Pubdate: Mon, 17 Jun 2002
Source: Press-Enterprise (CA)
Copyright: 2002 The Press-Enterprise Company
Contact:  http://www.pe.com/
Details: http://www.mapinc.org/media/830
Author: David Seaton

DISEASE SPURS NEEDLE IDEA

Hepatitis C: Riverside County Health Officials Say Injection Drug Users Are 
Creating An Epidemic

Riverside County health officials want to pass out clean syringes to 
intravenous drug addicts, hoping to slow the killer diseases of AIDS and 
hepatitis C.

Public Health Officer Dr. Gary Feldman expects to ask county supervisors on 
July 2 to declare a local health emergency. The move is required by state 
law to allow a needle-exchange program.

The climbing rate of hepatitis C, more than AIDS, is driving the proposal. 
The blood-borne disease attacks the liver and can lay dormant for years. 
There is no known cure.

"It has already eclipsed HIV and it will be the major infectious disease 
epidemic of the first part of this century," Feldman said. "It's out of 
control."

In interviews last week, only one of five supervisors ruled out supporting 
the first needle-exchange program in the Inland Empire.

"Give me a break," Supervisor Jim Venable said. "I would much prefer to 
hire another cop and go out there and start busting people who are doing 
that. People have to be responsible for their own dad gum actions."

Supervisor Roy Wilson said he usually comes down on the side of public health.

"If indeed there's a cost effective way of reducing the spread of disease," 
Wilson said, "I'd probably support it."

Proliferating

Needle-exchange programs have steadily proliferated across the state and 
country since the late 1980s as a way to decrease the spread of AIDS and 
other blood-borne diseases.

Riverside County District Attorney Grover Trask said handing out syringes 
undercuts Prop. 26, California's new law that sends people charged with 
drug possession to treatment instead of jail or prison.

"We're attempting to get these individuals in a new program, help them get 
clean, and here we're turning around and saying, 'We want you to use clean 
needles . . . it's OK to shoot up,' " Trask said. "It's in direct conflict 
with what we're trying to do."

California law forbids the sale or possession of a syringe without a 
prescription, although a bill that would allow individuals to possess up to 
30 needles passed the Senate last month.

In 2000, state lawmakers provided a legal mechanism for needle exchanges to 
operate: declaring a local health emergency and renewing it at regular 
intervals.

Feldman says he believes a needle exchange can save lives and money.

Cost of treatment

Injection drug use was the likely source of 23 percent of the county's 252 
reported AIDS cases in 2001, according to the health statistics office. The 
cost of treating one HIV-positive patient is nearly $200,000 per lifetime, 
according to the Centers for Disease Control and Prevention.

Injection drug use is linked to 60 percent of hepatitis C cases nationwide. 
There were 2,091 reported in Riverside County in 2001, a 23 percent 
increase over 1999. A study of adult jail inmates three years ago found 
that nearly a quarter tested positive for the disease.

"I feel that my mission is to protect the public health," Feldman said. 
"And I feel that folks in the community expect me to take a stand where I 
feel we must make a difference."

Health officials in San Bernardino County said they had discussed the idea 
of a needle exchange but have no plans to propose one. Reported cases of 
hepatitis C in the county swelled almost 20 percent between 1999 and 2001 
to 3,085.

"It doesn't seem like something our board would be supportive of at this 
time," said Alex Taylor, director of the county's HIV/AIDS programs.

The Inland AIDS Project, which runs food banks and outreach and housing 
programs for people with HIV and AIDS, has agreed to operate a needle 
exchange in Riverside County at no cost to local taxpayers.

Going mobile

The group expects to provide needles from a mobile van starting in the 
Perris-Lake Elsinore corridor because of the area's high concentration of 
injection drug users. Countywide, there are an estimated 11,000 injection 
drug users.

"We haven't locked down a location," executive director John Salley said. 
"We want to make sure it's accessible and safe. And that law enforcement 
knows where we are."

The exchange would operate twice a week, four hours a day at two locations, 
Salley said. Participants would exchange one dirty syringe for one clean 
syringe, with no limit on the overall number.

Norma, a former heroin user and a patient at the county's methadone clinic 
in Riverside, said she knows several people with hepatitis C. Two friends 
have died waiting for liver transplants, she said.

Addicts always need needles and would flock to a needle exchange, said 
Norma, whose ankles are scored by gray-brown marks and tiny craters, 
reminders of a life shooting heroin. The 43-year-old mother of five said 
she's grateful she stopped using nine years ago.

"Back then, it was just getting a fix," said Norma, interviewed at the 
methadone clinic, which requested that last names of patients not be used. 
"You were always fighting for who's going first, and when you're done, you 
just keep passing it through."

Off the streets

Her husband, Ben, also a recovering addict, said needles break, get clogged 
with blood and become dull. The more bad needles turned in, he said, the 
fewer there will be on the streets for kids to handle.

Addicts "are going to do what they can to get that dope," he said. "You 
don't ever think about how many people can be hurt by it."

Salley said a substance abuse counselor would be available at the exchange, 
as a well a social worker or nurse. The van also will offer disease 
prevention information, HIV testing and referrals to clinics for hepatitis 
C testing, county officials said.

"We're really looking at this in a more global concept than just the 
needle," Salley said.

Hepatitis C eventually causes chronic liver damage in 70 percent of cases 
and death in 5 percent, local health officials said. It is 10 times more 
contagious than HIV, and can be transmitted even through cotton swabs 
shared between users. As many as 90 percent of those injecting for at least 
five years are infected with hepatitis C, the CDC estimates.

Tough situation

Law enforcement authorities, however, are unconvinced there is a state of 
emergency.

"I certainly can't support giving out hypodermic needles for those who 
would use them for illicit purposes," said Undersheriff and Sheriff-elect 
Bob Doyle. "It puts us in a tough situation."

They also challenge studies health experts say prove needle programs can 
decrease new HIV infections up to 70 percent without increasing drug use or 
crime.

Studies done in Montreal and Vancouver during the 1990s showed HIV 
infection rates were higher among frequent users of needle exchanges. One 
study in Seattle found that a needle exchange did not decrease hepatitis 
infection rates.

The studies "are not very impressive," said Dr. Forest Tennant, a West 
Covina doctor who conducts research into drug dependency and pain.

Tennant said he has operated methadone clinics across the state and 
believes that most needle exchanges are not conducted in a clinical setting.

"The idea of preventing infectious diseases is to cut down on the number of 
injections," Tennant said. "These people are addicts. A physician should 
prescribe those needles."

But the author of the Vancouver study says it has been wrongly used as 
ammunition by opponents of needle exchanges.

Steffanie A. Strathdee, an associate professor at the Infectious Diseases 
Program at the Johns Hopkins School of Hygiene and Public Health, said the 
Vancouver program attracted cocaine injectors. They shoot up more than 
heroin addicts and there were not enough needles to keep up, she said. 
Another problem was a weak link between the needle exchange and treatment 
facilities, she said.

The vast majority of studies show providing clean needles helps decrease 
the spread of diseases without doing harm, Strathdee said.

Needle exchanges "are the cornerstone of HIV prevention," she said. "But 
they cannot work in a vacuum. They're not the silver bullet."
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MAP posted-by: Larry Stevens