Miranda Alam/Special to the Sun
Rick Reich, program director of Trac-B Exchange, a Southern Nevada Health District funded needle-exchange program, loads full sharps containers into Sterilis, a new machine that discards used needles at the Harm Reduction Center in Las Vegas on Monday, Dec. 11, 2017.
Monday, Jan. 1, 2018 | 2 a.m.
WHAT HAPPENS TO THE NEEDLES?
In Nevada, if you place used needles into a sealed, labeled, puncture-resistant container, you can legally just throw that entire container out with your everyday garbage. However, because part of its mission is keeping used needles off the streets, the Harm Reduction Center takes no chances when disposing of the thousands of dirty needles that come through its doors. Staff know a desperate enough person might rummage through garbage looking for any needle to use.
Its solution is a Sterilis Machine, a washing machine-sized piece of equipment that pulverizes and sanitizes sharps disposal containers and the needles within them. Dozens of red or black containers filled with used needles inside can be loaded up — and after an hour or so, they are nothing more than thick confetti. To the unassuming eye, what gets thrown out looks more like the aftermath of an office paper-shredding party.
“By doing this, we know it cannot be reused,” Reich said.
OTHER EFFORTS IN NEVADA
While the Harm Reduction Center works on the ground with drug users, other efforts are taking shape at the local and state level.
• Clark County has filed a lawsuit against major pharmaceutical companies, alleging they intentionally misled doctors about the addictive nature of prescription pain killers such as OxyContin and fentanyl. The county wants the companies to be held financially liable for costs incurred in combatting medical treatment and drug-related activity.
• Meanwhile, the state attorney general’s office is part of a multistate investigation into major pharmaceutical companies.
• Also, the Legislature passed several bills in 2017 related to prescription drug use and abuse. They included strengthening mandatory tracking of prescriptions, requiring health care professionals to report overdoses or suspected overdoses, and requiring prescribers to take continuing education on drug abuse.
Not a week goes by without somebody telling staff at the Harm Reduction Center Las Vegas that instead of just dropping off used needles in exchange for clean ones, instead of grabbing a few snacks to chow down before returning to life on the streets, they want off drugs.
Sometimes it comes after a scare — an overdose on heroin that could have killed them. Sometimes it doesn’t seem prompted by any one thing in particular — maybe they just needed to see the option in front of them the right number of times.
Regardless of the catalyst, when these moments happen, staff members are ready. They help people, who they stress are not just drug users, find a rehab facility or treatment center where they can begin to fight their demons. And before they leave on that day, Program Director Rick Reich tells them: “Whatever happens next, don’t be afraid or too proud to come back here.”
Statistically, most people relapse at least once after drug or alcohol treatment. Reich likes how musician Gregg Allman put it: “I went to rehab 11 times, but not 12.” And Reich is ready to be there for however many tries it takes before it sobriety sticks.
It’s arduous work, and one rehab referral out of the hundreds of people who visit each week isn’t statically impressive, but it’s what Reich sees as necessary for stopping the public health crisis of drug addiction in Southern Nevada. It’s why the Harm Reduction Center opened this past spring: to be a steady point of contact for people on drugs. The center provides addicts with resources to keep them as healthy as they can be — clean needles to avoid reusing dirty ones that could spread hepatitis, and naloxone kits that combat opioid overdoses. That way, when people are ready to get off drugs, their road to recovery is less fraught with challenges.
The center’s staff sees users of many substances, but the most common situation is opioid use. That includes synthetic opioids such as prescription pain killers and street drugs like heroin.
In November, the Harm Reduction Center and its Trac-B Needle Exchange program collected more than 3,100 used syringes. It estimates about half of clean needles distributed get returned directly to the center. Of those that don’t return, some are confiscated by Metro Police, and some wind up in sharps disposal containers and are thrown out directly. Others have been stolen by people with no relationship to the center.
“Anyone, when given the choice to protect their health, will choose to,” Program Manager Chelsi Cheatom said. “In talking to them, we see they try to protect themselves and their veins. They ask us about wound care. Our clients do care about themselves. Most are nice and respectful.”
According to Cheatom, people have visited the center from as far as St. George and Cedar City (both in Southern Utah) and Moapa Valley. Within the valley, all ZIP codes are represented, though a high percentage of visitors are homeless. One of the biggest requests from visitors is the need for a similar center in Henderson.
While once controversial, providing clean needles to drug users is now seen by public health professionals as a way to keep infectious diseases like hepatitis and HIV from growing and causing a community-wide crisis.
It also is seen as a cost-saving measure. The upfront cost of clean needles and disposing of dirty needles pales in comparison to the backend costs of emergency room visits, law enforcement calls and treatment. One national study found it costs an average city $160,000 annually to run a needle-exchange program, while one AIDS patient infected through a dirty needle runs up $120,000 in public health costs. Similarly, a 12-week hepatitis C treatment can cost $70,000 per person.
“We really want to spread the message that drug use is a medical condition,” says Kathryn Barker, an epidemiologist at the Southern Nevada Health District. “We need to view it as that and not just a criminal activity. That keeps the focus on getting people the help they need.”
In Clark County, opioid use and misuse were associated with more than 1,500 emergency room visits and more than 1,700 inpatient hospitalizations in 2013. The estimated costs of this medical treatment was $9.3 million in emergency room costs and $92.5 million in inpatient health care costs.
“Our rate of opioid overdoses is higher than the national rate,” Barker added. “It is a problem all across the country, but it’s a problem here in Clark County.”
Most of the efforts of the Harm Reduction Center are face-to-face interactions, but the center also operates three vending machines that dispense clean needles and other supplies for drug users. One is at Aid for AIDS of Nevada, 1120 Almond Tree Lane in Las Vegas. Another is down the street at Huntridge Family Clinic, 1830 E. Sahara Ave. The third is is expected to be placed in a new position soon. The pilot program launched in April and endured some skepticism as well-intentioned but not what homeless drug users — the most vulnerable among the group — need most.
Cheatom, though, said one of the vending machines had to be restocked three times in November. When it launched, it could go more than a month before needing to be restocked.
“We think the word has spread about them,” she said. “People realize it is OK. They can trust it.”
