Needle exchange helps create a ‘stigma free zone’

August 6 – Just before 2:30 p.m. on a recent Thursday, a white van drove down 32nd Street behind Safeway, stopping near the Astoria Riverwalk.

Two Clatsop County staff came out: Jenna King, Public Health Department Harm Reduction Coordinator, and Nadine Campbell, Department Nurse. They opened the back doors, installed a folding table and a sign at the top that read “Harm Reduction” and, at the bottom, “Syringe Maintenance Program.”

Soon a small woman approached the table and, with Campbell’s help, filled out a questionnaire. The visitor returned used syringes and left with new syringes, as well as supplies to filter the drugs and use them safely.

On that day, the syringe exchange set a record for the most syringes collected by the county in a single day: 27,980 at exchange sites in Astoria, outside the Premarq center in Warrenton and near Providence Seaside Hospital. The number given was slightly lower.

Launched in the fall of 2017 with the unanimous blessing of the County Council of Commissioners, the needle exchange aims to minimize the risks, especially the spread of disease, associated with the use of illegal drugs.

Needle exchange programs, which emerged in communities nationwide decades ago in response to drug addiction and disease transmission, recognize an uncomfortable reality – this behavior is going to happen – and endorse l idea that society should help reduce the associated dangers. Parallels are often drawn to the practice of distributing condoms in secondary schools, rather than relying solely on abstinence-oriented sex education, to prevent sexually transmitted diseases and teenage pregnancy.

The federal Centers for Disease Control and Prevention says, “Almost 30 years of research has shown that comprehensive (needle exchange) programs are safe, effective, and economical, do not increase the use of illegal drugs or increase drug abuse. crime, and play an important role in reducing the transmission of viral hepatitis, HIV and other infections. “

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Last December, the Clatsop County program distributed its millionth syringe. As of mid-July, the program had given away more than 1.2 million syringes in exchange for 1.3 million, according to county figures. Participants often exchange several needles for several people.

In addition, county staff distributed more than 4,000 doses of naloxone – a nasal spray that neutralizes opioid overdoses – saving more than 300 lives. This year alone has already seen over 120 such reversals. That’s “a huge number for a county our size,” Melissa Brewster, senior pharmacist at the Columbia Pacific Coordinated Care Organization, said in an email.

The surge in overdoses indicates that the local drug supply is “at much higher risk than it has been in the past two years,” Brewster said.

In the spring of 2020, fentanyl – a potent synthetic opioid – was noticed on the North Coast. Overdose deaths in Oregon during those months were up about 70% from comparable statistics in 2019, according to the Oregon Health Authority. The drug is now present in the majority of illicit substances, both methamphetamine and heroin, Brewster said.

The needle exchange team saw this danger looming and began distributing strips that test for the presence of fentanyl, to “prepare people to start testing their drugs more often and to make it some kind of standard. them, ”King said.

During the Thursday exchanges, program staff also ask participants if they would like to connect with addiction treatment and recovery, housing and health care, food, and COVID screening and vaccination. -19.

“This stuff is complicated”

Some of the initial fears about the needle exchange never materialized – for example, the fear that public parks and other child-friendly spaces would see a significant increase in the number of needles left behind by drug addicts.

Although the Astoria Police Department still receives calls about found needles, police were receiving those calls before the needle exchange, according to Deputy Chief Eric Halverson. Neither police nor staff from the city’s parks and recreation department say they noticed a difference in the complaints.

Needle exchange was not universally supported when the county launched a six-month pilot program almost four years ago. Local law enforcement officials have expressed skepticism that such programs are the wisest way to tackle drug abuse.

Sheriff Matt Phillips said in a recent interview that communities need to balance compassion and awareness without being “so permissive that we allow behavior.”

“In some ways it has been effective as a harm reduction tool,” he said. The sheriff pointed out that fewer cases of conditions such as cellulitis – a bacterial infection at injection sites – were presenting to emergency departments.

Phillips stressed that he was not opposed to the program and viewed the sheriff’s office and the health department as part of the “Clatsop County team.”

“If the program makes a difference in lives, I support it,” he wrote in an email. “If that doesn’t happen or creates additional problems … then maybe we should re-evaluate or modify the program.

“This stuff is complicated and we all have to work on it together.”

Phillips said he was curious how many people, following a referral from a needle exchange center, enter drug treatment and recover.

Brewster said that binding people who use the program to their request for treatment “(would violate) certain privacy rules regarding the protection of people with (substance use disorders)”.

It would be difficult to draw conclusions about the program’s impact over the past 18 months, Brewster said, as the coronavirus pandemic has led to “mind-boggling” levels of substance use.

The county also does not have a good way to measure the prevalence of syringe-transmitted diseases such as hepatitis C and HIV in the region, she said.

“Hope is just to plant the seed”

Before King became the County Harm Reduction Coordinator, she worked for Kerry Strickland’s nonprofit Jordan’s Hope for Recovery, named after Strickland’s son, who died in 2015 of a heroin overdose. . The association was dissolved in early 2020.

The needle exchange would ideally help people reduce their drug addiction, King said.

But when she works in the van – serving a population of both housed and homeless, people with families and people traveling alone – King has a more urgent short-term goal in mind: give them what they need to stay alive. . And that includes using that little window of time provided by the exchange to let them know what options are available to them.

“The hope is just to plant the seed so that they can get to a point where they’re looking for something different,” King said. “But they have to keep coming to figure this out and navigate themselves.”

By establishing what she calls a “stigma-free zone,” King and her colleagues hope those who rely on the exchange can find their way sooner. “And, unfortunately, a lot of people don’t. That’s the nature of addiction,” she said.

On that record-breaking Thursday, King and Campbell had planned to show up about 15 minutes earlier, but were slammed at Seaside and then at Warrenton.

Before this first visitor left, she asked through a mask if King and Campbell knew how much their work was appreciated.

That the woman was masked was not unusual. In general, King said, people who use the needle exchange have followed the rules of the pandemic – covering their faces, keeping their distance.

Neither was the woman’s show of gratitude. When asked if they often hear such things, King replied, “Whenever we are here. Every time.”