Doing No Harm
Amid our injection drug epidemic, service providers rethink strategies for reducing unsafe practices
by Larry Buhl
The U.S. is in the midst of an opioid drug crisis and the use and misuse of injected opioids like heroin and oxycodone—and new synthetics like fentanyl—has led to a spike in blood-borne infections.
The Centers for Disease Control and Prevention (CDC), has found that ten percent of new HIV cases in the U.S. in 2015 were attributable to IV drug use. And that’s a statistic likely to worsen, as heroin use among adults under twenty-six years old has more than doubled over the past decade, according to the CDC.
People who inject drugs are at high risk for HIV, HCV and other diseases due to sharing syringes and other equipment used for injection, as well as an accidental stick from used syringes.
With a few exceptions, injection drug use is considered a law enforcement issue, rather than a health crisis, and policies like needle exchanges and supervised injection sites are still met with pushback from communities and elected officials.
But the severity of the injected drug crisis is now making some communities give these controversial practices a second look.
What Happens in Vegas
With an agenda of reducing the spread of hepatitis C (HCV) and HIV, Las Vegas health officials in April installed the nation’s first needle exchange vending machines.
The vending machines are funded by private donations, and administered through the Southern Nevada Health District, Nevada AIDS Research and Education Society and Trac-B Exchange, an organization providing harm reduction and syringe exchange.
Anyone in southern Nevada can use the machines. There’s a catch: Users must first register with Trac-B Exchange or one of its community partners first. Those who register can receive a card and a code that lets them access to up to two kits per week. Each kit contains ten syringes, a tourniquet, a disposal container for used syringes, wound care supplies and information about addiction treatment.
Customers can also drop off used syringes into a Sharps “mail box,” located next to the vending machines.
The machines are located in the agencies already working in HIV/HCV prevention field, Rick Reich, Project Director with Trac-B Exchange, tells A&U.
“But we’ll also be adding one or more storefront [machines],” Reich says. “But still, they will have to register to get into the system and get their codes.”
Reich adds that syringe vending machines are a solution for a spread-out city like Las Vegas, where users are unlikely to travel to one central location, especially on a 110-degree summer day.
While Las Vegas will be the first U.S. city to dispense syringes through vending machines, Puerto Rico, Europe and Australia have been using similar machines for years.
Supervised Injection in Seattle
In January, the King County (Seattle) Board of Health voted unanimously to endorse supervised injection sites for drug users, a strategy to prevent overdose deaths that have risen substantially in the region in recent years. King County’s medical examiner said the county set a new record for fatal overdoses with 359 deaths in 2016, with the bulk of them involving opioids.
If they receive final approval, which is expected soon, the sites will be the first of their kind in the U.S. There are approximately 100 supervised injection sites (SIFs) operating around the world, mostly in Europe, but also in Australia and Canada.
According to the Drug Policy Alliance, numerous peer-reviewed studies have shown positive impacts of SIFs, including a reduction in risky behavior (syringe sharing) that can lead to transmission of HIV and HCV. Studies have also shown that SIFs lead to an increased participation in addiction treatment.
In September, a King County task force consisting of experts on heroin and opioid abuse recommended injection sites in Seattle and surrounding areas as a way to not only reduce overdoses, but to create a conduit to health care, long-term treatment and other services for those addicted to drugs.
King County Prosecuting Attorney Dan Satterberg endorsed the sites last year, saying that the opioid crisis should be considered a health crisis more than a criminal justice issue. He also pointed out that the World Health Organization has found that needle exchange programs, which have been highly controversial in the U.S., have been effective in reducing the transmission of HIV, HCV and other infectious diseases.
The task force also recommended expanding drug treatment programs and providing easier access to opioid-treatment drugs like Suboxone.
Larry Buhl is a radio news reporter, screenwriter, and novelist living in Los Angeles. Follow him on Twitter @LarryBuhl.