February 17, 2016
"Syringe programs have really been concentrated in large cities and have done an excellent job of preventing HIV infection where they have been implemented, but we now really need to move to address the new injectors that we see in small towns and in rural areas, particularly in Appalachia," said Don Des Jarlais of the Icahn School of Medicine at Mount Sinai, who has spent 25 years studying the exchanges.
Des Jarlais said federal funding should enable existing centers to expand and new ones to open.. "With the exception of a few states, there really has not been adequate funding of needle exchange programs in the US," he said.
Libby Harrison, who manages the Cincinnati Exchange Project in Ohio, said it was "about damn time" for the change in federal policy.
"We've had the science on syringe exchange for almost 30 years. People and their politics getting in the way of science drives me crazy," said Harrison, whose exchange has two staff members and is open three days a week in a region that has been hit hard by drug abuse.
Inside the lobby of the Harm Reduction Center in Los Angeles, customers wait in a line marked with red tape on the floor. A poster on the wall reads in big letters, "Needle exchange saves lives."
At the front of the room, plastic bins are filled with syringes, sterile water ampoules, rubber bands, antibacterial ointment and alcohol swabs. An oversized, locked red bin sits nearby, and clients deposit dirty needles into it.
They don't need appointments, insurance or even identification. They simply answer a few questions, including whether they are homeless. When 26-year-old Eli Guerra walks up to the front counter, he tells the clerk he is out of needles. The clerk asks him what he uses now.
"Whatever I get my hands on," he replies.
Guerra, who uses heroin, has been coming to the needle exchange for about a year but says he hopes this will be one of his last visits.
"This ain't me, really," he says. "I am really trying to stop."
Chloe Blalock, program coordinator of the center, said she hopes federal funding will enable her to hire more people and expand services such as therapy, medical care, overdose prevention training and medication-assisted treatment. For now, she can afford to stay open only seven hours on weekdays and six on weekends.
"We should be open 24 hours," she said. "From a public health standpoint, you want to make sure people have what they need -- or more than what they need -- no matter what."
On a recent Tuesday, Dr. Rolando Tringale was at the center, teaching medical students about the health effects of drug use.
Tringale, who treats abscesses and wounds, explained why staffers hand out alcohol swabs. "This is an important part of harm reduction education, preventing skin-based infections," he said.
Diamond Mendoza, a self-described homeless man who is addicted to heroin, said that since coming to the exchange he has learned a lot about injecting drugs more safely. He wipes his skin with alcohol before puncturing it. He goes to see the doctor whenever he gets a wound or an abscess. And he always uses clean needles, he said.
"I don't have HIV because I am really careful," said Mendoza, who exchanged 40 needles on a recent morning.
Michael Poor said he has been using drugs since getting hooked on Vicodin, when he was a registered nurse. At first, Poor said, he couldn't get clean syringes and often reused and shared them.
"You had to use one that had been used 15 or 20 times," he said.
He said he believes that's how he became infected with hepatitis C.
Poor said he has been coming to the center for about five years and stocks up so he can give clean needles to others. Staff members know him by name.
During his recent visit, he dumped about 35 used syringes into the red bin.
Minutes later, he was back out on the street, holding a small brown lunch bag filled with supplies.
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