A program once mainly associated with urban drug use may find its way to one of Colorado’s most rural areas. Officials in the San Luis Valley are investigating whether to implement a needle-exchange program to ward off the health risks that come with heroin and other injected drugs, and to provide drug users with a wider range of services, including treatment.
The San Luis Valley, an area larger than Connecticut that contains just 46,000 residents, has experienced a rise in the use of opioids. As in many of America’s rural corners, a crackdown on prescription painkillers several years ago gave rise to the use of a cheaper drug — heroin.
While the valley lacks exact statistics on use rates, many indicators paint a portrait of growing abuse. A methadone clinic is now in its first year of operation in Alamosa. At least one local doctor has begun treating patients with suboxone, a drug that combats opioid addiction. A task force to help pregnant mothers with opioid addiction and other substance abuse was established in Rio Grande County.
The work by public health officials on that task force, in turn, has led to discussions about potentially launching a needle exchange, a program that provides clean syringes to injecting drug users. Users who share needles put themselves at risk of exposure to HIV and hepatitis C, a virus that can lead to liver damage, failure and death. Needle exchange programs follow the philosophy of harm reduction, an approach that seeks to mitigate the harms of drug use instead of merely preaching abstinence.
“This is the piece that we really don’t have,” said Della Cox-Vieira, Alamosa County’s director of public health. “It’s only a matter of time when we’re going to start seeing secondary infections creeping into our population — we’ve seen it in other communities.”
Many needle-exchange programs offer screening for HIV and heptatis C in addition to educating users, their friends and family about drug abuse and how to avoid passing on potential infections. They can also provide an avenue to treatment for willing participants. That broader focus, beyond simply syringe exchange, has been an important part of the discussion in the valley, Cox-Viera said.
“Honestly, if we’re going to have a program we need this to be part of that conversation,” she said. “It’s not enough to pick up needles in exchange for clean needles.”
Cox-Viera estimated the cost of getting a program up and running at roughly $100,000, based on discussions with others who manage exchanges around the state. That’s cheaper than medically treating people who’ve contracted HIV or hepatitis C. Treatment costs can rise to tens of thousands of dollars for a single patient.
Needle exchange programs weren’t always widely accepted. An evaluation of studies on needle exchange in the mid-1990s by a panel for the National Research Council and Institute of Medicine found some possible negative outcomes, including an increase in improperly discarded used needles, the sanctioning of illegal drug use, and a perception of lower risk of infection. A congressional ban on the use of federal funds for needle exchanges held sway for most of three decades.
Most recent research, however, has come to different conclusions. A 2015 study in the Journal of Public Health found that publicly-funded needle exchange programs were linked to lower rates of HIV infection, an increase in the distribution of clean needles and greater numbers of health and social services distributed to participants.
As drug use in many communities has shifted from opioids to heroin, politicians have been forced to reevaluate their attitudes toward needle exchange programs, and the stigma has begun to dissolve. The federal funding ban was partially lifted in January, allowing the use of federal dollars for everything associated with such programs but the needles themselves.
In Colorado, state lawmakers addressed needle exchange in 2010, passing a measure exempting needle-exchange participants from laws prohibiting the possession of drug paraphernalia. They also passed a measure outlining the elements of any such program, including voluntary testing for blood-borne diseases and the ability to refer patients to drug abuse treatment. The implementation of a needle exchange program must first be approved by local boards of health, which in the valley’s six counties are composed of their respective boards of county commissioners.
To date, needle exchanges in Colorado exist mainly along the Front Range, with another in Grand Junction on the state’s West Slope. Still, it is not uncommon for them to draw people from rural areas, which lack exchanges of their own. Prowers County, on Colorado’s eastern plains, is also taking a preliminary look at needle exchange, but it’s at a similar early stage as the efforts in the valley. “Any kind of harm reduction program you talk to anywhere is going to take some creativity and flexibility to get things running,” said Andrew Hickok, prevention services manager for the Colorado Aids Project.
Before a proposal in the valley can take shape, public health officials will have to find an organization to host the program, as well as potential funding sources, which currently include the state and foundations. Officials will also have to determine which communities in the valley will take part and whether the program would be a mobile service or offered at a fixed location. And after those questions are answered, the proposal would still require public hearings and the approval of county officials.