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season 2 Episode 8: Needle Exchanges

This is the last episode of Season 2. For people addicted to heroin and other drugs, how do we keep them safe and prevent them from overdosing?

We look at the idea of harm reduction and focus specifically on needle exchanges. Those are hundreds of places across the US that hand out clean equipment, the overdose reversal medicine Narcan and other help to people addicted to heroin and other drugs.

But needle exchanges are still controversial in many parts of the country, including Tacoma, Washington, where Finding Fixes contributor, Amber Cortes, brings us the story of the oldest needle exchange in the United States.

That exchange started during the AIDS epidemic. Now, it and needle exchanges like it are finding they have what it takes to respond to the current opioid epidemic.

LINKS TO MORE INFORMATION AND RESOURCES:

If you want help finding local drug treatment, support groups, or organizations in your community for yourself or someone else, you can call 1-800-662-HELP (4357) and speak with someone at the national helpline run by SAMHSA, the Substance Abuse and Mental Health Services Administration. It’s free, confidential, and open 24 hours a day/365 days a year, available in English and Spanish. More information here.

Learn more about Swedish Pain Services’ “mini boot camp” for chronic pain patients (called the Structured Functional Restoration Program) here.

TRANSCRIPT

Anna Boiko-Weyrauch: We’re at the last episode of Season Two of Finding Fixes. I’m Anna Boiko-Weyrauch. All this season we’ve been looking at the opioid epidemic like it’s a giant swimming pool. You get into the pool the first time you use opioids, the more and longer you use, the further you go towards the deep end and the bigger your risk of addiction and drowning. 

On this episode—we look at the deep end. How do we keep people in the deep end safe? How do we stop them from dying if they’re already addicted to heroin?

We’re going to look at the idea of harm reduction, and we’re focusing specifically on needle exchanges. Those are hundreds of places across the US that hand out clean equipment, the overdose reversal medication Narcan, and other help to people addicted to heroin and other drugs. 

But needle exchanges are still controversial in many parts of the country, including Tacoma, Washington, where Finding Fixes contributor Amber Cortes brings us the story of the oldest needle exchange in the United States.

That exchange started during the AIDS epidemic and it had a very simple idea—to help people exchange their used needles for clean, sterile ones. Now, it and needle exchanges like it are finding they have what it takes to respond to the current opioid epidemic.

Here’s Amber with the story.

Amber Cortes: You could almost walk by it without even noticing,—a white van in a parking lot, mid-afternoon on a Wednesday. 

(People near van chatting)

Cortes: Some folding chairs in front, and few people chatting and drinking cups of coffee. It looks like a low-key tailgate party except for the small cardboard sign that says, “Tacoma Needle Exchange.”

Stephanie Prohaska: Well, we have 27, 28, 29, 30s. 

Cortes: That’s Stephanie Prohaska, a community health worker with the exchange, and she’s really busy right now. Clients are lining up outside the van.

(needles being dropped into bio bins)

Cortes: Clients step up to the door and drop off their used needles. Stephanie gives them sterile ones in plastic bags. 

Prohaska: What gauge would you like? 

Man: I’ll take twenty—

Prohaska: Twenty nine? 

Man: Yeah.

Prohaska: Ok.

Cortes: Then she asks them if they need any alcohol prep pads, cottons, cookers, ties, fentanyl test strip kits, or safe sex items. 

Man: Sure. We'll take it all. 

Prohaska: Alright.

Cortes: People who inject drugs, such as methamphetamine and heroin, are at risk for dangerous health problems. That’s because sometimes people share their needles, for a number of reasons: easy access, cost and availability, and lack of information about the risks. But dirty needles can spread diseases like AIDS and Hepatitis B, and spread bacteria that can infect the skin, muscles and tendons. 

As more people use opioids, diseases like HIV are becoming more common in some communities. 

At this needle exchange, Stephanie isn’t here to judge people or tell them to get off drugs—she’s here to support them. 

Prohaska: That's somebody’s brother, husband, nephew, cousin. And everybody's human. Everybody needs something, whether it's a wave, a smile a—anything.  

Cortes: Or maybe even the wag of a tail?

(Dog sniffing around) 

David Venes: Ethel! Come on, let’s go.

Cortes: Ethel is another feature of this place. A sweet dog that belongs to David Venes. 

Venes: Ethel, my baby, she is a golden doodle that grew up at the needle exchange. When I first brought her, she would sit next to the seven-gallon buckets that we use at the exchange. And she wasn't even half as tall.

Cortes: David works at the needle exchange as care coordinator. His shift ended about an hour ago, but he’s back at the van to check up on a couple clients.

Venes: It's hard to describe my job, especially now, but it is just being a human. And being able to look over any kind of issues with a person so that you are nonjudgmental, caring, empathetic, and compassionate towards the people.

Cortes: As a care coordinator David helps people, especially the most marginalized—like those who are homeless or veterans—get into drug treatment if they want it and find housing or medical care. His job ranges from driving someone to get groceries, to saving someone’s life with Narcan. And he’s been doing it for almost 20 years.

Venes: You doing ok? 

Woman: Yeah. 

Venes: Good. Good to hear.

Cortes: We talk by the big white van as he waves to clients who come and go. One big change he’s seen is the rise of fentanyl—an opioid that’s 30-50 times stronger than pure heroin. Even a dose the size of a few grains of salt can be fatal. 

Venes: Now we're not having as much trouble with skin infections and abscesses as much, but we have way more deaths. Because people can't judge their hit. It's just impossible. See you later! Keep smiling please! Okay.

Cortes: Now, to respond to the risk of fentanyl overdoses, the Tacoma Needle Exchange hands out Narcan, the overdose reversal drug, along with clean needles. 

They also hand out fentanyl test kits. They’re thin strips of paper that users can insert into a mixture of water and a few drops of heroin or meth from a needle to test for fentanyl. One red line means it’s positive, two lines mean negative.

Despite their best attempts to keep the crisis at bay, fentanyl is killing more and more people across the nation, here in Washington state, and in this community. And David and other care workers are on the front lines. 

Venes: Right now, my clients are either doing really well, or they're dead. And that sucks. So it’s mixed with a really high high of helping someone as best you could, and then a total failure of not being able to reach somebody that—you're working with. It sucks. It sucks. Sorry, get a little emotional. It's just, it's just what my job is. Thank God for dirt bikes. Let me race between some trees, please! Clear this shit out of my head! 

Cortes: Does that help? 

Venes: That's the only thing that helps for me. The only thing.

Cortes: As more and more people become addicted to and die from opioids, needle exchanges, and the services they provide, have gotten even more important.

Paul LaKosky: I’ll show you the office. 

Cortes: Sure.

Cortes: You can see that demand in a cramped office in the dockyard just outside Tacoma. Medical supplies and boxes of syringes are stacked to the ceiling.

LaKosky: It looks very different than it did last week.

Cortes: You’re shifting around.

LaKosky: Yes, we're shifting around because we have so many supplies to store. I mean, what we really need is office space and supply space. But we’ve been having to combine office with supply space.

Cortes: Paul LaKosky is the Executive Director of the Tacoma Needle Exchange and of NASEN, The North American Syringe Exchange Network. The organization provides supplies to needle exchanges across the country. 

One of the reasons the place is so packed with supplies Paul says, is that there’s been a 20 percent increase in demand for their services every year for the last several years.

LaKosky: And we thought maybe that was just local. But as we talked to other folks through the state, as well as nationally, there's been a huge increase in demand for syringes.

Cortes: For example, in 2012, NASEN distributed about 20 million syringes to their national network. In 2018, it was close to 115 million syringes.

LaKosky: And we're still not meeting demand.

Cortes: The Tacoma Needle Exchange, and the almost 400 other exchanges in the network, Paul says, are in a great position to fight the opioid crisis because they do more than just hand out needles. They’re a doorway to health services and help that anyone can pass through. You don’t have to stop using drugs first.

LaKosky: We really provide access to services that a lot of these folks can't get anywhere else, one because they're stigmatized, and they won't go other places, they've been treated badly. We provide judgment-free help for people who want to improve the quality of their lives.

Cortes: That judgment-free help is very, very intentional. The philosophical bed-rock of this approach is called harm reduction.

LaKosky: So for whatever reason they are using drugs, the harm reduction philosophy is we give them the tools and resources so that they can reduce the amount of harm they do to themselves, they do to their families, they due to the greater society, by making sure that they have sterile clean injection equipment, that they don't infect themselves, they don’t share those things. So harm reduction really comes from a place of acceptance of people’s behaviors. And it is really about non-judgmental acceptance of an individual's chosen behavior. 

Cortes: This idea is actually pretty old. The same approach is being used to fight fentanyl and supply Narcan now, but harm reduction came on the scene decades ago. The needle exchange van and this national network of places like it—they’re the legacy of one man, who started the Tacoma Needle Exchange—the first legal syringe exchange in the United States.

Podcast host: When you go to the dictionary, and you look up the words needle exchange, the name you find in between needle and exchange is Dave Purchase! 

Cortes: Dave Purchase died in 2013, but we can still hear from him in this 2010 interview with an Australian podcast about the history of harm reduction.

Podcast host: Hi, Dave!

Dave Purchase: Hey, cowboy.

Cortes: Dave Purchase was a drug counselor who directed a methadone clinic in Tacoma, and thirty years ago he was working to fight another serious epidemic—AIDS. By the late eighties the AIDS crisis gripped the United States, killing over 200,000 people a year. Sharing dirty needles was the second leading cause of the disease, after unsafe sex. 

(Protestors demonstrating) 

Protestors: Silence equals death! Silence equals death!

Cortes: You’re hearing audio from The Second National March on Washington for Lesbian and Gay Rights, recorded for an NBC news broadcast in 1987. 

News Broadcaster: More than 600 demonstrators crossed police lines to protest, and to be arrested on the steps of the Supreme Court. 

Cortes: AIDS activists were demanding more medical research, government support, and an end to the anti-gay discrimination that often came with an AIDS diagnosis. 

People were dying fast, and it seemed like nothing was getting done. 

Enter Dave Purchase.

Venes: Dave Purchase was a giant of a man. 

Cortes: That’s the care coordinator at the Tacoma needle exchange, David Venes, you met him earlier. 

Venes: Probably, you know, about my size, six foot-ish, someplace in there. And over 200 pounds. A large man and a person who liked to talk a lot.

Cortes: Dave Purchase used to ride around town on a motorcycle, sometimes wearing big, floppy straw hats. He was described in a local paper as a “bearded, burly Mother Theresa.” He let people addicted to drugs crash on his couch while they tried to get clean.

Dave Purchase knew it was important for IV drug users to have access to clean materials. He heard about a needle exchange project in Amsterdam. Then, after a motorcycle accident took him off his feet, Dave had some free time to think about what he could do in Tacoma.

Purchase: And it occurred to me I could start a needle exchange! And we started in August of ‘88. 8/9/88.

Cortes: You could say Dave Purchase had a morbid sense of humor. Here he is standing in a graveyard for a video encouraging drug users to use condoms and clean needles.  

Purchase: I want you to be alive a year from now, five years from now, 10 years from now. So, do it. Tell your friends, make it popular. If you don't, I'll find you, because I know where you are. And I'll break both your legs! Be kind. Take care of yourselves.

Cortes: Don De Jarlais is a public health professor at NYU. He remembers when Dave Purchase first started the exchange. 

Don De Jarlais: The original Tacoma syringe exchange was a card table on a street near a high drug use area in Tacoma. And he had a bucket where people could put used syringes in, and he had clean syringes out on the table. And so he would ask people to bring their used syringes, put them in the sharps container, and then he'd give sterile needles and syringes to people. And they would stop and they would talk, and he was developing relationships with them as part of the exchange.

 Cortes: And Dave Purchase was developing other strategic relationships, too. He asked De Jarlais and other researchers to study the needle exchange. They produced the first scientific study in the US to show that syringe exchange programs reduced diseases like Hepatitis B and AIDS by 60%, and decreased risky behaviors like needle sharing. 

The program was working—in the first five months Dave Purchase took 13-thousand dirty needles from drug users and gave them clean ones.

There was just one little problem. Technically what he was doing was illegal. Here’s Paul LaKosky again—the head of the national needle exchange network.

LaKosky: I don't know if he was breaking the law, or if he was just defying the law, bending the law. But you know, syringe exchange had never really occurred before in the United States. 

Cortes: Dave Purchase wanted to operate above board. So, he started making calls to some friends. Like the mayor and the chief of police.

Venes: Another friend was the state senator, another one was the head person at the Tacoma Pierce County Health Department, you know, he had the connections, to put these steps in place, and Dave was also the person who knew that connections and deals are all made in hallways and bars and otherwise.

 Cortes: Dave Purchase used data from the researchers, and the support from his political connections, to start paving the way for a legal precedent for his needle exchange. In 1989, when the Washington State Attorney General said it was illegal to distribute needles under the Controlled Substances Act, Dave and his team were ready. They challenged the ruling in county court and won. Eventually, state law allowed for syringe exchange under supervision of a public health department and as part of an HIV prevention program.

Since then, scientists and researchers have proven that syringe exchange works. Research studies in the US, Canada, and Australia have all shown that needle exchanges reduce the spread of infectious diseases like HIV and Hepatitis B. Needle exchange as a harm reduction method has been reviewed and endorsed by the American Medical Association, the World Health Organization, the UN, and multiple government agencies. 

But it was only very recently—in 2016—that the US government lifted their ban on federal funding for needle exchanges. And even then, federal dollars can’t go towards buying the actual needles themselves.

That’s in part because from the beginning, needle exchanges have been unpopular with politicians and neighbors. Here’s a KOIN news report from last September about a local needle exchange in a Southeast Portland neighborhood:

News Broadcaster 1: Neighbors concerned for their safety—they’re taking matters into their own hands and patrolling the area they say is now being overrun by drug addicts. 

News Broadcaster 2: They’re saying a local needle exchange site in southeast Portland is not doing enough to keep the area safe from clients.

Cortes: This stigma attached to drug use means some exchanges in the NASEN network have to operate under the radar—with precarious funding, all-volunteer, and even from undisclosed locations, Paul Lakosky says. 

LaKosky: So, in some places it still feels to a large degree like civil disobedience. But with a lot of science behind it.

Cortes: Needle exchanges frequently get their funding pulled because of concerns that they are encouraging litter and crime. Here’s another local news report, this one from KIRO:

News Broadcaster 1: And a North Sound City says it will not use taxpayer dollars to support Snohomish County’s needle exchange in Everett.

News Broadcaster 2: The county is considering taking over the needle exchange which is now run by a non-profit. Good evening again. I’m Siemny Kim.

News Broadcaster 1: And I’m Dave Wagner. But if they do, city leaders in Marysville say they will pull the money they contributed to the health district.

Cortes: Paul says these are misconceptions. Multiple long-term studies of needle exchanges found that there are no increases in injection drug use or needle-sharing behavior near their sites.

And other studies have shown what we noted earlier—that needle exchanges, with their harm reduction approaches, can be an important bridge to treatment programs.

Paul says the open-door, come-as-you-are attitude helps people using drugs get the support people need—and even move away from drugs, if they want to stop using. 

LaKosky: They don't always just come for syringes. Sometimes they just come to talk. Sometimes they just need someone to listen to them. You know, if they're using seven times a day and they just want to get down to four times a day, if we can help them get there—that's, that is our role and that is the strength of the syringe exchange.We have folks that the community trusts.

(car driving by)

 Venes: Perfect. I'll put it in one o'clock on—

Cortes: David Venes is back at work.

Venes: Monday the 29th—

Cortes: His golden doodle, Ethel at his side. He’s taking me to meet some clients of his at Nativity House, a homeless shelter down the street from the needle exchange van. Clients, David says, but also friends. 

Venes: I think, working with marginalized clients the way we do at the exchange if you're really vested in helping, to a certain extent you are going to be looked at as a friend. You’re not just a person there collecting a paycheck.

Cortes: He’s got plenty of friends back at the van, but at Nativity House, where everyone calls him Dave, he’s got his very own fan club, starting with Suzanne Seyton, who works the front desk here. 

  (clapping)

Suzanne Seyton: Dave’s my hero. Let me tell you. He doesn't like to hear; he's gonna walk away but Dave, Dave is who we all strive to be, huh? It’s true.

Cortes: She says there’s three people in particular—Tutti, Rick and Jimmy—whom David’s known for years—he helped get them get off the street, find housing and mental services, and eventually quit drugs. 

Jerry Garcia: My name is Jerry Garcia. My friends call me Tutti. I was out on the streets of Tacoma for 15 years and homeless, just kind of camped anywhere we could have when we were out there, you know, under bridges under freeways. Crazy stuff.

Rick Giltner: My name is Rick Giltner, and I've been out here for too long. I'm now living in an apartment, been there for what, three and a half years.

James Hunter: Hi. I'm James Hunter. One of the Dave's people.

Cortes: Here’s Suzanne again. 

Seyton: Those three, they get up and go to methadone every morning. And they sit in the apartment together and they hang out and they have coffee. And truthfully, they would not be here today, specifically because of Dave.

Cortes: It starts with the small, everyday sort of things that David does.

Garcia: On the daily, he takes me to and from my appointments, he keeps track of my appointments. And he'll run me to the pharmacy. If I need to go to the grocery store, he'll help me out. 

Cortes: He also helps Jimmy take care of his wounds. He’s got cellulitis in his legs.

Hunter: They need to be wrapped, they swell up really bad. And he's been coming over every, every three days, or every other day, he comes over to my house and wraps my legs for me.

Seyton: So when our residents come in here, they have a lot of their dignity taken from them. And we always say like, we're the first point of contact for them, for a lot of people we're their emergency contact, and Dave is that person, Dave is their family. He's their friend. 

Garcia: We went through a lot of depression. For myself, you know, I went back to using, came back, bounced back, you know? And he doesn't scold me or anything, but I know that he knows. Then he says, “Isn't there something you want to talk about?” No. (laughs)

Seyton: And a lot of times, he's their conscience. And he'll say, like, “Is this really what you want to do?”

Hunter: I would have died if it wasn't for him.

Cortes: Needle exchanges are about more than just clean needles—it’s about the people who support others, even though they use drugs. People who save lives. 

People like the two Daves—Dave Purchase, who started the exchange to combat the AIDS epidemic, and David Venes, the care coordinator who, thirty years later, is working feverishly to fight another epidemic. And who helps people more than he even realizes.

For Finding Fixes, I’m Amber Cortes.

Boiko-Weyrauch: Finding Fixes is a project of Investigate West, a nonprofit journalism organization working in the public interest. 

Financial support comes from the Philadelphia Foundation, Moccasin Lake Foundation, and listeners like you. Please support this podcast by making a tax deductible donation at findingfixes.com. And please rate the podcast and leave us a review on iTunes. 

This episode was reported by Amber Cortes and edited by me, Anna Boiko-Weyrauch and Alisa Barba. Our producer is Nicolle Galteland. Music by Jake Weholt.

Thank you to everyone we talked to in this episode. And thank YOU so much for listening.