Recent comments in The Daily World and The Vidette prompt us to comment on the Needle-Exchange Program. This is an important policy decision and we will, of course, administer whatever policy direction is set by the Board of Commissioners, which is also the Board of Health.
One official recently told me, “I hate needle exchange — but I hate the alternative even worse.” Part of our responsibility as a Health Department is to provide the information needed for decision-making, so this seems a good time to review the information that led to setting up the syringe exchange program 10 years ago.
The purpose of syringe exchange is to protect you and your family. It does not cause needles; it prevents them from being discarded where they can hurt you. We know you still see needles in parks and other public places, but they are left by drug users who are not visiting the exchange. If we discontinue our exchange, we predict you will see many more needles.
The Needle-Exchange Program works as an exchange, on a one-for-one basis. You have to bring a needle to get a clean one and they are carefully counted. So, Needle-Exchange Program does not increase the number of needles, it just replaces dirty needles with clean ones. We have collected and safely disposed of more than 550,000 needles so far this year. If we stop collection, and anywhere near that volume of needles hits our public spaces, it could become a public health disaster.
Discarded needles can carry diseases such as hepatitis B, hepatitis C and HIV. After a needle stick injury, we worry most about hepatitis C. If you or your child has a needle stick injury, we recommend you go immediately to a hospital Emergency Department to seek evaluation and testing. In order to be sure an infection has not occurred, blood tests are done immediately after the injury and again at 6 weeks, 12 weeks, and 6 months.
Overall, the chance of getting a disease after a needle stick injury is small, but as an anxious parent or spouse, 6 months is a long time to wait. So far this year, the hospital has responded to about 20 community members who were stuck accidentally by a needle (and who are not health care workers.) If discarded needles become more common in the environment, we can expect more needle stick injuries and many more anxious waiting periods.
In other cities, both the number of inappropriately discarded needles and the number of injuries dropped dramatically when Needle-Exchange Program was introduced. A few examples: In Baltimore, 50 percent fewer needles. In Portland, 66 percent fewer needles. In Connecticut, police reported 66 percent fewer needle stick injuries.
Another way Needle-Exchange Program protects you is by suppressing disease rates among the people injecting drugs. We have had a local Needle-Exchange Program for 10 years, and we believe it is helping to keep disease rates low within that group. If we stop exchanging clean needles for used ones, we expect disease rates to rise. That means the level of danger for each needle stick injury will also rise.
If people who inject drugs have clean needles from Needle-Exchange Program and don’t share them, they do not transmit disease to one another. If clean needles are not available, they will not stop injecting drugs, but they will share needles — and that will spread disease. San Francisco started an Needle-Exchange Program early in the HIV epidemic, in the 1980s. By the year 2000, just 7 percent of IV drug users were HIV positive. By contrast, New York City did not begin Needle-Exchange Program until the mid-1990’s, and by then 40 percent of IV drug users were HIV positive. Hepatitis C studies show the same pattern.
About half of all new HIV cases are in IV drug users. About 1.5 million people in the United States have hepatitis C and among those who tested positive, three-quarters list IV drug use as a risk factor.
Why should you care? Because those diseases don’t stay neatly put in a group of drug users. More disease combined with more discarded needles increases the threat to everyone from needle stick injury. In addition, some people inject drugs and are very adept at hiding it. If you or your family member became romantically involved with someone hiding a drug addiction and had sex, you would be at risk and never even know it.
Another consideration is the cost impact of untreated disease stemming from addiction. People who inject IV drugs often experience soft tissue infections (abscesses, cellulitis, and infected ulcers.) Using dirty needles increases the rate of infection. That will lead to more people with very bad infections being seen in the hospital Emergency Department, frequently needing hospitalization. The infections carry huge costs and very often there will be no source of payment, so they become an economic threat to our hospital.
The cost of one syringe is 8 cents. The cost of treating one person with HIV case is $25,000 per year or about $600,000 in lifetime costs. The cost of a liver transplant, which might follow hepatitis C, is more than $500,000. From a dollars-and-cents perspective, Needle-Exchange Program is seen as having a high return on investment.
What Needle-Exchange Program will not do: Solve our drug problem. We are in the grips of a terrible heroin epidemic. It will not be altered by clean or dirty needles. To stop the impact of drug addiction in our community we are going to have to face it head on — and give it everything we’ve got: Increased treatment, policing and education. We can do that, and we’ll talk about how in a future column.
Joan Brewster is the director of Grays Harbor County Public Health & Social Services.