Harm reduction offers hope in increments

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By ERIC A. HOWALD
Of the Keizertimes

Chris Gray is in the business of starting conversations with injection drug users.

“Once someone engages you and says, ‘I want to use a clean needle,’ that’s the beginning of some sort of contemplation,” said Gray, harm reduction outreach specialist for the Benton County Health Department.

The Benton County harm reduction program is one of the nearest harm reduction and needle exchange programs to Keizer. Marion County offers no such service and calls and e-mails for comment on the current status of the local conversation went unreturned.

However, such programs are proven in their effectiveness when it comes to not only weaning drug abusers off their habits, but containing outbreaks of potentially lethal diseases such as Hepatitis C and HIV. Earlier this year, Austin, Indiana, was the epicenter of one such outbreak – nearly 150 cases of HIV were diagnosed in a short span of time  after widespread needle-sharing was uncovered.

Benton County’s program offers a 24/7 needle drop box, a decentralized network of secondary needle exchange nodes, rapid HIV and Hep C testing, access to Hepatitis A and B vaccinations and can even hook up users with detoxification centers and provide transport. All of it is free of cost to those in need and the supplies only set the county general fund back about $38,000 per year.

“There’s additional outreach prevention time, but that’s what it is for materials and supplies,” said Charlie Fautin, deputy director of Benton County Health Department.

In return, more than 50,000 needles are kept off the street and out of landfills each year.

Getting started

When Benton County began looking at the possibility of offering a harm reduction program in 2002, officials started by talking with anyone who might have a stake in the issues surrounding injection drug use.

They started by surveying as many active injection drug users as they could find, about 150.

“About 53 percent of the users surveyed said they frequently, often or always shared needles,” said Fautin. “But we also surveyed them as to what services they would use to help them get off drugs.”

Fautin said officials spent the better part of a year in community conversations with local leaders about the science behind harm reduction programs and attempted to allay fears about what such programs represent.  Harm reduction programs often spark two polarizing views. They are either cast as “enabling abusers” or “saving lives,” and Fautin said Benton County met with both types of individuals.

“The compelling arguments were preventing infection and preventing health care costs, but the enablement argument comes up all the time. There are those who believe that zero-tolerance is the only approach, but there is consistent research that shows harm reduction programs deter the transmission of blood-borne diseases,” Fautin said.

Washington state was an early adopter of syringe exchange to curb transmission of HIV and hepatitis among drug injectors. Now, its rate of cumulative AIDS cases attributable to injecting drug use is the fifth lowest in the nation.  One study found every $1 invested in syringe exchange saves $3 to $7 in HIV treatment costs.

Fautin said some of the harm reduction program’s biggest supporters are now law enforcement and solid waste disposal suppliers.

“We get quite a bit of support from law enforcement because they don’t want to pat someone down and find needles. We’ve also gotten support from the solid waste disposal folks because they don’t want their employees in danger while carting away a trash can filled with sharps,” Fautin said.

When budgets are tight, the program usually ends up in the crosshairs, but the science-founded arguments have kept Benton County’s harm reduction program going.

Establishing harm reduction programs at the local level is also easier now than it was in 2002. The North American Syringe Exchange Network offers start-up kits for new needle exchanges, $1,200 gets the organization credit with the Buyers’ Club and is equal to about 14,000 syringes or a combination of syringes and other supplies. There is currently a ban on using federal funds to establish and operate harm reduction/needle exchange programs.

How it works

While Benton County offers the drop box for round-the-clock disposal, county officials rely on a decentralized network of distribution partners to get most of the used needles off the streets.

“One of the basic principles is reducing harm to the self and others,” said Gray. “The way we operate now is we make contact with leaders in local communities and they can be someone in a homeless camp or a trailer park or just someone in their own home. Most of them have Hep C or HIV and they have a vested interest in reducing harm to others.”

Those individuals are selected to operate secondary exchange sites and given supplies of needles to exchange for used ones and sharps containers to collect used needles being turned in. Gray and the county operate the secondary exchanges on the honor system. Sometimes secondary exchangers don’t even need to give their full name.

“We’ve been very lucky to have low turnover in Chris’s position and that’s given us a lot of street credibility to make the right contacts with people in a position to help us,” Fautin said.

Gray also offers rapid HIV and Hep C testing that he performs out in the community away from the spaces – county health clinics – where some might fear “an ambush” by government employees.

A solution in stages

While harm reduction programs are by no means an end-all solution to injection drug abuse, Gray said keeping the focus on incremental improvement shows their effectiveness.

“Seeing someone go through the stages of harm reduction is the most powerful thing. They’ll move from using and sharing needles to not sharing to using less to deciding to go into rehab to asking if I can get them a bed in a detox center,” Gray said.

Fautin said buying into such programs requires doing the legwork of starting community conversations, but also fundamentally shifting perceptions of drug abusers.

“People tend to think of addicts and users as totally irresponsible. It increases impulses and reduces inhibition, but there are people dealing with HIV or Hep C and they want to protect their friends and acquaintences who are at risk,” he said.

Fautin has been surprised in recent years to see the number of requests for needle drop boxes grow, even within the more rural areas of Benton County.

“We go out and talk with some of the local town councils and pretty soon someone asks if they can get a drop box in their area,” he said.

While law enforcement can stem, at least temporarily, the tide of drugs available, Gray said the real resolutions come from seeing an addict not just as an addict but as a person.

“Addicts are not going to go away, they are our brothers  our sisters, our mothers, our fathers. We can choose to ignore them or choose to engage them,” Gray said.

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