In the midst of opioid epidemic, Weld County Health Department looks into syringe access programs | MyWindsorNow.com

In the midst of opioid epidemic, Weld County Health Department looks into syringe access programs

Kelly Ragan
kragan@greeleytribune.com

Just a couple blocks from the bustling streets of Old Town Fort Collins, lined with cafés, boutiques and dotted with blooming summer flowers sits a well-kept office building with large, open windows.

A quiet office building, it also is a place for people who use intravenous drugs.

Here, they can walk discreetly down a set of stairs attached to the building and enter the basement office below. At The Northern Colorado AIDS Project, 400 Remington St., they are greeted with a smile at the front desk. They can ask for clean syringes and drop off used ones. They can also stock up on other supplies necessary for their drug habit, such as fresh cotton balls and aluminum cookers.

The Northern Colorado AIDS Project — which has been in Fort Collins since 1984 — will give them those supplies anonymously and free of charge as part of the only syringe access program in the region. The program, which was established in 2012, aims to reduce the spread of HIV/AIDS and hepatitis, diseases often associated with shared needles.

A similar program may be pitched in Greeley as officials prepare for a possible surge in heroin use in the wake of health officials scaling back on prescription opioids.

Mark Wallace, the executive director of the Weld County's Health Department, said he's had conversations with the Northern Colorado AIDS Project about what it would take to establish a similar program.

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Wallace said the community has to be forward-thinking as hospitals and law enforcement crack down on the redistribution of opioids.

According to the Center for Disease Control, the opioid epidemic claimed 10,500 lives in 2014.

Wallace anticipates more people turning to heroin as prescribed opioids become more difficult to get. That could lead people to using needles.

And according to local police, the drug is readily available on the streets of Greeley.

"It always starts out with knowing somebody," said Lt. Steve Black of the Weld County Drug Task Force in a previous interview. "But all you really need to do is hang out in a bar long enough, and you'll meet someone."

According to the Colorado Health Institute, 73 people died due to opioid overdose and 42 people died due to heroin overdose in Colorado in 1999. In 2014, 338 people died due to opioid overdose and 151 people died due to heroin overdose.

The number of deaths due to overdose in Weld County has been climbing for years, according to the Colorado Health Institute. Between 2002-06, Weld saw four deaths per year. Between 2007-11, that bumped up to five deaths per year. Between 2012-14, Weld saw six deaths per year, the last year the health institute had an accurate count.

Local police, however, said between January 2014-October 2016, Weld saw a total of 18 heroin related deaths. Numbers were not yet available for 2017.

Wallace is looking into what kind of impact syringe access programs can have in a community such as Fort Collins, which as also seen more heroin overdoses. Between 2002-04, Larimer County saw five deaths per year, 2005-08, Larimer saw six deaths per year, 2009-11 six deaths per year and 2012-14 saw eight deaths per year.

If and when people decide they want to get treatment, Northern Colorado AIDS Project has behavioral health specialists on site who can offer counseling.

Rebecca Cranston, director of regional programs for the Northern Colorado AIDS Project, said if people do want to seek treatment, they can start with counselors they already know and trust.

"People don't start injecting drugs because they're in a great place in their lives," Cranston said. "They often times feel really isolated and alone. We're able to give them the tools they need and connect them with resources."

Cranston said the goal is two-fold. They can help clients living with HIV live long, healthy lives and reduce transmission rates by working with an at-risk population.

"From a public health perspective, it's a slam dunk," Cranston said.

The Northern Colorado AIDS Project is interested in folks who use intravenous drugs. People who use and are not involved in syringe access programs are about 3.5 times more likely to become HIV positive than those who do not participate, Cranston said.

When folks have access to exchange programs, it also limits the spread of hepatitis C and hepatitis A, Cranston said.

While sexual transmission is still the leading cause of HIV, the proportions are changing nationwide, Cranston said. More people are contracting HIV via drug use.

That could happen in Weld County too, Cranston said.

"There's no doubt there's a growing problem with opioids and injections in Weld County and in Greeley," Cranston said.

Why doesn't Weld have the program?

Syringe access programs are not, at this point, legal in Weld County.

In 2010, the Colorado legislature passed a law allowing syringe access programs if individual county health boards approved them. Weld hasn't approved the program, but that could change.

Wallace said the health department will have to lay a lot of groundwork to launch an access program, as it would require coordination between the health department, county commissioners and law enforcement.

Wallace plans to speak to commissioners at a work session in late August or early September, he said.

Northern Colorado AIDS Project does have an office in Greeley, 2017 9th St.

It's open 11 a.m. to 6 p.m. on Mondays and 10 a.m. to 3 p.m. on Thursdays. The Weld County office offers Hepatitis C testing and HIV blood testing.

The controversy

Wallace said the implementation of a syringe program would hinge on law enforcement, and that's where he anticipates the most resistance. Fort Collins succeeded in launching a program because prominent law enforcement officials didn't publicly oppose the program, Wallace said.

"Without law enforcement being on board, it's not going to work," Wallace said.

But it's a tough problem to tackle. At the end of the day, people using syringe access programs are still using illegal drugs. That concerns law enforcement officials such as Greeley Police Chief Jerry Garner.

"I'm very much aware of the trend to move drug addiction away from the criminal side into treatment of a disease," Garner said. "But to be a drug addict, you have to be in possession of drugs. We're troubled by seemingly facilitating felonies."

Beyond the legality, he worries that people might take clean needles and never properly dispose of the used ones. Accidental needle sticks are a daily concern for officers. He doesn't want to add more used needles to public places such as parks, which is already a problem in Greeley.

Garner said he hasn't yet seen solid research that shows people commit fewer drug-related crimes when syringe access programs are available.

"We're waiting to see proof it reduces drug-related crime," Garner said. "I'm willing to rethink anything based on the evidence I see."

Understanding addiction

A combination of factors has stopped syringe access programs from catching on in Weld, said Kendell Alexander, the director of integrated care and prevention programs at North Range Behavioral Health.

Weld has historically been a conservative community, he said. For years, programs have been strictly abstinence based. On top of that, he said, until the opioid epidemic, Weld didn't historically see high numbers of intravenous drug users.

Some of that mentality is shifting.

Providers aren't shying away from the term "harm reduction" like they used to, Alexander said.

Harm reduction refers to the policies, programs and practices that aim to reduce the harms associated with the use of drugs in people who are unable or unwilling to stop using. The focus is more on the prevention of further harm than the prevention of the drug itself.

"We need to set up opportunities for people to come forward and acknowledge they have a problem and not be afraid to get in legal trouble," Alexander said. "Places for people to access assistance, touch points and places people know they can reach out and not be afraid."

Furthermore, several federal studies by agencies such as the National Commission on AIDS, the National Academy of Science and more show syringe access programs do not promote or result in increased drug use.

Alexander's father died 12 years ago of cirrhosis, chronic liver damage caused by alcohol abuse.

His wife didn't know he was drinking. His doctors didn't know he was drinking because they didn't ask. If they had asked, Alexander said, they would have had to do something about the problem and they didn't know what do to about it.

That's why it's important to think of addiction as a disease, Alexander said.

"It's not a matter of pulling yourself up by your bootstraps," Alexander said. "We need to recognize people need assistance and it's not an issue of willpower."

Community health

Jasjot Johar, medical director of the emergency department at McKee Medical Center, thinks syringe access programs benefit overall community health. They cut down on accidental needle sticks and create opportunities to build relationships with people addicted to drugs who want to quit.

Studies have shown HIV can survive in a syringe for up to six weeks and disposing of used needles is difficult, Johar said. No one wants to find needles at a playground or by the pool. People who pick up trash and work in landfills face the risk of an accidental needle stick. Law enforcement officers and emergency medical services personnel also are at risk for accidental needle sticks.

Syringe access programs can provide safe places for people to dispose of those needles and reduce the risk to others in the community.

Johar said the idea that folks will be less likely to use drugs if getting needles is more difficult is a fallacy.

"They aren't likely to change their behavior without intervention," Johar said.

Syringe access programs provide an opportunity to interact with people addicted to drugs on a regular basis, Johar said. That gives providers a chance to check in with them, ask how they're doing, connect them to counselors, provide information about detox and more. Those deeper interactions can help people get clean, he said.

Community health experts tend to agree nationwide.

According to the Centers for Disease Control and Prevention, syringe access programs are an effective component of a comprehensive, integrated approach to HIV prevention among people who inject drugs.

A study published in Public Health Records in 1998 by Robert Heimer, a professor of epidemiology and pharmacology at Yale, states syringe access programs can help in two significant ways: Programs can provide information on prevention measures, and connect people with substance abuse treatment and medical care; and they also can help folks who are alienated from the health care system by income level, criminal status and housing status connect with services that provide a physical and psychological care that can reduce the risk associated with injecting illegal drugs.

According to a study titled "Syringe Access for the Prevention of Blood-Borne Infections Among Injection Drug Users," published in BioMed Central Public Health, free access to syringes via access programs have been found to be effective in preventing disease without promoting drug use.

Risk of outbreak

In 2015, Scott County, Ind., experienced an HIV outbreak that captured national attention.

Before the outbreak, only five people were diagnosed HIV positive from 2004-13. In 2015, that number jumped to 181.

The Courier Journal reported that a close network of people living in Scott County injected Opana, an opioid, and they shared needles. Dr. William Cooke, a physician in Indiana, told the Courier Journal the county had every indication the spread of HIV was possible, including poverty, high unemployment, adverse childhood experiences and a steady flow of opioids in the community.

Cranston of the Northern Colorado AIDS Project, said rural communities in Weld have many of the same risk factors.

According to the Center for Disease Control, in 2015, 6 percent of the 39,513 diagnoses of HIV in the United States were attributed to intravenous drug use. If current rates continue, 1 in 23 women who inject drugs and 1 in 36 men who inject drugs will be diagnosed with HIV in their lifetime, according to the CDC.

What's to come

Wallace plans to meet with Weld County commissioners in late August or early September for a work session. He plans to lay out the numbers and provide the health background to commissioners. Ultimately, they will be the ones who decide whether to approve a syringe access program.

If the program got approved, it would likely be run by a nonprofit such as Northern Colorado AIDS Project, which relies mostly on state grants and fundraising.

Cranston hopes that's the case.

"If the stigma and shaming worked, we'd see something very different," Cranston said. "The all-or-nothing approach doesn't work with drug use."

Wallace said he knows the opioid epidemic isn't going away any time soon. He thinks heroin will become even more common in Weld.

"We know that because we've seen it," Wallace said.

— Kelly Ragan writes features and covers health for The Greeley Tribune. Have a tip? Want to share your story? Call (970) 392-4424, email kragan@greeleytribune.com or connect on Twitter @kelly_raygun.

By the numbers

» Lifetime treatment for HIV is estimated to cost between $385,200-$618,900.

» Medication to cure hepatitis C costs about $70,000.

» Cost of a liver transplant is about $577,100.

» Average syringe at Northern Colorado AIDS Project costs 8 cents.

» According to a 2014 study, Weld County is outpacing Larimer County in hepatitis C infections. In 2014, Weld had 44.5 hepatitis C cases per 100,00 people.

Source: Northern Colorado AIDS Project

For more

For more information about the Northern Colorado AIDS Project, click here.