Missing the point: Clean needles can control the added health risks of drug users

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When he needed syringes to shoot up, Nick Stamerra would walk into a pharmacy and ask for a 10-pack. But he knew that many pharmacists would refuse, so he hid his used needles at the top of his closet, or in the upholstery of his car, where his 10-year-old sister wouldn’t find them. And, sometimes, when he needed a fix and didn’t have a needle, he would borrow a used one from a friend. 

The re-use of syringes should have been curbed in 2009, when the Pennsylvania Board of Pharmacy revised its rules to allow pharmacists to sell needles without a prescription. Yet addiction specialists and their patients report that the change in regulation has not had the desired effect: Many heroin users still have to use dirty needles, exposing themselves to HIV, hepatitis C and a whole list of bacterial infections.

And as heroin use in Pennsylvania continues to increase -- both in cities but also in small towns and rural areas -- experts worry that there will be a public health crisis. Between 80 percent and 90 percent of injection drug users get hepatitis C within the first year of injecting, say public health specialists, and the virus is the most common reason for liver transplants. 

“Rural counties suddenly have high rates of hepatitis C, and it’s a very expensive disease to treat,” says Alice Bell, a coordinator at Prevention Point Pittsburgh, a needle exchange program that disperses clean needles. “It’s going to bankrupt the local health departments.” 

Ms. Bell has heard many stories like Mr. Stamerra’s.  The people who come into the needle exchange often report being turned away from pharmacies. Some people -- especially in small towns -- are afraid to go in and ask for syringes because of the stigma surrounding heroin addiction. But for those who do go in, the sale often depends on how you look.

“If you are in a suit and tie, they’ll sell you syringes, but if you look bedraggled, they won’t,” Ms. Bell says. 

Mr. Stamerra is 22, and lives in North Huntingdon. He has been clean for almost eight months, but his memory of what it is like to need a fix is crystal-clear: “It’s the worst feeling you’ve ever had. It’s the worst flu you’ve ever had, multiplied by 1,000, coupled with terrible anxiety.” 

Like for many others, his heroin addiction began with other, softer drugs. When he did begin to use heroin, in 2010, during his senior year of high school, he began by snorting it. As his addiction grew, he needed more and more of the drug to get his fix.

Neil Capretto, medical director at Gateway Rehabilitation Center, explains that when you snort a drug, not all of it gets through the membrane in your nose, and when you swallow it, the acid in your stomach begins to break it down. “When you inject a drug directly into the blood system, you maximize the effect,” he says. It means that injection is the cheapest way to satisfy a heroin addiction. And once you go from snorting to injecting -- as Mr. Stamerra did in July 2010 -- you almost never go back. 

“It became a cost-analysis thing,” says Mr. Stamerra.

He remembers getting into arguments with pharmacists when they asked why he wanted syringes. But he also remembers pharmacists jacking up the price of syringes so that people with addiction would not be able to afford them. What was listed as $2 or $3 would be sold for $15, he says. 

Different pharmacy chains have different policies about the sale of syringes. None of them prevent their pharmacists from selling syringes without prescriptions, but both Rite Aid and Giant Eagle leave it up to the discretion of the pharmacist. A CVS spokesperson said that the 2009 change in regulation was for the express purpose of ensuring clean needle access, and that the company would look into the matter if a customer complained. 

Many independent pharmacists refuse outright when they think customers want syringes for heroin use. If customers claim the needles are for insulin injections but can’t produce a prescription, they are out of luck. Other pharmacists pretend there are no syringes behind the counter. 

“I don’t care what the law says. If a 21- or 22-year-old comes in ratty and unkempt, I just tell them to get their syringes where they get their insulin,” says an independent pharmacist in Belle Vernon, who did not want to be identified. “I’m not going to contribute to the downfall of society.”

These pharmacists feel that to sell syringes without prescriptions is to encourage drug use. But research shows that those who are addicted will simply find another, less safe way of injecting the drug, says Ms. Bell. 

“You’re not going to stop addicts from using drugs,” says Mr. Stamerra of pharmacists who would not sell him syringes. “You’re just making it more dangerous.”

In Allegheny County and Philadelphia, needle exchange programs make it a little easier to find clean syringes, but not that much easier. There is a ban on both federal and state funding for needle exchanges to purchase sterile injection equipment, and the lack of funds means that Prevention Point Pittsburgh relies heavily on grants and donations and can only offer very limited services. (The nonprofit hands out needles noon to 3 p.m. Sundays at the Allegheny County Health Department building, 3441 Forbes Ave., Oakland; and 1 to 3 p.m. Wednesdays at Kirkpatrick Street and Bentley Drive in the Hill District; other opportunities by appointment, 412-758-4257.)

“Our type of program should be implemented statewide if Pennsylvania is serious about addressing this issue,” says Renee Cox, executive director of Prevention Point Pittsburgh. 

Over the summer, state Sen. Gene Yaw, R-Lycoming, and the Center for Rural Pennsylvania have been holding hearings to learn more about the spike in rural heroin use. They have discussed legislation that would grant wider access to naloxone, a drug known as Narcan that can reverse overdoses. They have also discussed Good Samaritan laws, which would protect someone from being arrested for drug possession and use if he or she calls 911 for a friend who is overdosing. 

But clean needle access has only been mentioned in passing, says Mr. Yaw. The last of the hearings on rural heroin use was held last week in Clarion County. As Ms. Cox put it, “When drug use goes into the realm of death and disease, you’ve got a far worse problem than the drug use itself.”

Eric Boodman, a senior at Yale University, was a Post-Gazette summer intern.

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