DISEASE SPURS NEEDLE IDEA

Hepatitis C: Riverside County Health Officials Say Injection Drug Users Are
Creating An Epidemic

Riverside County health officials want to pass out clean syringes to
intravenous drug addicts, hoping to slow the killer diseases of AIDS and
hepatitis C.

Public Health Officer Dr. Gary Feldman expects to ask county supervisors on
July 2 to declare a local health emergency. The move is required by state
law to allow a needle-exchange program.

The climbing rate of hepatitis C, more than AIDS, is driving the proposal.
The blood-borne disease attacks the liver and can lay dormant for years.
There is no known cure.

"It has already eclipsed HIV and it will be the major infectious disease
epidemic of the first part of this century," Feldman said. "It's out of
control."

In interviews last week, only one of five supervisors ruled out supporting
the first needle-exchange program in the Inland Empire.

"Give me a break," Supervisor Jim Venable said. "I would much prefer to
hire another cop and go out there and start busting people who are doing
that. People have to be responsible for their own dad gum actions."

Supervisor Roy Wilson said he usually comes down on the side of public health.

"If indeed there's a cost effective way of reducing the spread of disease,"
Wilson said, "I'd probably support it."

Proliferating

Needle-exchange programs have steadily proliferated across the state and
country since the late 1980s as a way to decrease the spread of AIDS and
other blood-borne diseases.

Riverside County District Attorney Grover Trask said handing out syringes
undercuts Prop. 26, California's new law that sends people charged with
drug possession to treatment instead of jail or prison.

"We're attempting to get these individuals in a new program, help them get
clean, and here we're turning around and saying, 'We want you to use clean
needles . . . it's OK to shoot up,' " Trask said. "It's in direct conflict
with what we're trying to do."

California law forbids the sale or possession of a syringe without a
prescription, although a bill that would allow individuals to possess up to
30 needles passed the Senate last month.

In 2000, state lawmakers provided a legal mechanism for needle exchanges to
operate: declaring a local health emergency and renewing it at regular
intervals.

Feldman says he believes a needle exchange can save lives and money.

Cost of treatment

Injection drug use was the likely source of 23 percent of the county's 252
reported AIDS cases in 2001, according to the health statistics office. The
cost of treating one HIV-positive patient is nearly $200,000 per lifetime,
according to the Centers for Disease Control and Prevention.

Injection drug use is linked to 60 percent of hepatitis C cases nationwide.
There were 2,091 reported in Riverside County in 2001, a 23 percent
increase over 1999. A study of adult jail inmates three years ago found
that nearly a quarter tested positive for the disease.

"I feel that my mission is to protect the public health," Feldman said.
"And I feel that folks in the community expect me to take a stand where I
feel we must make a difference."

Health officials in San Bernardino County said they had discussed the idea
of a needle exchange but have no plans to propose one. Reported cases of
hepatitis C in the county swelled almost 20 percent between 1999 and 2001
to 3,085.

"It doesn't seem like something our board would be supportive of at this
time," said Alex Taylor, director of the county's HIV/AIDS programs.

The Inland AIDS Project, which runs food banks and outreach and housing
programs for people with HIV and AIDS, has agreed to operate a needle
exchange in Riverside County at no cost to local taxpayers.

Going mobile

The group expects to provide needles from a mobile van starting in the
Perris-Lake Elsinore corridor because of the area's high concentration of
injection drug users. Countywide, there are an estimated 11,000 injection
drug users.

"We haven't locked down a location," executive director John Salley said.
"We want to make sure it's accessible and safe. And that law enforcement
knows where we are."

The exchange would operate twice a week, four hours a day at two locations,
Salley said. Participants would exchange one dirty syringe for one clean
syringe, with no limit on the overall number.

Norma, a former heroin user and a patient at the county's methadone clinic
in Riverside, said she knows several people with hepatitis C. Two friends
have died waiting for liver transplants, she said.

Addicts always need needles and would flock to a needle exchange, said
Norma, whose ankles are scored by gray-brown marks and tiny craters,
reminders of a life shooting heroin. The 43-year-old mother of five said
she's grateful she stopped using nine years ago.

"Back then, it was just getting a fix," said Norma, interviewed at the
methadone clinic, which requested that last names of patients not be used.
"You were always fighting for who's going first, and when you're done, you
just keep passing it through."

Off the streets

Her husband, Ben, also a recovering addict, said needles break, get clogged
with blood and become dull. The more bad needles turned in, he said, the
fewer there will be on the streets for kids to handle.

Addicts "are going to do what they can to get that dope," he said. "You
don't ever think about how many people can be hurt by it."

Salley said a substance abuse counselor would be available at the exchange,
as a well a social worker or nurse. The van also will offer disease
prevention information, HIV testing and referrals to clinics for hepatitis
C testing, county officials said.

"We're really looking at this in a more global concept than just the
needle," Salley said.

Hepatitis C eventually causes chronic liver damage in 70 percent of cases
and death in 5 percent, local health officials said. It is 10 times more
contagious than HIV, and can be transmitted even through cotton swabs
shared between users. As many as 90 percent of those injecting for at least
five years are infected with hepatitis C, the CDC estimates.

Tough situation

Law enforcement authorities, however, are unconvinced there is a state of
emergency.

"I certainly can't support giving out hypodermic needles for those who
would use them for illicit purposes," said Undersheriff and Sheriff-elect
Bob Doyle. "It puts us in a tough situation."

They also challenge studies health experts say prove needle programs can
decrease new HIV infections up to 70 percent without increasing drug use or
crime.

Studies done in Montreal and Vancouver during the 1990s showed HIV
infection rates were higher among frequent users of needle exchanges. One
study in Seattle found that a needle exchange did not decrease hepatitis
infection rates.

The studies "are not very impressive," said Dr. Forest Tennant, a West
Covina doctor who conducts research into drug dependency and pain.

Tennant said he has operated methadone clinics across the state and
believes that most needle exchanges are not conducted in a clinical setting.

"The idea of preventing infectious diseases is to cut down on the number of
injections," Tennant said. "These people are addicts. A physician should
prescribe those needles."

But the author of the Vancouver study says it has been wrongly used as
ammunition by opponents of needle exchanges.

Steffanie A. Strathdee, an associate professor at the Infectious Diseases
Program at the Johns Hopkins School of Hygiene and Public Health, said the
Vancouver program attracted cocaine injectors. They shoot up more than
heroin addicts and there were not enough needles to keep up, she said.
Another problem was a weak link between the needle exchange and treatment
facilities, she said.

The vast majority of studies show providing clean needles helps decrease
the spread of diseases without doing harm, Strathdee said.

Needle exchanges "are the cornerstone of HIV prevention," she said. "But
they cannot work in a vacuum. They're not the silver bullet."