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Syringes returned now exceed syringes distributed

March 10, 2019 GMT

HUNTINGTON — The syringe exchange at the Cabell-Huntington Health Department, which provides intravenous drug users sterile syringes and disposes of their used ones, is taking in more syringes than it is giving out, according to department statistics for 2017 and 2018.

The surplus of used syringes returned over clean syringes dispensed stretches back eight consecutive months to June 2018, and has since plateaued to “a new normal,” as described by Dr. Michael Kilkenny, physician director at the Cabell-Huntington Health Department.

By December 2018, the number of both syringes returned (around 19,000 that month) and syringes dispensed (around 18,000) had hit their lowest monthly totals since the syringe exchange, part of the department’s Harm Reduction Program, began in September 2015.

The change is driven jointly by policy changes tightening access to the syringe exchange and how many syringes are given out, but also by the innate moral decency of many intravenous drug users themselves, who regularly find and turn in more needles than they are given, officials state.

“We do have some very responsible people who are in the throes of addiction that don’t want (syringes) out in the public,” added Michelle Perdue, director of the health department’s Harm Reduction Program. “They’ll say they don’t want it in the parks or lying on the ground, so that person will pick them up so they’re not out there.”

The goal of the syringe exchange is to prevent the outbreak of bloodborne diseases spread through the use and sharing of unclean needles — ideally providing one clean syringe for every injection and disposing of that syringe once it’s used.

The source of the surplus needles is speculative. It is possible these could be syringes dispensed months or years earlier, when the outflow exceeded the intake, that are just nowfinding their way back

to the health department. They could also be from other private sources, including diabetic needles, that the health department trashes if turned in. Clients, often living with others who also inject drugs, also appear to be turning in used syringes discarded by others close to them.

But where they get the needles isn’t a major concern, Perdue said.

The syringe exchange now only gives out a maximum 40 syringes per visit, meaning clients have no additional incentive to turn in more than 40 syringes. Still, returns regularly exceed 40 syringes, Perdue said, and sometimes more than 100 — though they’ll receive no more in return.

Addiction doesn’t override a sense of common decency, Kilkenny added. If a client were asked if they throw needles on the ground, the vast majority would respond with disgust at the thought of leaving it there for someone else to find.

It’s comparable to the percentage of the general public who throws out everyday litter, he continued, that likewise the majority of intravenous drug users feel a responsibility to properly dispose of their syringes.

“You have a conversation with someone who’s in active addiction, and if you ask a moral question, they’ll give their moral compass back,” Kilkenny said. “They’ll understand that they’re (using drugs), but they also understand that it’s hurting them, and they’ll feel very guilt-ridden and ashamed of what they’re doing.”

Kilkenny has continually noted that the issue of syringe litter and that of intravenous drug use are two concurrent but separate issues, adding the amount of syringe litter is a function of the total number of intravenous drug users. In Cabell County, there are currently more than 1,800 active IV drug users, according to a study published in February by Johns Hopkins University.

But syringes were found in public areas prior to the Harm Reduction Program’s beginning in 2015, and the perceived litter likewise increased with the number of overdoses experienced through 2017. Syringes are also found in neighboring Lawrence County, Ohio, Kilkenny added, which does not have a harm reduction program, nor does the Cabell-Huntington Health Department serve Ohio residents.

“We’re not the source of their syringe litter problem,” Kilkenny said. “Injection drug use is the source of the litter problem.”

Policy changes and the measurable impact

Starting in April 2018, the health department instituted a handful of major changes to the Harm Reduction Program, leaning on input from the Huntington Police Department and Cabell County first responders.

The changes came against the backdrop of the controversy and eventual demise of the Kanawha-Charleston Health Department’s Harm Reduction Program, though they were not made in direct response to it.

First-time participants are now given 40 syringes and expected to return the same amount or more to receive a new 40 syringes. Clients only receive as many syringes as they return, and are given none at all if they return empty-handed.

The program is limited strictly to Cabell County residents who can provide adequate identification, instead of serving anyone regardless of their home county. Homeless clients can still be served if they can be verified by one of the county’s homeless coalition partners.

While it was initially speculated whether former Kanawha-Charleston clients would travel to Huntington with the program’s end, Cabell County no longer accepts clients from other counties or states anyway. Likewise, it’s not believed the remaining Kanawha-Charleston syringes significantly inflated Cabell-Huntington’s syringe return totals, Kilkenny said.

Clients may now only pick up and exchange syringes for themselves, ending “secondary distribution” where a family member could take needles on behalf of another.

The time of those changes correlates with not only syringes returned exceeding syringes distributed, but a marked decrease in both.

In March 2018, syringes returned (around 61,000 that month) surpassed syringes distributed (around 58,000) for the first time since the program’s creation in 2015. By May, syringes returned (around 25,000) still slightly surpassed syringes distributed (around 24,000), though both had fallen by more than half.

From June through the end of 2018, each of those six months saw less than 20,000 syringes distributed, though syringe returns peaked and plateaued wildly — as much as around 45,000 returned in August compared to 19,000 distributed.

By December 2018, both had hit their lowest totals in at least two years, with around 19,000 syringes returned and around 18,000 dispensed.

Because of the sheer volume and hazardous nature, the totals of syringes are determined based on the weight rather than counting exact numbers. The totals also count returns made to the drop-off kiosk outside the health department, which can be made anonymously at any time, but does not count toward receiving clean syringes.

Syringes collected by the Huntington Police Department are also factored in.