It doesn’t look like much to the world, the minibus that is currently parked outside Maria Hospital. But care is provided from it to the homeless and people with addictions. Nurses Vicky Tersmeden and Mimmi Deinum are just back after today’s operation.
– Much is about creating a good relationship with the patients. We have succeeded in this over the years. If they know we’re coming, maybe we’ll get ten new patients that day, says Vicky Tersmeden, who has worked with the bus since 2019.
Knowing where to go is not always easy, especially in the beginning. They have had to call social services or the police to find good places to stand. Even the patients themselves give tips. Sometimes the bus goes to temporary settlements.
– They are demolished, then the people move on. Then it will be a bit of detective work to find them again.
An important part of the business is the syringe exchange. It was started as a project in 2019, as a complement to fixed receptions. The bus travels throughout the city of Stockholm and covers an area from Hallstavik in the north to Södertälje in the south.
Visitors are also offered treatment and sampling for diseases such as hepatitis a, b and c as well as HIV. Mimmi and Vicky are used to moving in the small bus. Mimmi holds up a small bottle of medicine.
– It is a nasal spray that can reverse an overdose, which patients can use themselves. We are generous with printing it, she says.
Most patients come just for clean syringes.
– There will also be conversations about where the person is and what needs they have. Often it’s a nice conversation, maybe because it’s not always so solution-focused, but it’s about us listening.
Despite many visitors, the two colleagues still believe that there is a large number of people in need of care.
– We know that there are those who share their syringes with others who do not dare to come here for various reasons. But we are a link to support in all situations, says Vicky Tersmeden.
Last fall, a decision was made to make the syringe exchange bus permanent. The hours it is out were also increased to 30 hours a week.
– It is one of the designated areas to strengthen addiction care. We have to adapt and make sure we are where the patients are, says Sandra Ivanovic Rubin (MP), chairman of the region’s health and medical care board’s psychiatry committee.
At the same time, a downward trend can be seen in how many people visit the syringe exchanges in Stockholm. This applies to both the fixed receptions and the bus.
The region is therefore simultaneously reviewing the possibility of opening more fixed syringe exchanges at outpatient clinics in the county.
– Instead of patients having to go to different receptions for different parts of their care, we are looking at whether we could get better overall care at the outpatient reception. We need to continuously adapt care to even better meet patients’ needs and conditions, says Sandra Ivanovic Rubin.
In the autumn, the old bus will be replaced by a new one. The biggest change it brings – in addition to them getting a microwave and toilet – is that they get a bunk bed. It is used when they have to do an elastography, which is done by people before treatment for hepatitis c.
– It’s wet today, if we have a bunk bed, all we have to do is lie down on it, says Vicky Tersmeden.
Fewer and fewer people in addiction exchange clean needles at the region’s syringe exchanges in the inner city. Therefore, the reception on Kungsholmen closes – instead, visitors have to go to Södermalm.
At the syringe exchange on the Sankt Göran hospital grounds, addicts can exchange clean syringes and needles.
But fewer and fewer are visiting the syringe exchange clinics on Kungsholmen and at Maria Hospital on Södermalm. It has gone from 26,000 to 19,000 visits per year in the last five years.
The syringe exchange at Sankt Göran is also conducted in a pavilion with a temporary building permit that cannot be extended after December 31.
– Therefore, the best solution is that it can be continued as a reception at Maria Hospital. Work has begun to find a better location there, writes Maria Andersson, head of the psychiatry unit at Region Stockholm, in an email.
The syringe exchange is located on Maria prästgårdsgata. In recent years, they have had an average of 40 visits a day.
Victor Malmcrona
More available
Collecting the syringe exchange at Maria hospital does not mean any specific advantages, according to the administration. Rather, it is about them having difficulty justifying keeping the reception at Kungsholmen.
Why the decrease in visitors has occurred is not certain, but according to the region’s health and medical care administration (HSF), it is most likely that visitors receive more syringes per visit, that similar operations have become more available in other parts of the country and that more patients enroll for drug-assisted treatment.
Sandra Ivanovic Rubin (MP), chairman of the health and medical care board’s psychiatry committee at the region.
Press photo Fredrik Hjerling
To be reinforced by bus
Following a decision from the red-green board in the region, the administration looks at how addiction care can be better adapted to patients’ needs and conditions.
– Part of that is to review how the syringe exchange can be made more accessible. There, the mobile care clinic – the syringe exchange bus – is an important reinforcement. Right now, the administration is reviewing how the syringe exchange will be organized when the temporary building permit at St. Göran expires, writes Sandra Ivanovic Rubin (MP), chairman of the health and medical care board’s psychiatry committee in the region.
No proposal has yet been brought up to political level, but it is likely that the proposal will be to close the reception at Sankt Göran. Then the syringe exchange at Maria Hospital will be the only permanent reception in the inner city.
However, they are also looking at opening smaller syringe exchanges around the region.
The syringe exchange at Maria Hospital opened in 2019.
Mostphotos
Damage reduction
It was also recently announced that the addiction emergency at Maria Hospital will close at the turn of the year. The patients are referred to the addiction emergency at Sankt Göran.
– However, it is important to distinguish that these are two completely different changes to completely different businesses and the changes have no connection to each other, writes Maria Andersson.
The syringe exchange can thus end up completely separate from an addiction emergency.
Do you see any risks with that?
– HSF sees no tangible risks as syringe exchange is a so-called harm reduction activity and has nothing to do with acute addiction care, writes Maria Andersson.
Considered controversial
The syringe exchange at Sankt Göran’s hospital area opened in 2013. The reception at Södermalm opened in 2019.
Here, people who inject drugs can exchange clean syringes and needles. The aim is to reduce the incidence of various blood diseases.
At the receptions, patients are also offered further care and support as well as vaccinations.
At the opening, the business was considered controversial. The objection that existed was that it would lead to more people starting to use drugs.
Over the years, syringe exchange has become a more accepted type of intervention and the spread of, for example, hepatitis C has decreased among the target group.
In 2022–2023, the reception at Södermalm had 40 visits a day on average. Kungsholmen had 25–30 visits in the same period.
Source: Region Stockholm/Kunskapsguiden
The decrease in patients is due to this
Fewer and fewer are visiting the syringe exchange clinics on Kungsholmen and at Maria Hospital on Södermalm. It has gone from 26,000 to 19,000 visits per year.
The most likely explanations for the decrease are these, according to the region:
Visitors receive more syringes/needles per visit.
Syringe exchange operations have become more accessible in the country and in nearby regions – which reduces the burden in Stockholm.
The region has seen an increased referral flow from the syringe exchange to LARO – drug-assisted treatment for opioid addiction.
More also seek care at LARO clinics and stay longer as patients there.
Source: Region Stockholm
Maria Andersson, head of the psychiatry unit at Region Stockholm, sees no risks with the syringe exchange moving to Södermalm.
Anna Molander/Victor Malmcrona
7,000 fewer visitors in five years ✔ Maria hospital will be the only reception in the inner city ✔ To be strengthened by bus
