Pubdate: Wed, 14 Sep 2005
Source: Baltimore Sun (MD)
Copyright: 2005 The Baltimore Sun, a Times Mirror Newspaper.
Contact:  http://www.baltimoresun.com/
Details: http://www.mapinc.org/media/37
Author: Alec Mac Gillis
Bookmark: http://www.mapinc.org/hr.htm (Harm Reduction)
Bookmark: http://www.mapinc.org/find?143 (Hepatitis)
Bookmark: http://www.mapinc.org/heroin.htm (Heroin)
Bookmark: http://www.mapinc.org/find?137 (Needle Exchange)

REACHING OUT TO THE FRINGES

Baltimore's Needle Exchange Program Has Been Deemed An Overall Public 
Health Success. But Most Younger Drug Users Aren't Participating, And 
The City's Worried.

The young redhead with the stylish black backpack and heart-shaped 
earrings had come a long way to be standing at Monroe and Ramsay 
streets in Southwest Baltimore, waiting her turn outside the big 
white van. For years, she'd put off this moment: signing up herself 
and her husband for the city's needle exchange program.

The couple -- their street names are Pebbles and Bam-Bam, a nod to 
the Flintstones television characters -- have been injecting heroin 
since they were 17, she said. They've been sharing used syringes with 
others and attempting to clean them with water and bleach between 
uses, rather than coming to the exchange for new ones, even though 
they were aware of the serious health risks in sharing.

"I always think, 'I'm going to get clean, so I don't need to [join 
the exchange],' but then we don't get clean, and we don't accept the 
fact that we're using," said the 21-year-old woman, who is from 
southwestern Baltimore County. "So just today, I said, 'We're going.' 
I've been thinking about getting clean, but if I'm going to keep 
living this lifestyle, then I ought to at least do this."

At a time when heroin remains Baltimore's leading drug scourge, city 
officials wish more addicts like the couple would make use of the 
exchange program -- a key tool in efforts to curb the spread of HIV. 
But despite growing up in the shadow of AIDS, or acquired immune 
deficiency syndrome, most younger drug users are not participating, a 
problem especially acute among whites in their teens and 20s.

A recent study by researchers at the 
(http://www.baltimoresun.com/entertainment/visitor/college/bal-hl-hopkins,0,3324446.story)Johns 
Hopkins University Bloomberg School of Public Health found that only 
10 percent of people who started injecting drugs in the past five 
years rely on the exchange as their main source for syringes. An 
additional 18 percent of the 294 users surveyed, most of whom were 
interviewed in Southwest Baltimore, said they were mainly obtaining 
their syringes from pharmacies, where a 10-pack costs about $2.50.

But most users said they bought needles on the street -- a risky 
practice because they can't be sure the needles are new -- or shared them.

While the study found that addicts were more likely to visit the 
exchange as they grew older, Susan G. Sherman, the lead author, said 
"it's really important" to attract users soon after they first start on drugs.

"Habits get established very early," she said.

There are no reliable statistics for what proportion of drug 
injectors of all ages rely on the needle exchange, which the city 
instituted 11 years ago after overcoming opposition from some state 
lawmakers and other critics who argued it would encourage drug use. 
The exchange has registered more than 15,000 people since it began 
and has about 325 visitors a week, many of whom are believed to 
distribute or sell the needles they obtain to other users.

Overall, the program, which costs just under $500,000 a year, has 
been deemed a public health success: Every week, the exchange's two 
vans distribute about 6,500 syringes and other injecting equipment 
(swabs, cookers, bottles of water and bleach) in exchange for dirty 
needles at a dozen sites around the city. The vans also offer HIV 
tests and drug treatment information. Since the program's inception, 
the rate of new HIV cases attributed to intravenous drug use has 
dropped by a fifth, to about 40 percent of cases.

But Monique Glover Rucker, the city Health Department's senior 
adviser on HIV/AIDS and harm reduction programs, acknowledged the 
problem identified by the Hopkins study. Only 6 percent of those the 
program has enrolled since it began were younger than 25, she said, 
and the number of younger addicts registering with the exchange has 
remained flat even as the program has expanded its number of sites.

To address that, the city is applying for a $25,000 grant from the 
Tide Foundation to improve the exchange's reach among younger users, 
Rucker said. The grant money would be used to pay younger addicts who 
use the exchange to do outreach work among other younger injectors 
and to pay for a new weekly exchange time that would be dedicated to 
users younger than 30.

The hope is that such measures could increase the comfort level that 
younger addicts, particularly younger white addicts, feel toward the 
exchange, Rucker said. Previous studies have shown that heroin 
addicts in their teens and early 20s in Baltimore tend to be white, 
whereas blacks tend to start using hard drugs later, in their late 
20s and 30s. The exchange's staff is all black, which Rucker 
speculated could deter some white addicts from using it.

"Ideally, the [exchange's clientele] would be completely 
representative of [the addict population], but it's not. The users 
are changing, and we need to make sure we're reaching all of the 
population," Rucker said

Increasing the program's reach among younger users won't be easy, 
however. Interviews with about 20 addicts who recently visited the 
city's exchange site at Monroe and Ramsay revealed a variety of 
reasons that others stay away.

Some clients said younger addicts were in denial about their 
addiction or were hiding their drug use from their families. The same 
feelings of shame, they say, keep many younger addicts from buying 
syringes from pharmacies, which several years ago were allowed to 
sell syringes over the counter. (The law gave pharmacists discretion 
on sales, but addicts say it's not difficult finding stores that sell needles.)

Clients at the van suggested a dedicated exchange site for young 
people be located in a building or another more secluded location, 
not at a well-trafficked street like Monroe.

"They're scared that somebody walking by will see them and will tell 
their family, 'I seen so and so by the van,'" said Chris Morcek, a 
36-year-old construction worker in a black T-shirt from Arbutus who 
recently visited the van.

Devon, a tall, blond 26-year-old prostitute raised in Essex and 
Middle River, said an outreach effort by younger addicts who use the 
exchange would also be a good idea because many young addicts, some 
of whom hail from outside the city like herself, didn't necessarily 
know about the exchange sites. Just that day, she said, she had 
persuaded a friend to come with her to the exchange for the first 
time because the friend had tested positive for hepatitis C.

"I'm not letting her use my tools," said Devon, who, like some others 
interviewed, would not give her full name because she didn't want to 
expose her addiction.

Several younger addicts who use the exchange program said it took 
them a while to start coming simply because they were too busy 
"running the streets" looking for drugs and money to pay for them and 
not thinking clearly enough to get themselves to the site on time.

A 23-year-old addict, a West Virginia native who gave only her first 
name, Amy, came rushing up to the van with her black purse full of 
syringes to exchange, just moments after it had closed for the 
afternoon -- the second time that had happened to her, she said.

"I didn't realize what time it was," said the rail-thin brunette, as 
a middle-aged man waited for her in a car across the street. She said 
he supported her $75-a-day heroin habit. It took her about a year of 
injecting before she even started coming to the van at all, she said. 
"It's being lazy about it. I had the time, but I didn't want to take the time."

To some older addicts who have been coming to the van for years, the 
reluctance of younger users is just another sign of the foolhardiness of youth.

"They think, 'It can't happen to me.' That's the way they are," said 
Mark Bartlett, a native of Southwest Baltimore who has used heroin 
since his teens and looks much older than his 32 years. "To them, 
[the exchange] is a waste, a joke. Anything dealing with their health 
is a waste of time. It's, 'I'm young; I'm going to live forever.'"

A related recent Hopkins study of a similar population of addicts 
found that more than 90 percent of younger addicts interviewed knew 
about the risks of contracting HIV or hepatitis C from shared 
needles. (In both studies, about 5 percent of addicts interviewed 
tested positive for HIV, while the rate of hepatitis C infection 
ranged from a third in one study to more than half in the other.)

But Sherman, the author of both studies, said addicts' awareness 
about disease risk doesn't always translate into prudence when users 
are craving heroin.

"By 11 o'clock in the morning you're very sick, and you're not 
thinking about what's going to happen [from sharing]. Your boyfriend 
shoots up and there's only one syringe, and so what are you going to 
do? They're not thinking," she said.

Pebbles, for her part, said she and her husband weren't so reckless, 
even before they decided to come to the exchange. They tried, she 
said, to clean shared syringes by dipping them repeatedly in water 
and bleach, which, if done right, can greatly reduce the risks of 
disease transmission.

But it got to the point where she deemed even the risk left after 
cleaning to be too big.

"Who knows? It might be too late," she said. "I might have already 
caught something."
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MAP posted-by: Elizabeth Wehrman