Health care providers call for syringe exchange

Pete Paquette’s addiction began the way it did for many — with a pain injury in high school and a prescription for opioids.

Liking the feeling from the pills, he became a recreational user, and eventually moved on to IV drug use.

“The only reason I started shooting drugs initially was economically,” he said. “I could buy this one pill for $50 and get high off of it four or five times injecting it.”

For the first few years of his addiction, Paquette kept down a job in construction — traveling to the bush in the North Slope to earn enough money to feed his addiction.

“I would be home — I would use. I would go to work — I’d kick, you know, clean up, do my work hitches … and then come back with money and pay all my bills.”

Eventually he quit his job, and found himself living on unemployment and taking odd jobs to survive.

“I was just kind of working jobs here and there to make it happen,” he said. “But it was going down the toilet really fast.”

At the time he began injecting drugs — about 13 years ago — the community of injection drug users was relatively small. With the decrease in the availability of prescription pills, heroin use skyrocketed.

“It almost seems like it happened overnight,” Paquette said. “There was a few people I know that were injecting and then it was just a few months later, it was just like everyone.”

As the number of users increased, knowledge about how to prevent the spread of infections like Hepatitis C and HIV decreased, he said.

“They were reusing needles multiple, multiple times without cleaning them. Not cleaning injection sites. Getting abscesses,” Paquette said.

Between 2011 and 2015, annual rates of hepatitis C cases in the Gulf Coast region, which includes the Kenai Peninsula Borough, increased 45 percent among 18- to 29-year-olds, according to a State of Alaska Epidemiology Bulletin issued in August 2016. Statewide, there was a 100 percent increase reported for the 18- to 29-year-old age group, a steep incline for an infection that has been mostly associated with baby boomers who picked up the disease decades ago.

Now in recovery, Paquette is passionate about helping those who want to end their addiction, and about finding ways to reduce harm for those using. He is one of a growing number of people who support needle exchanges — which provide sterile injection tools and a place to dispose of used needles.

Reducing harm, providing care

For two years, the Homer Needle Exchange has offered IV drug users free access to supplies to help them inject drugs safely, and provided a repository for dirty needles that might otherwise have been left in a parking lot, along a beach, or even used again.

It’s a small operation with a simple purpose — reducing harm for those with addictions.

Twice a month for two hours, volunteers put out a placard behind a South Peninsula Hospital clinic in Homer and stack tables with supplies — syringes, clean cotton filers, sharps containers, tourniquets, sterile water and small cookers.

The project came out of concerns from local health care providers about the increase in IV drug use, and the subsequent increase in including a sharp increase in Hepatitis C infections, Sarah Spencer, a doctor of osteopathic medicine, said.

“Heroin has become very cheap and wildly available in Alaska,” said Spencer, who works for the Ninilchik Community Clinic and is a founding member of the Needle Exchange.

During an open house held last month, volunteers at the exchange walked a group of state officials and explained their strategy for harm reduction.

The Homer exchange has operated with a few thousand dollars in grant money and an all-volunteer force of health care providers. It operated for its first six months on a single $1,000 grant. Initially the exchange was distributing about 1,000 syringes a month. That number has doubled to about 2,000 a month.

The exchange has experimented over time, and tweaked their approach. Initially, the exchange was limiting the number of needles to 40 or 50 a week. After receiving feedback from clients, who reported running out of needles between openings, the exchange allows clients to take as many needles as they think they will need.

Clients also pick up needles for other members of the community, who may not be comfortable coming in themselves.

Between June 2016 and December 2017 the exchange disbursed approximately 15,000 clean syringes and disposed of 4,000 dirty needles, and received about 170 visits during that time. Health care providers also offer free rapid HIV or Hepatitis C testing, and provide a connection to additional services.

Before setting up the exchange, organizers met with a coalition of community members, including health care providers, police, the hospital board and city council, Spencer said. They also reached out to neighbors and nearby businesses to let them know when the exchange would be operating. Spencer said so far she hadn’t received any complaints from neighbors.

While initially hesitant to get involved in a needle exchange, Spencer said there has been little pushback from the community.

“I was really pleased to find out there was a lot of support from the community,” Spencer said.

Capt. Michael Duxbury, commander Alaska Bureau of Investigation and Statewide Drug Enforcement Unit, leads a trooper unit dedicated to tackling the opioid problem. Although his mission is fundamentally focused on law enforcement, he said there has to be a multi-faceted approach to solved the issue of opioids.

“We are trying to demonstrate that we can’t arrest our way out of this problem. And there are people who are dying and that’s a tragedy,” Duxbury said.

Duxbury, who attended the open house at the Homer Needle Exchange last month, acknowledged that many people are uncomfortable with the idea of a needle exchange.

“But this is quality of life issues. And we all have quality of life issues. All of us,” Duxbury said.

Creating a healthier community

Dirty syringes can pose major health hazards to users, and to the wider community.

Needles become porous with repeated use, allowing them to harbor bacteria. That can cause a wealth of health problems, such as sepsis, inflammation of the heart valves and skin infections. Hepatitis C can live on surfaces for two weeks, and remain alive in the barrel of a syringe for two months. Abandoned syringes pose a health risk to the larger community, Sherra Pritchard, a nurse with the Kenai Public Health clinic, said.

Beyond providing clean supplies that can help prevent infection, a syringe exchange could be an entry into “big picture care,” for a population that is hard for health care providers to reach, Pritchard said.

“Maybe they’re not ready to completely kick their addiction right now, but they want to do things that will keep them healthy,” Pritchard said. “And so providing them the means to do that while still figuring out if it’s the time to recover, it’s a pretty crucial point in their timelines to be able to address their current health concerns.”

Pritchard also emphasized the cost-effectiveness of a needle exchange. With medication for Hepatitis C running upwards of $80,000, and additional provider fees ranging from $20,000 to $40,000, a needle exchange is vastly more cost effective.

Kenai public health nurse Tami Marsters regularly sees injection drug users come through the local clinic, and said there’s widespread support among the user community for an exchange.

“They really want a syringe exchange,” Marsters said. “Most everybody I’ve talked to, who comes in, that is currently involved in (IV drug use), they say, we’re not going to quit doing it, so we would like to be safer when we’re doing it. And of course, they’re all talking about going to treatment, but, that’s not, not their goal today. Their goal today is to stay alive and stay as healthy as they can.”

Shari Conner, who works with Change 4 the Kenai, a grassroots community organization dedicated to preventing substance abuse, said there’s been a taboo around providing needles in the community.

She said several years ago many pharmacies in the area required a prescription to get needles. Conner said she reached out to local pharmacies, many of which now allow people to purchase with a prescription.

“There are people who think that you are providing approval, or continuing to okay someone to use drugs,” she said. “Someone’s going to do this whether they’re provided a clean instrument or not.”

Conner said Change 4 the Kenai has looked into setting up a needle exchange in the area, but the operation would require funding for materials, volunteers, a distribution location, means of disposal for exchanged syringes and buy-in from the community.

“We’re ripe for a real hard discussion about that,” Conner said.

Moving toward recovery

Paquette’s road to recovery has been a long one. He has been going to treatment for substance abuse at residential treatment centers and outpatient clinics across the state. He’s accidentally overdosed twice. He has a felony record, stemming from a drug possession charge, and spent time in Wildwood Correctional facility. During his last stint in jail he was given the options — more jail time or treatment.

He found lasting recovery through Serenity House, Central Peninsula Hospital’s 12-bed residential treatment center.

Paquette said having an environment free of judgment that gave him treatment options helped him make the decision to stay clean.

“They asked me, what I thought about my life, or what I thought would help me in my life, what I thought would help me move in that direction,” he said.

Five years later he works in Serenity House detox and volunteers at a needle exchange in Anchorage when he can.

“People have questions. I have a lot of experience. I’m a felon. I’m an IV drug user — I did all this stuff, he said. “And now I’ve gone through it. And that helps people.”

Reach Erin Thompson at ethompson@peninsulaclarion.com