Dr. William Koenig: Needle exchange a project with a point

jarino47/Can Stock Photo ##
jarino47/Can Stock Photo ##

An ounce of prevention is worth a pound of cure” is an adage that recommends thinking ahead to avoid a bad outcome and possibly save a life.

“Harm reduction” is a term we use to promote prevention in areas of everyday work and life. It is implemented through policies, programs and strategies aimed at reducing negative consequences for people engaging in reckless behavior or exposing themselves to high-risk hazards.

Guest Writer

Guest writer Dr. William Koenig is a board-certified pediatrician who’s been practicing at the Physicians Medical Center in McMinnville since 1998. He earned his doctor of osteopathy degree from Des Moines University in 1989, then undertook a pediatric residency at the Mayo Clinic School of Graduate Medicine in Rochester, Minnesota. He is a fellow of the American Academy of Pediatrics. When not treating children on the job, he enjoys tending cattle at the home place.

Every day, most of us encounter some sort of harm-reduction strategy to keep us safe. Wearing a seat belt in a car, applying sunscreen for a day at the beach and donning a hard hat on a construction site are all types of harm-reduction plans.

Syringe exchange programs, like the one now under consideration in Yamhill County, represent another example of a harm-reduction strategy.

Syringe service systems may assume a variety of forms. They can be fixed or mobile in nature; they can be supported by certified recovery mentors or communicable disease outreach personnel.

The goal is not only to provide greater safety to people injecting drugs, but also to the community at large.

Used needles can carry devastating chronic diseases, such as Hepatitis C and HIV. When needles are shared, individuals put themselves at great risk of contracting these diseases, as they are blood-borne pathogens.

Needles that aren’t disposed of properly — perhaps tossed on sidewalks, park sites, playgrounds or the floor in a public restroom — put members of the public at risk of accidentally poking themselves. And that includes children.

In Yamhill County, we have had reports of needles found on public school and park grounds.

Research shows communities implementing syringe exchange programs report fewer needles on the street. Many programs track the number of needles returned, and, in many cases, it meets or exceeds the number distributed, suggest its far less likely needles would be discarded in public places.

Another issue is the use of contaminated needles.

Using the same needles repeatedly increases the risk of acute infections. These include septicemia, a blood infection; abscess and cellulitis, forms of skin infections; and endocarditis, a heart infection.

Infections can migrate into bone, making them very painful, costly and difficult to treat. And cardiac infections may require high-cost valve replacements.

Programs that provide new sterile syringes save costly medical interventions that can and should be prevented or greatly reduced. And the bill for those interventions is largely borne by the taxpayer.

There are some myths out there associated with syringe exchange programs. Here are some of the more common ones:

“Don’t syringe exchange programs just enable people who use drugs?”

No, they don’t. In fact, people who access a syringe exchange are five times more likely to enter drug treatment, easing both the strain on their lives and the burden that represents for the taxpayer.

“Isn’t it expensive to start a syringe exchange program?”

Costs vary, based on the program’s model and location. But overall, they save communities a significant amount of money.

For every dollar invested in a needle exchange, four dollars are saved on treatment of skin infections and Hepatitis C alone, studies show. In Yamhill County, averting just four Hepatitis C infections would cover the total cost of the program.

“Don’t syringe exchange programs increase the number of needles found on the street?”

No, they don’t. Generally, communities with a syringe exchange program available find fewer needles on the street.

The benefits are legion:

Exchange users are five times more likely to seek treatment. Fewer needles end up in playgrounds, parks and other public places. HIV from intervenous drug use drops 50 to 70 percent. Needle-sharing declines almost 90 percent. Hepatitis C transmission falls more than 60 percent. Every dollar of investment produces four in return, through reduced healthcare costs.

As an added bonus, the number of overdoses declines because exchange sites facilitate education in how to avoid — or at least survive — an overdose.

Aiming to make the program truly countywide in scope, Yamhill County plans to field a mobile unit in addition to establishing fixed locations. A group of partners, including community members, peers, healthcare providers and law enforcement personnel are teaming up with the public health staff to work out the details.

In addition to providing syringe exchange services, the program would actively engage IV drug users. It would offer referral to treatment programs and help the user remove any barriers he may be encountering.

Syringe services programs provide the community at large with additional safety, while also installing hope in a struggling population for better days ahead.