of Medicine, Irvine; Orange County Needle Exchange Program (OCNEP), Santa Ana, USA. kyle.barbour@uci.edu.
authors.forename: Kyle
authors.identifier: 0000-0002-4751-0302
authors.initials: K
authors.lastname: Barbour
authors.affiliation: UC Irvine School of Medicine, Irvine; Orange County Needle Exchange Program (OCNEP), Santa Ana, USA.
authors.forename: Miriam
authors.initials: M
authors.lastname: McQuade
authors.affiliation: UC Riverside School of Medicine, Riverside, USA.
authors.forename: Brandon
authors.initials: B
authors.lastname: Brown
mesh_terms: D040261:Harm Reduction; D006801:Humans; D018671:Needle-Exchange Programs / Q000379:methods*; D015397:Program Evaluation; D013334:Students
keywords: Advocacy; Graduate students; Harm reduction; Leadership; Medical education; Medical students; Needle exchange; Stigma; Student-run free clinics; Syringe exchange