Making a Point : Pacoima: Program in which drug users exchange dirty needles for clean ones is supported by results of a new medical study.
The news is not new--at least not for public health workers.
For years they have known what a prestigious medical panel recently concluded: Programs that provide drug users with clean needles help decrease the spread of the HIV virus and do not increase illicit drug use.
“I’m not surprised by the results because other studies have reached the same conclusion,” said Maurice Weiner of the Tarzana Treatment Center, a private clinic that operates the Valley’s only needle-exchange program in a litter-strewn alley. Since it started about seven months ago, the Pacoima program has already seen the kinds of results reported in a study released this week by the National Academy of Sciences. About 300 drug users have brought their dirty needles to the alleyway near Glenoaks Boulevard and Paxton Street and exchanged them for clean ones. In all, about 17,000 needles have been swapped.
“The other way of looking at it is 17,000 dirty needles taken off the street,” Weiner said. “That helps to reduce the risk of HIV infection.”
Conducted at the request of Congress, the study concluded that needle-exchange programs, “should be regarded as an effective component of a comprehensive strategy to prevent infectious disease.” The panel urged federal officials to lift their current ban on federal funding for such exchanges and encouraged states to repeal laws barring the sale and possession of injection paraphernalia without a prescription. But although the findings and recommendations bolster the position of public health workers who have long advocated needle exchanges as a means of stemming the spread of the HIV virus, it is not certain what impact the findings will have on local programs--or public sentiment.
Several proponents echoed Weiner, who said he hoped the public “will be very much impressed with and moved by this study.”
“My sincere hope,” said Ferd Eggan, the city’s AIDS coordinator, “is that this will mean that the state of California will lift its ban on syringe exchange.”
“The governor has considered legislation that would have permitted a waiver of the state law about the requirement of prescriptions for needles three years in a row and vetoed it three times.” Eggan continued. “I fear that our governor is motivated more by venal political considerations than by scientific truth.”
Nationwide, needle-exchange programs have been highly controversial. In Los Angeles County, where a UCLA study documented about 14,000 drug users infected with the HIV-virus through contaminated needles, there are few programs. As in many other states, California law prohibits possessing hypodermic needles without a prescription. In the past, local needle-exchange workers have been arrested, often at the request of community members opposed to the practice.
Technically, existing needle-exchange programs, including the one in Pacoima, are operating outside the law.
Just as lawmakers have so far resisted the idea, public opposition on the issues has persisted, even though other studies have demonstrated the value of such programs, said Douglas Longshore, a behavioral scientist who works for the UCLA Drug Abuse Research Center.
“It’s hard to be optimistic,” Longshore said. “I’m not an expert on the mood of the country, but the subject of drug use is so highly charged that people think needle exchange is condoning drug use, and that’s where their thinking stops. It seems like most people are not willing to think in terms of harm reduction. Just like with drugs itself: zero tolerance, and they think zero tolerance is the best way towards a solution.”
At the Pacoima exchange Thursday, workers from the Tarzana Treatment Center handed out clean needles and free advice to drug users who came on foot and by car to the group’s familiar white van. Health educators Mario Perez, Ester Ocon and Alex Adams sat near boxes of syringes, preparing “safety kits” filled with small bottles of bleach and water, cotton, condoms, lubricants and cookers. When they are available, users can choose from two types of syringes. “It’s important for us to accommodate people to keep them coming back,” Perez said.
Since February, the number of people using the program--mostly heroine addicts--has grown steadily while community concern seems to have calmed, largely through education, Perez said. “When we first started, people were on their toes about having a needle exchange in their back yard,” said Perez, coordinator of HIV education and prevention programs for the Tarzana Treatment Center. “That’s dissipated. People know we’re here. It’s become pretty routine for us to be here.”
As Perez spoke, Willie, a heroine user, dropped old syringes into a red plastic bin on the ground and picked up new syringes--and the telephone number for a treatment program.
“Before this came into existence, this thing about sharing needles among people who use drugs around here, it [sharing needles] was common. People said, ‘The hell with catching AIDS.’ They needed an outfit,” Willie said, referring to the syringes. “They didn’t care where it came from.
“They’re not just giving out outfits,” he said, after talking to Perez about getting treatment. “They try and sign people up for a program.”
Robert, another heroin addict, dropped 26 syringes in the bin and picked up 26 more.
“You want Terumo or B.D.?” Perez asked, meaning the brand.
“How about half-and-half,” Robert said. The 36-year-old addict, who had read reports of the Academy’s findings, agreed with their conclusions.
“I really haven’t used more or less” heroin since the exchange program began, he said. “It just makes it so you have clean rigs.”
The study also found that referrals and counseling were added benefits to needle-exchange programs.
Weiner called his program a bridge that links drug users with treatment programs and other services. Those who continue to use drugs report that they have changed the way they do things--such as reducing their number of sexual partners, using condoms more often and not sharing syringes anymore. “The fact that they have clean needles available to them means that they are not forced into methods of desperation,” Weiner said.
The city funded the needle exchange with a $52,000 grant, but the money can be used only for salaries and other administrative costs. Because of state and federal laws, the city cannot pay for the time of workers actually engaging in needle exchange, or the syringes themselves, Eggan said. The program has had to rely on private donations to actually pay for the needles, Weiner said.
Eggan said the new findings could eventually help exchange programs by enabling them to receive more funding.
Just last month, the Pacoima program received another $52,000 city grant, though the restrictions on its use remain the same.
“Certainly it’s a positive step,” Perez said of the study. “A recommendation from the federal government can only do so much. We need key political figures to understand the value of needle exchange.”
