Needle exchanges — Why NJ should give addicts syringes right now
One of the most pernicious consequences of NJ’s heroin crisis is the proliferation of biohazardous waste left behind — most ominously, dirty, contaminated syringes.
The heroin crisis means more needles. And more needles means more dirty needles. And that means more blood-borne cooties.
Oh, and by the way, we still have a heroin crisis. So what are we going to do about it?
They say an ounce of prevention is worth a pound of cure. So here’s a plan: Embrace harm reduction, the practice of reducing negative consequences commonly associated with substance use.
Examples include e-cigarettes or nicotine gum to quit smoking. Clean needles for IV heroin users. Condoms for anyone forced into sex work to afford their next high. Here’s a fact: Illicit drug use and abuse are already happening. New Jersey has the body count to prove it.
Here’s another truth: Some ways to consume drugs are demonstrably safer than others.
This isn’t about trivializing the harms and the dangers of illicit drug use. It’s about reducing the costly, painful long-term damage of IV drug abuse. A clean syringe costs less than a dollar. A lifetime of health care for someone with hepatitis comes with a six-figure price tag. A good investment? You bet.
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Where we stand now
More than a decade ago, New Jersey approved its first needle exchange programs, allowing exchanges to open up in Atlantic City, Camden, Jersey City, Newark and Paterson — essentially, many of the state's black and brown communities. But we all know heroin isn't only a black and brown problem.
Those programs have had a huge impact. The programs distribute more than 1 million sterile syringes, according to the governor's office. In all, they've served nearly 22,000 individuals.
And they're not just getting needles. According to a state report in 2012, about 2,100 participants in the programs were admitted into drug treatment. Hundreds more received HIV testing, and dozens got treatment. Dozens of pregnant women were linked to prenatal treatment because of the programs.
And that was five years ago. Hundreds more have been helped since.
But when New Jersey authorized these programs, it made available no state money for them. None. The programs were so desperate for funding that last year, the Camden Area Health Education Center created a GoFundMe account to support the five needle exchanges.
New Jersey took one huge step last year. Gov. Chris Christie, who has been pretty good on this issue, signed a law allowing any municipality to open a needle exchange, and directing the state's health commissioner to invest $200,000 for the five pilot programs.
But in the time since, no new programs have come online. That shows you just how committed our leaders are to making it happen.
But is needle exchange good policy?
“It’s probably one of the most important public health initiatives we’ve adopted in years, which really prevents the transmission and spread of HIV/AIDS and hepatitis C among those who are using needles and sharing needles for their addiction," State Sen. Joe Vitale, D-19, told me. He chairs the Senate Health Committee in Trenton and he clearly laments NJ’s slapdash approach to harm reduction.
He told me many of those in government were concerned about sending the wrong message — that heroin use is OK.
It's as if they're saying “because you did this drug, you OD'd and you deserve to die," Vitale said. "That’s an awful argument.”
"It’s really not okay to use heroin. But it’s more important that we protect that person and others from the spread of HIV/AIDS. With the introduction of these harm reduction programs in New Jersey now, we’ve seen a dramatic decrease of transmission rates," he said.
As the heroin epidemic has grown, so has the increase in the sharing of needles, Vitale said.
"That’s why it’s so important that more communities and more sites open up to provide clean syringes to those who use needles to inject their drugs," he said.
Experiences with needle exchange
Dr. Jennifer Chuang is friend and a neighbor — and an outspoken advocate for healthcare as social justice. She ran in the Democratic primary for the New Jersey Assembly, looking to represent the 7th District in South Jersey, earlier this year.
“I think that Sen. Vitale is correct. (A) syringe exchange program is one of the most important public health initiatives that New could take, a big step in the right direction in reducing transmissions of HIV and hepatitis B and C in New Jersey," she said.
She's also got experience with needle exchanges — as a volunteer in Philadelphia's program while she was in medical school, during the height of the HIV crisis.
"So, in the early '90s needle exchange in Philadelphia was legalized, and in the eight years following that, the incidents of HIV infection went down by 38 percent in the population that uses (IV) drugs," she said.
The risks aren't only among people who share needles — those who reuse their own are exposed to all sorts of scary diseases.
“So most people think about blood-borne pathogens when we talk needle exchange programs. They think of HIV, hepatitis B, hepatitis C, which they certainly should," Chuang told me. "But what a lot of people don’t think about are the skin pathogens, stuff that lives on all of us, including staph. And when people get a skin infection, they can get boils, another term for abscess. They can get necrotizing fasciitis, which is a deep skin infection involving, really, the liquidation of the muscle inside. It’s awful and it’s life-threatening."
So there you have it: A flesh eating virus. Life-threatening, and pretty gory it I do say so myself.
How we can help law enforcement
Law enforcement and first-responders are also vulnerable to the growing threat. And whether they’re searching a suspect or reversing an overdose, our officers constantly risk encountering dirty syringes.
Al Della Fave is spokesman for the Ocean County Prosecutor's office. We reached out to ask: “Are dirty hypodermic needles a threat to law enforcement as well? Has anyone on his force ever been accidentally stuck with a used syringe?"
“Absolutely, yes,” Della Fave said.
Della Fave — who has held several roles with several police agencies, including the Port Authority Police and New Jersey State Police — said it's no secret that it's happened to many officers.
"And it’s a nightmare in the weeks and months after getting blood tests and waiting to to see if they have any issues," Della Fave said. "When that’s happened, you can see the terror in their eyes and on their face as they realized what’s happened to them.”
He said it's a part of the job every cop has to be aware of — "That’s a concern for those folks on the front lines.”
Full disclosure
We’ve discussed disease a lot in this episode. You should know: I’m HIV-positive for 26 years, the result of unsafe sex in the early '90s, back when HIV was a death sentence.
I was lucky enough to be a junkie in Philadelphia, with easy access to safe syringes. I have no doubt whatsoever that’s why I dodged the hepatitis bullet.
I acquired HIV as during an unsafe sexual encounter when I was a teenager. I’m 45 now. That’s a heavy price to pay — on me and on society.
The costs — Human and financial
George Lowe knows a thing or two about the costs of HIV and Hepatitis. He directs client services at The Center in Asbury Park. He helps poor and homeless people who have HIV/AIDS.
According to Lowe, treatment for someone with HIV could easily be $10,000 per month.
So that's $10,000 a month every month for the rest of somebody's life. And if they're on insurance, that's raising all of our premiums. If they're in surety care, that's something all taxpayers pay for.
"And you have to remember, it's an infectious disease so they can be passed on to other people," Lowe said. "So it's not just that one person. So you really want to make sure the individual has everything they need to not get something they can pass on."
What's holding us back? What's stopping needle exchange programs from growing?
"The ideology that, you know, they're addicts. And we’re condoning this behavior if we do this. That seems to be the biggest obstacle. That we are supporting their bad choices, their bad decisions — and I don't get it. I don't. For the life of me. And for all the reasons were talking about," Lowe said.
I asked him: Can you imagine what it would be like, if someone had an overdose, but the doctor refused to save him because he or she didn't want to send the message drug use was OK? Isn't that the same thing?
That's definitely one way of looking at it, for sure," Lowe told me.
It's gross. I get it.
Getting off heroin is hard enough without adding a terminal disease.
Look, you may not agree with my prescription at first blush. But it’s a hell of a lot better than just telling you how freaking awful this is. You know how bad this is. And the media, whose role is critical, patronizes you when they simply rattle off scary statistics and click-bait headlines about this crisis.
And then what? Now that you’re awakened and sufficiently concerned about the opiate situation in New Jersey. Well hopefully you’ll join me to lobby hell out of our policymakers to do more than just talk.
New Jersey needs a properly funded syringe access program yesterday. The only thing holding up back is our judgments. And until we change what’s socially acceptable, we can count on more dead people. And many more sick people. So let’s change what’s acceptable, yeah?
In our next installment, we'll talk about Narcan — and why everything you think you know about it is wrong.
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