It’s been a part of Everett’s street culture since 1988, the early years of efforts to address the AIDS epidemic and the “bleach and teach” outreach to those using injectable drugs to stop sharing needles and to sterilize the syringes in order to reduce transmission of HIV and other diseases.
That legacy remains in its official name, AIDS Outreach, but to most it’s known as the needle exchange, which for many years has done its work quietly but efficiently from a small office in north Everett that is indistinguishable from the other businesses in its neighborhood.
Since 1994, it has offered a syringe exchange service that trades used needles for new syringes on a one-for-one basis, along with other supplies, all focused on reducing harm to those using drugs but also to the community at large that too often comes in contact with used needles in parks, streets and public restrooms.
In that first year, it exchanged about 25,000 needles, said Cheri Speelman, program director. That number had grown to 125,000 in 1996, her first year with the program. Even as needles have become a common sight on sidewalks and elsewhere, last year the program collected more than 2.1 million used syringes, heading off their improper disposal and cutting the risks for infectious disease.
As importantly, the program provides the opportunity for Speelman and health educator Matt Standerfer to talk with clients, advise them on safer practices and ways to avoid and respond to drug overdoses and be a resource for services that can move people into treatment for addiction. It also can connect them with additional health information and services, often for people who may have little interaction with police or health providers.
As Snohomish County, its agencies and other local city governments have recently launched cooperative efforts to address the opioid crisis, homelessness and related issues, the Snohomish Health District has an opportunity to assume oversight for the needle exchange and even expand its access and effectiveness.
But even after more than 20 years of operation in Everett, some unfamiliarity and even fear needs to be confronted.
Harm reduction: The benefits of syringe exchanges are well-understood and are backed by more than 15 years of study and have been promoted by the Centers for Disease Control and Prevention, U.S. Health and Human Services, U.S. surgeons general and numerous medical and health experts.
The programs, which are in operation across the nation, reduce the number of used needles in communities; reduce the risk for transmitting diseases among drug users and the general public; and increase opportunities for drug users to seek rehabilitation, as well as testing and treatment for HIV and hepatitis, especially among hard-to-reach populations.
A 2012 study published in the medical journal, Drug and Alcohol Dependence, compared the number of discarded needles in two major cities: San Francisco, which had needle exchange programs, and Miami, which didn’t. The study found eight times the number of improperly discarded syringes on the streets of Miami than in San Francisco.
Needle-stick injuries are particularly reduced among police and aid crews, who face a 1-in-3 likelihood of being stuck with a needle during their careers, the CDC reports
The CDC reports that people who inject drugs are five times as likely to enter treatment for substance abuse when they regularly use a syringe exchange. The programs limit the incidence of death from overdose, can offer training in using naloxone to reverse an overdose and reduce new HIV and hepatitis infections among a population where 1 in 3 are infected with hepatitis C. And those reductions in disease and death mean a savings resulting from fewer hospital ER visits and response by police and aid units.
Opposition: Despite that success, the programs, here and nationally, have faced opposition, some of it stemming from confusion with so-called safe-injection sites, officially sanctioned centers where drug use is supervised in a controlled setting. Such programs have recently been banned in Snohomish County, and similar action has been approved or is being considered in some local cities.
But syringe exchanges should not be confused with safe-injection sites. While both seek harm reduction, the similarity ends there. Drug use is not allowed at the needle exchange. Nor do needle exchanges encourage drug use, as supported by numerous federal studies.
Denying access to sterile syringes and other equipment doesn’t address addiction and won’t convince those using drugs to stop; they will continue to use, just without the benefit of a clean needle.
Joining the health district: Since last year, the Snohomish Health District has been considering a proposal to assume oversight of the syringe exchange program in Everett, which receives its funding through a state Department of Health contract.
Adoption of the program by the health district would require about $20,000 to $30,000 in additional revenue for the program’s operation in its first year during its transition. The district’s Board of Health has asked staff to seek partners for funding not provided in the state contract, as well as expanded testing and treatment, according to minutes from a December board meeting.
Additional funding from partners could allow for some expansion of the program, which in addition to office hours, goes out into the community. But its staff, Speelman and Standerfer, have used their own vehicles for that outreach. A partnership could provide funding for an official mobile unit that would allow more room for supplies as well as opportunities for testing for hepatitis and other basic medical care.
The program already has a partnership with Mercy Watch, a Mukilteo-based faith-based program that provides “street medicine” and other services to homeless people. Mercy Watch now offers an informal clinic at the exchange’s offices.
The health district’s oversight also would allow for better coordination with cities and other communities where the mobile services are offered, as well as cooperation with social workers that several cities and the county have teamed with law enforcement.
The proposal had been on the agenda for a recent meeting for the Board of Health, whose members currently are the five county council members and representatives from city councils for Darrington, Marysville, Mukilteo, Everett, Edmonds, Lynnwood, Bothell, Mountlake Terrace, Monroe and Lake Stevens. Action has been postponed to allow for staff to gather more information for the board.
Already working: In Everett, where most of the program’s work takes place, the exchange has the full support of Mayor Cassie Franklin, who knew about the program because of her previous work as executive director of Cocoon House.
“In our community it’s really reduced the needles that people find in parks,” she said. “And it’s helped ensure pathways to treatment.”
Likewise, the proposal is backed by County Executive Dave Somers. Somers said he understands the concerns of some, but disagrees that the availability of clean needles promotes drug use by those with addictions. The program reduces the incidence of HIV and hepatitis, and thus reduces the costs to the public in treatment of those diseases.
And, if there are concerns about management of the program, Somers said, the health district’s oversight would allow the best opportunity for addressing concerns.
As the program’s state funding is secure, immediate action isn’t required, but once board members’ questions are answered, the proposal deserves full consideration and adoption.
The inclusion of the needle exchange as part of the health district is a natural fit with its public health responsibilities and will only add to the benefits the program has provided for more than 20 years.