On the first day, no one came. The second day, an addict in the throes of withdrawal showed up looking for advice. The third day, five people came in search of options for drug treatment programs and testing. Slowly but surely, those in need are beginning to seek out one of the few safe havens in the area willing to help them stay alive.
After eight long years in the making, the Cincinnati Exchange Project (CEP) is finally up and running. The area’s first syringe exchange program swaps used needles for clean ones in an attempt to limit the spread of disease along with ridding the streets of tainted paraphernalia. The mobile unit officially opened Feb. 23 in Springdale.
“It’s a very new program and it’s a population that statistically anecdotally is sort of hounded, so it takes a long time to get going when it’s new to an area,” says Cincinnati Exchange Project Program Manager Libby Harrison. “These people want to know they’re not going to be arrested, judged or treated badly. There’s justifiably some trepidation in the population.”
In addition to syringe exchange (equal numbers of used needles for clean ones), the program provides HIV, Hepatitis C and pregnancy screening along with counseling and referrals to treatment facilities and support organizations. The Ohio Department of Health provided a $48,000 grant for two years to distribute nasal naloxone, a medication that instantly stalls drug overdose.
According to Dr. Judith Feinberg, CEP medical director and infectious disease specialist at the University of Cincinnati Medical Center, the program addresses three separate needs: keeping the addicts themselves healthy until they seek treatment; keeping first responders and the general public safe from discarded syringes; and lowering overall health care costs by limiting exposure to disease.
“It’s a really broad public health agenda, and I think that was so compelling to the people in charge in Springdale,” Feinberg says. “There are so many addicts — you can’t arrest your way out of this epidemic. You have to reach addicts where they are, build a bond of trust and wait for them to get to the point where they want to be in recovery.”
Because the program assigns value to needles, it encourages users to not only exchange their own, but retrieve dirty ones from streets, parking lots and playgrounds, which helps keep the public safe. Feinberg says last year a sanitation worker at Findlay Market tragically contracted hepatitis C from a discarded syringe during the course of his job.
“Communities like Portsmouth, where they’ve had this exchange for almost three years now, there’s been a 50-percent drop in Hepatitis C diagnosis and they’ve seen a tremendous clean up in public spaces,” Feinberg says.
For anyone in denial the city is in need, just take a look at the statistics, says Project Director Adam Reilly. In 2013, 1.8 residents died every two days from a heroin overdose in Hamilton County alone; essentially a person a day, he explains. He says a rough estimate points to about 10,000 IV drug users in the Tristate area, many of whom started out using expensive prescription painkillers such as Oxycontin and Percocet then moving to heroin, which costs about $5 to $8 on the street.
Critics have accused such programs of increasing drug usage, a ridiculous notion, explains Reilly. During the past seven years, he and Feinberg have been collecting data and visiting other cities with successful programs already in place. He says he’s incensed by those who haven’t bothered to do the research yet feel the need to publicly attack the program, suggesting people will decide to suddenly start using IV drugs as they can now get a clean syringe.
“It doesn’t encourage drug use; what it does do is it encourages drug treatment in the long run,” he says. “So in reality there’s actually less people who are shooting up because they now have a link to treatment through these kinds of a programs. “
Interact for Health awarded a $50,000 grant for daily operation. Feinberg and Reilly have been tireless in their efforts to secure funding and authorization to move these programs forward.
Nearly a decade ago, while performing hospital duty, Feinberg saw multiple cases of endocarditis, an infection of the heart directly related to IV drug use. After further research, she discovered an increase in both Hepatitis C and HIV cases, both related to needle sharing. Recognizing the city was on the precipice of an epidemic, Feinberg and Reilly, formerly of Stop AIDS, obtained an emergency order from the Cincinnati Board of Health to begin a syringe exchange program in February 2012. But the project came to a screeching halt shortly thereafter. Feinberg says the previous city administration opposed the program and it couldn’t move forward without a buy-in from the city solicitor and police chief.
Feinberg and Reilly found a sympathetic ear in Springdale, where the mayor and health department recognized that they needed to take a new approach to solving these problems, Feinberg explains. She says she’s encouraged by positive feedback from new Cincinnati Mayor John Cranley and hopes to get approval to park the mobile unit within city limits.
“The first neighborhood we’ll go to is Lower Price Hill, which is very hard-hit,” Feinberg says. “We’ve already been in touch with community activists, but I need to know that the mayor has had this conversation with the police chief, because you have to work with the local police and the local community to make sure everything is in place.”
However, providing syringe exchange is only one step in solving the problem. Cincinnati, like many areas in the country, is in dire need of additional drug treatment facilities, Reilly explains. Until the city and state allocate additional funding, an extreme shortage of capacity exists. Reilly points out that on average an addict may wait up to 60 days to get into a drug treatment facility.
“The only reason we decided to do pregnancy testing,” Reilly says, “is that’s the only way you can get someone into treatment quickly is if it’s a pregnant woman, they can get into treatment right away.”
To spread the word, Harrison points to their comprehensive grassroots campaign to reach IV drug users. She says they’ve hit the streets, hanging posters, handing out flyers and approaching individuals directly to tell them about the program.
“Sometimes they’re drug addicts and sometimes they’re not, and sometimes they’re offended and sometimes they’re not,” Harrison says. “We’ve tried to get mainstream media coverage and our partnerships with other health organizations are spreading the word as well.”
One crucial element is still lacking is compassion for those who suffer from addiction, Feinberg says. She explains the disease actually alters brain chemistry and isn’t simply weakness on the part of the user. She says people choose not to discuss the problem, but addiction often touches their lives at some time.
“The idea of blaming the victim is crazy,” Feinberg says. “These are diseases, and people who have them are unfortunate; they’re not bad people. There are no 60 year-old heroin addicts — they either clean up or they’re gone. This is someone’s daughter or grandson or brother. It’s all very sad, so I want to do something about this. It’s my passion.” ©
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