SYRINGE EXCHANGE CLIENTS BOOST AMPHETAMINE USE

Island Program Makes Gains

A big increase has occurred in drug users starting to inject amphetamines,
an annual evaluation of the state's syringe exchange program reveals.

About 20.4 percent of syringe exchange clients reported injecting
amphetamines last year compared with 6 percent or 7 percent the previous
year, said Don Des Jarlais, who conducted the study.

He said he believes the increase is partly due to the availability of
methamphetamine in Hawaii. He said he doesn't know if drug users chemically
modify the drug before injecting it. Most of those injecting amphetamines
also inject heroin, he added.

Des Jarlais, research director at the Chemical Dependency Institute at Beth
Israel Medical Center in New York City, reported his findings today to the
state's Syringe Exchange Oversight Committee.

The Community Health Outreach Work Project was established by the state
Department of Health in 1989. Hawaii was the first state to start a syringe
exchange program in 1990.

The law requires annual evaluations, which Des Jarlais has done for four
years. "Things continue to go well," he said in an interview. "I would say
even better."

He said 219,000 syringes were exchanged from September 1999 to September
last year -- setting a new state record. The previous year's total was 193,000.

Peter Whiticar, chief of the Health Department's STD/AIDS Prevention
Branch, said he's "always amazed at such an increase year after year." It's
due to a number of factors, he said. "On Oahu, we're doing a better job of
getting out to where users are because we have a fully mobile program.
We're using vans a lot."

Also, the Big Island has a peer approach where injection drug users,
particularly in rural areas, are telling other drug users they can and
should benefit from exchanging needles, he said.

The peer program is reaching drug users who were avoiding the exchange
program because of fears of confidentiality, Whiticar said. "We're looking
at this as a national model for rural areas."

Des Jarlais agreed that it could be a national model. "We're in the process
of writing it up to put in scientific literature because it's doing so
well," he said.

Another development is what the Community Health Outreach Work Project
calls "individually scheduled exchange services," he said. Outreach workers
make contact with drug users, then set up a meeting for an exchange, he
said. "That has sort of taken off in the last year."

About 50,000 of the total syringes exchanged last year were done through
individually scheduled exchange services, he said.

It is a popular approach because of "confidentiality and convenience -- two
very important things in any health-related service," he said.

Des Jarlais recommended that special attention be given to amphetamine
injectors to try to make sure they always have clean needles and practice
safe sex.

At some point, he said, additional drug use treatment probably should be
developed for people injecting both amphetamine and heroin. He suggests
continuing and replicating the peer education project from East Hawaii to
other parts of the state and continuing and expanding ISES services if
possible.

ISLAND PROGRAM MAKES GAINS

Among other findings in an annual evaluation of the state's syringe
exchange program:

About one-third of all AIDS cases nationally are related to injecting drug
use. In Hawaii, it's about 17 percent or half of the national percentage.

About 1 percent or less of Hawaii drug-injectors are infected with HIV, a
drop from 6 percent to 8 percent in the last 10 to 12 years.

It's declining because people with HIV infection and AIDS are dying and the
rate of new infections appears to be very low, Des Jarlais said. "This is
good news, particularly when one considers what's happening with HIV and
drug-injectors in the rest of the world."

The average age of syringe clients last year was 41, a slight decline from
the previous year's average of 42.2. They reported injecting drugs 17 or 18
years.