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El Paso County needs a needle exchange

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It is no secret that Colorado Springs — and El Paso County at large — has an intravenous (IV) drug use problem. When I was a sophomore at Cheyenne Mountain High School, a group of students at my school gained notoriety for their involvement in a black tar heroin ring. That was perhaps the first time I became aware of IV drugs in my community; today, as a medical doctor in training and public health student, I encounter them and their myriad effects every day.

In the time since I graduated from high school, rates of IV drug use in Colorado have increased substantially (there’s been a fivefold increase in heroin use alone between 2003 and 2014). To an extent, this has spurred a response from policy-makers — campaigns against the “opioid epidemic,” for example — although addiction is but one piece of the problem.

One of the principal public health concerns of IV drug use is the risk of transmitting serious diseases like hepatitis C, which damages the liver, and human immunodeficiency virus (or HIV, which can progress to AIDS), which reduces the body’s ability to fight infections. Such diseases can be passed from one person to another when needles used to inject drugs are shared or not disposed of properly.

Indeed, the U.S. Centers for Disease Control and Prevention (CDC) has noted that increased IV drug use has resulted in outbreaks of severe infectious diseases, even in suburban communities similar to those that comprise Colorado Springs. Specifically, the CDC estimates hundreds of new cases of hepatitis C each year in Colorado, while the Colorado Department of Public Health and Environment (CDPHE) reported 168 new cases of HIV between 2012 and 2016 in El Paso County alone. These trends should shed further light on the urgent need for measures that can prevent transmission of these life-altering diseases.

What can be done? One evidence-based response that the CDC supports is the needle-exchange paradigm. Such programs help people who inject drugs to safely dispose of dirty needles and obtain clean ones, thereby reducing exposures to viruses on used needles. They also house expansive resources for substance use disorder treatment, testing for infectious diseases like HIV and hepatitis, education on safe practices to prevent overdose and disease transmission, and many other social services that can support people who utilize these resources.
Are these programs effective? Yes, and they have already been implemented throughout Colorado. According to CDC data, needle exchange programs increase rates of entry into substance abuse treatment, decrease overdose deaths and identify carriers of infectious diseases like HIV and hepatitis C, further reducing transmission of these diseases. Such diseases are very expensive to treat (nearly $400,000 for a person with HIV over a lifetime), and therefore by preventing new cases of such diseases, needle exchanges save public health dollars. In addition, safe disposal of needles also protects first responders, law enforcement officers, health care providers and trash collectors, who are all at risk of contracting illness from unseen needles of those that have been disposed of improperly.

Why now? I am far from the first to recognize the need for such a program in El Paso County. Most recently, the El Paso County Board of Health blocked the development of a needle exchange program in December 2017 following a unanimous vote by El Paso County Commissioners on a resolution opposing it. This program was presented by local infectious disease doctors and public health practitioners, whose proposal was informed by extensive evidence and clinical and public health experience. Unfortunately, their plan was flatly dismissed by several commissioners, who in the past have derided such programs as “enabling” in spite of overwhelming evidence to the contrary.

Such criticisms betray a gross misunderstanding of the problem at hand, and demonstrate a glaring disregard for professional expertise and scientific evidence. What’s more, they obstruct programs that create a healthier public. HIV and hepatitis C are not problems just for those users of injectable drugs; contaminated needles are a health hazard to police and first responders, and we should not forget that high rates of preventable diseases like HIV and hepatitis increase public health costs, which in the end we all shoulder.

The evidence supporting the value of needle exchange programs is not “fake news” or some partisan campaign, but rather bolsters a sensible program that has created healthier communities across the country. It is time that policymakers in El Paso County give science its due, and give our county what it rightly needs.

— Jake Fox

Jake Fox is a Colorado Springs Native and student at the University of Colorado School of Medicine and Colorado School of Public Health. His views do not necessarily represent those of either school.

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