Needle Litter is the Problem; Needle Exchange is the Solution

There has been much discussion over the last several months concerning the wisdom of having a fully functional Needle Exchange Program in our community. Many have expressed doubts about the public health benefits of such a program but a clear-eyed and dispassionate analysis of those benefits has been subsumed by an overriding public safety concern. That concern is primarily based upon the belief that a proliferation of discarded contaminated syringes or “needle litter” constitutes a real and present threat to the public health and welfare of our community. I think we can all agree that we don’t want discarded needles turning up on our beaches or in our parks and playgrounds. And surely, no one can dispute that even one accidental needle stick is one too many. But in my opinion, a well run and efficient NE would not only serve the interest of public health, it would also effectively reduce the number of used syringes that are present in public spaces. And although it may seem counter intuitive at first blush, I submit that the best way to reduce needle litter is to prevent it at the source. Needle Exchange is not the cause of needle litter. It is the solution.

Syringe Exchange Programs, or as they are more commonly known, Syringe Services Programs (SSPs), operate with the primary goal of providing injection drug users (IDUs) with new, sterile injection equipment as a means of reducing the spread of blood-borne viruses and or injection-related infections. But perhaps just as importantly, SSPs have increasingly placed emphasis on simultaneously removing used injection equipment from circulation through a process of exchanging old syringes for new ones. In my view, both are valid and essential goals. I have long advocated for a Needle Litter Abatement Program which could track the distribution of clean syringes and incentivize the collection of used, contaminated needles. This is both possible and practical and is lacking only the commitment by public officials to directly address the concerns of our community. But that is a topic for a fuller discussion at another time. Addressing needle litter through needle exchange is the topic I address today.

Many members of our community doubt the veracity of studies that show a decrease in the infection rate among IDUs as a direct result of SSPs and I will not debate that point here. However, widely accepted studies show the presence of a syringe services program is associated with a sharp decrease in improperly discarded syringes and that is the salient point that this comment is intended to address.

A 2011 study compared syringe disposal practices in San Francisco, a city that has a Syringe Service Program to Miami, a city that does not. This study found that in Miami 95 percent of syringes were inappropriately discarded as compared to San Francisco where they found 13 percent of syringes inappropriately discarded. *Needle Exchanges Reduce Harm to Public [Tookes]. In Santa Cruz the numbers are even more compelling. The SSP now being operated by the Santa Cruz County Health Services Agency reports that they are distributing approximately 10,000 syringes per month. Add to that the 5,000 per month sold through local pharmacies and the overall number of syringes distributed in Santa Cruz County over a 12-month period would be 180,000. Volunteer clean up efforts which track the number of needles found in public spaces report that they have found about 2,000 discarded needles in that same period. That means that our rate of inappropriately discarded syringes in 10 percent. This is significantly lower than San Francisco but I would be the first to admit that this percentage is still alarmingly high.

Now consider this: During the period of its operation, our volunteer needle exchange run by Street Outreach Supporters estimated that fewer that 1 percent of all syringes that it distributed were inappropriately discarded. Why? Because responsible needle collection was as important to their mission as the public health benefits of providing clean syringes.

In point of fact, the closure of the SOS syringe exchange sites at Barson and Bixby and at the Emeline Complex did not lessened the amount of injection drug use in that part of Santa Cruz, but it did remove one of the only places where sharps could be properly disposed of. The unintended consequence of this closure was that there are now more improperly discarded syringes in public spaces, not less.

Street Outreach Supporters volunteers were trained Community Health Outreach workers who collected used needles in biohazard containers and took the equivalent of an oil drum filled with used needles every week for disposal. SOS provided a life-saving service to the Santa Cruz community by working to improve the health and wellness of drug users along while simultaneously ensuring that syringes were properly disposed of and did not pose a health risk to the community.

And I will leave you with one final statistic. During the years that the Satellite Exchange Program was operated by the Santa Cruz AIDS Project, it distributed 320,000 syringes per year. And yet, because they were efficient, professional and responsible and operated several different exchanges sites in Santa Cruz, including sites in the urban core, there were no reported instances of significant needle litter during any of their years of operation.

This leaves us as a community with one inescapable conclusion: Needle Exchange is not the problem. In fact, it is the solution.