Needle exchange: Program proposal an attempt to prevent the spread of disease

Hepatitis C can stay alive on a surface for at least a month, and in a needle for 42 days.

That’s the threat Washington County Health Commissioner Dick Wittberg and Director of Nursing Valerie Betkoski are concerned about as they discuss a proposal for a needle exchange program in the county. Such programs exchange used needles for clean ones in an attempt to prevent the spread of disease.

“At first glance, people against this will see it as a supply (enabling) drug users,” noted Wittberg. “But the assumption that the disease will stay in that population is not an accurate one. People don’t realize how hardy hepatitis is. It can stay on a hard surface for at least a month, it’s not just a kid that steps on a needle in the park and boom they have hepatitis. It’s being found in people who have none of the risk factors–no risky behaviors– and it can remain on the surface of a table, in a bathroom or on a doorknob waiting for the opportunity to strike.”

So the two are eliciting feedback from other programs across Ohio that have installed a needle exchange program on how one would work, and be funded.

“The major cost in this would be the cost of time, being able to take the time to talk with people and have the personnel available for it,” said Wittberg.

Then the marginal cost to supply a one-for-one ratio of clean needle and syringe for a used one would run at the rate of $12.50 for 100 needles, according to Betkoski.

The health department already buys needles in bulk for use in its day-to-day services, though this additional service would increase the needed supply.

Looking at model programs across the state, Betkoski added the evidence within Ohio where a one-for-one exchange of dirty/used needles for clean ones, in fact, reduces the littering of needles in public spaces and adds face-to-face contact with resources for rehabilitation and recovery.

One example is a program in Canton.

“We received grant funds from the AIDs

Healthcare Foundation for the startup cost ($25,000) and we only got that through sponsorship from the AIDs Resources Center in Cleveland,” explained Diane Thompson, director of nursing for the Canton City Health Department.

Saturday marks the one-year anniversary of the Stark County needle exchange program called SWAP – Stark Wide Approach to Prevention.

“And (Friday) we had our largest participation to date. We had 52 clients come through and the majority were returning but we also saw our highest number of new clients (13),” Thompson said. “And we have a 75 percent return rate with the needles we distribute that come back to us. When you can get the users to understand that they have a responsibility too in the community’s safety and health and are actively bringing in the hazard instead of leaving it, that’s huge.”

At the close of May, the official tally was 191 individual participants served of which 56.54 percent were male and 43.46 percent were female.

“We have a nurse that assesses wounds and distributes needles, an HIV tester, a person to man the registration table and OhioCAN who provides snack bags and typically makes hot sandwiches,” Thompson said, noting the partnership also with the local crisis center and a representative from Stark County providing hot sandwiches throughout the two-hour weekly clinic. “Some of our clients haven’t eaten in a few days and they get a hot meal and probably the biggest impact this has had is that a population that’s already so stigmatized and ostracized has a place to come where somebody truly cares about their lives while they’re in the midst of addiction and cares whether they’re as healthy as they can be while they struggle, that’s big.”

Thompson explained that the program is anonymous, assigning an identification number to each individual with some data to track who is bringing needles and leaving with them.

She also noted that a specific container for medical waste is not provided as part of the program, rather “fit paks” are given if needed.

“(They’re) hard containers for needles,” she explained. “(But) most have their own container that they put the needles in.”

Betkoski said hard plastic containers like bleach bottles or coffee canisters can easily be sealed and used to dispose of needles adequately.

“Bring me your empty coffee cans,” she said, gesturing to the stack of Folger’s red canisters stored under her desk already Friday.

Betkoski also noted other successful needle exchange programs across the state.

“Portsmouth city has a robust needle exchange system, and they have actually been able to reclaim a public park,” she said. “Zanesville/Muskingum Health Department has one, Marion City public health has one, plus the major cities. We would love to have community partners too like they do. These guys are tag-teaming with social workers who can speak about treatment programs.”

She explained that the way the park in Portsmouth was cleaned was mostly from the drug-using community seeing the dirty needle as a commodity.

“They’re cleaning up their own mess and not only their own needle but saw where another guy also left one and picked that one up as well,” she told Deputy David Tornes of the Washington County Sheriff’s Office as he picked up new naloxone dispensers for first responders Friday.

At first, Tornes said he was wary of the idea, noting he doesn’t log many needles into evidence that are found around the county.

“I see a few needles come in, maybe six to 10 a year when occasionally there will be a syringe or a syringe tube (that) will be reported and found in a parking lot. If they don’t know whose it is it goes to be destroyed,” said Tornes, who handles the evidence locker for the sheriff’s office. “But I see more from the drug raids, there will be several cataloged depending on how big the bust was.”

But Jackson Patterson, a youth basketball coach who recently kicked off the MOV Rebound for Kids program on the west side, noted the numerous needles he’s removed from Flanders Field and Playground in the last few months.

“It used to be I was finding at least one every day, then once a day for about a week before the program really kicked off and the police started really coming (to participate) I was finding four or five a day,” he said. “You used to find a lot of drug paraphernalia around the port-a-potty. But I’ve not been finding any now since the basketball program has been kicking off.”

But that just means the drug abuse has gone elsewhere, away from the police presence.

Betkoski noted the biggest challenge to kicking off a needle exchange program though, is getting the start-up funding.

“Federal and state funding don’t want to even foster the thought that this is happening,” said Betkoski. “There’s no real state funding to test for HIV anymore at the local health department level, it all boils down to money. It’s not that we don’t want to do something, it’s how are we going to pay for it.”

Leo Beletsky, a drug policy expert and associate professor of law and health sciences at Northeastern University has spoken to press about the opportunity for current opioid lawsuits against pharmaceutical companies to perhaps fund solutions like syringe exchange programs.

Thompson noted while these lawsuit funds could in the future be helpful, they don’t address the immediate need.

“We were facing higher rates of Hep-C and you know how long legal battles take. We needed to meet the need now,” she said.

Instead, communities like Canton utilize multiple resources like grants and public health dollars to fund similar programs.

“The start-up cost is averaging about $25,000 and that’s lasting these programs several years,” explained Betkoski.

She explained that the needs of the program are threefold:

¯ Funds to purchase clean needles.

¯ Funding for medical waste pickup.

¯ Staff time allocated to collection.

To respond to those opposed to providing a one-for-one exchange, Betkoski stopped and thought through who she hopes this program would protect.

“I have 18-year-olds who have chronic hepatitis, how sad is that?” she asked. “If I can prevent someone from getting Hep-C and also give them the tools to help them quit by partnering with addiction recovery agencies, maybe not the first visit, but maybe three or 10 times later …A person who is truly addicted doesn’t want to be a slave to that drug.”

Patterson noted that he’s also hesitant to support a needle exchange program without seeing the added drug prevention piece as well.

“Prevention means not doing it,” he said in plain terms. “I don’t think it’s a good idea because it’s condoning use, but I could be wrong. If it does help people I’m open to ideas like this. And that Your Voice Mid-Ohio Valley program at the fairgrounds coming up I’m planning to go to that to hear the other ideas. I’d like to hear what other people have to say.”

The statistics, full list of services and returns for the Stark County program can be found at bit.ly/cantonSWAP.

The Marietta Times has partnered with Your Voice Ohio and other local news entities to sponsor the following three forums in Parkersburg, Belpre and Marietta to invite public input in finding community directed solutions to the drug epidemic in the Valley.

¯ July 15, 1:30-3:30 p.m., Boys & Girls Club, Parkersburg.

¯ July 16, 6-8 p.m., Masonic Lodge, Belpre.

¯ July 17, 6-8 p.m., Washington County Fairgrounds, Marietta.

To register for the free events and learn more information visit The Marietta Times Facebook or contact Publisher Jennifer Houtman at 740-373-2121.