With all the media attention surrounding Fentanyl overdoses, many forget the other, oftentimes more deadly, risks faced by I.V. drug users today. Many users contract and some users lose their lives from HIV, hepatitis, and other infectious diseases that are preventable when users are given access to clean needle programs, aka clean needle exchange programs.

More so than HIV, in my experience, I.V. users frequently suffer from bacterial infections leading to hospitalization. Many users contract these infections from sharing, or even reusing their own, needles. These infections turn into abscesses and, if not treated, enter the bloodstream.

Life-Long Scars

A dear friend of mine, Cara, relapsed a month out of residential inpatient treatment. Cara was too ashamed to go back into her 12-Step home group to get another 24-hour chip. Living with this shame drove her to move out of her parents’ house and in with a boy she had just started dating. Ironically, this boy was her drug dealer.

Cara woke up one morning with an abscess on her arm. She had had abscesses before so she did what she always did; stuck a needle in the middle to drain out the pus and covered her arm with a hot compress. The next day the swelling had gone down so she forgot all about it.

Two days later, she woke up feeling nauseous and feverish. With no visible abscesses, she figured she had come down with the flu. After a week of worsening symptoms, Cara begged her boyfriend to take her to the hospital. At this point, she could not get out of bed. The boyfriend gave her a shot of heroin and she went back to sleep.

The next day, she woke and could not move her legs. She called me and explained what was going on. I picked up my best guy friend(knowing I could not lift Cara on my own), and sped to the boyfriend’s apartment. My buddy lifted Cara out of bed, into the car, and we drove straight to the E.R.

After a couple hours of tests, a doctor notified Cara that, the infection from her abscess had spread to her bloodstream. She now had abscesses up and down her spinal cord. Cara was put on a cocktail of I.V. drip antibiotics in the hopes of killing the infection. The doctor informed us, if Cara made it through the surgery to remove the abscesses on her spinal cord, she may never walk again.

Thankfully, a year later, Cara is alive and walking. However, the 18-inch scar straight down her back is a constant reminder of how quickly things can go wrong when access to clean needles is limited.

Since most users are ashamed to go to the hospital, these infections frequently result in death. With proper injection training and access to clean needles and alcohol swabs, we can drastically reduce this number.

The Sharp Facts

Infectious Diseases

Access to clean needles results in some addicts sharing needles. As a result, rises in diseases, such as HIV, Hepatitis C and Hepatitis B, have been reported. According to DrugRehab.com,

• 40 percent of I.V. drug users contract Hepatitis C within two years of their first injection
• 50 – 80 % of I.V. drug users contract Hepatitis C within five years of their first injection
• 53 percent of the 17,000 new cases of Hepatitis C in 2010 were among I.V. drug users
• Each year, approximately 10 percent of new HIV diagnoses are the result of injection drug use
• Since the beginning of the HIV/AIDS epidemic, injection drug use has been responsible for 1/3rd of adult and adolescent AIDS cases in the country
• Read full text here.

MRSA and other Infections

An article written by Basseti and Battegay notes “infections, in particular soft tissue infections (cellulitis, skin abscesses), are the leading cause for emergency department visits and hospital admissions of drug injection users.”

Needles used to inject drugs are not meant to be used more than once. However, most users save their needles because it is difficult to find new ones.

MRSA is commonly referred to as the “superbug” of bacteria because it is extremely antibiotic-resistant.  Many are not aware that MRSA is not only found in the hospital, but also on most of our skin.

Every time a needle is reused, the risk of infection increases. One reason is increased exposure to bacteria. The more times a needle is uncapped, the higher chance it has of coming into contact with bacteria. Many users, especially the homeless, are not able to practice perfect hygiene, increasing the risk of bacteria exposure.

Another reason for the increased risk of infection is every time a needle is reused, the point becomes duller.  I.V. users repeatedly inject in the same area and, over a period, scar tissue develops. Once this scar tissue develops, a user has to force the needle into the skin, further dulling the needle with each poke.

Without access to new, syringes, a user is forced to reuse dull needles, increasing the development of scar tissue. After a period, many I.V. users grow frustrated and skin-pop or muscle their injections. Skin popping is injecting directly below the skin and muscling is injecting deeper into a muscle. These practices also lead to infection. Any foreign substance under the skin, like a shot of heroin that did not make it into a vein, will signal the body to defend itself. The body forms a protective barrier around the missed shot and an abscess is born.

Dull needles, dirty needles, bacteria on the skin, and missing injections all contribute to the increasing infection rates among I.V. users. All of this can be prevented with easier access to clean syringes and better education of safe injection practices.

Nothing to Lose

All this data and we still argue whether needle exchange programs are necessary?  This is just unbelievably STUPID. (Excuse the less than eloquent language, but it does not take a rocket scientist to understand access to clean needles would greatly decrease disease transmission and infection rates among I.V. drug users.)

The argument that access to needles would increase I.V. drug use is comical. When I started using opiates, the thought of whether I could get readily get syringes NEVER crossed my mind. Granted, had I completed a pros and cons list beforehand, I may have taken this into consideration! (Note the sarcasm, please!) Sorry, but the ability to acquire needles is not taken into consideration when deciding to use I.V. drugs.

The 2016 Surgeon General’s Report, Facing Addiction in America states:

“Harm reduction programs provide public health-oriented, evidence-based, and cost-effective services to prevent and reduce substance use-related risks among those actively using substances, and substantial evidence supports their effectiveness. These programs work with populations who may not be ready to stop substance use – offering individuals strategies to reduce risks while still using substances. Strategies include outreach and education programs, needle/syringe exchange programs, overdose prevention education, and access to naloxone to reverse a potentially lethal opioid overdose. These strategies are designed to reduce substance misuse and its negative consequences for the users and those around them, such as the transmission of HIV and other infectious diseases. They also seek to help individuals engage in treatment to reduce, manage, and stop their substance use when appropriate.”

I have bolded some of the important information for review. Hopefully, this report can spark some change in the way we think about harm reduction programs like clean needle exchanges or allowing syringe purchases without a prescription at major pharmacies.

Where can I buy clean needles?

Shot in the Dark Arizona

Limited access to clean syringes is a common issue faced by I.V. drug users. In Arizona, syringes are classified as drug paraphernalia and, if caught in possession of syringes, you may be charged with a felony.

Fortunately, despite the risk of prosecution, a non-profit organization called, “Shot in the Dark,” is leading the way in harm reduction by handing out safe injection kits to drug users.

When this program was first launched, a group of volunteers would meet users anywhere in the valley to hand out clean syringes. The popularity of the program led the organization to set up meeting sites around the valley. An I.V. user calls a cell phone number and the meeting site locations, days and times are listed on a voicemail recording.

If the I.V. user can make it to a meeting site, they are given a safe injection kit. The kit includes a few packs of clean syringes, metal cookers, clean cotton for filtering, medical-grade ties (to properly cut circulation and make veins pop), alcohol swabs, and Narcan. Narcan is a lifesaving drug that can be administered in the event of an overdose. If a user is interested, the volunteers are happy to give out referrals to detox or treatment centers.

Surprisingly, Phoenix-area law enforcement has turned a blind eye to these needle distributions sites set up by Shot in the Dark. An anonymous officer stated he and many of his colleagues, on the low, support the program because it decreases a risk they face daily, being jabbed by a dirty needle while conducting a search.

If you live in the Phoenix-area, you can call Shot in the Dark at West Valley-623.738.5539 and East Valley-602.456.9811

For more information of the history and mission of Shot in the Dark, click here: Shot in the Dark

Other States and Nationwide

At a national level, the debate persists.

Republicans argue the government should not help people use illegal substances by giving them the means to inject.

Democrats argue prevention.

At this point, with the epidemic our country faces today, it should not matter what side of the aisle you are on. Clean needle programs provide the resources needed to prevent disease transmission. Program staff is educated on local treatment options and needle distribution sites provide a forum for users considering treatment to review their options.

Many cities have funded programs like Shot in the Dark, but they have yet to be implemented nationwide. Some states have needle exchange programs where users can hand in dirty needles and receive clean ones in return.

What about the Pharmacy?

Depending on the laws in your state, you may be able to purchase syringes from your neighborhood pharmacy. Some states allow the pharmacy to set their own policies. Some pharmacies leave discretion on whether to approve a sale of syringes without a prescription to the head pharmacist.

It is important to know the laws pertaining to carrying syringes in the state you reside in. This database found on LawAtlas.org seems to have the most detailed information on state-specific syringe laws.

Arizona Pharmacies

Walmart pharmacies tend to be the most lenient on syringe sales in Arizona. However, this does not apply to all Walmart pharmacies and you may be turned down. If you find a Walmart willing to sell syringes, you can purchase a box of 10 packs, 100 total syringes.

Arizona-based Walgreen’s pharmacies leave the decision to sell syringes without a prescription to their pharmacist. Therefore, depending on which pharmacist is on duty, you may be turned down. If you find a Walgreens that will sell to you, a purchase is usually limited to 3 packs of 10 needles, 30 syringes total.

CVS seems to be the most strict on syringe sales without a prescription in Arizona, but occasionally, the pharmacist allows it.

What do I say to the Pharmacist?

Pharmacies will refuse to sell you syringes if you admit to being an I.V. drug user. This is understandable because no one wants to be complicit to illegal behavior.

If asked, your best bet is to say the syringes will be used for injecting insulin or health supplements, such as liquid B-12. Some pharmacies require proof your insulin prescription was filled by their pharmacy. Keep in mind, liquid B-12 and other health supplements that are taken by injection can be bought online, so it would not be possible to show proof of prescription with their pharmacy. It is unfortunate a reason need be provided at all, but I would rather encourage a small fib than risk more complications from shared and reused needles.

Lastly, know what type of syringe you are buying before you are asked at the counter. Typically, syringes used for injecting are:

• 1 CC
• 50 or 100 Units
• ½ or ¾ Inch needle length
• 28, 29, 30, or 31 Gauge.

If you sound educated, the pharmacist will be less suspicious.

Buying Syringes Online

The most common place to find syringes online is on diabetic supply websites.  However, syringes can also be purchased online for the use of vitamin injections and other medical purposes not requiring proof of prescription.  Keep in mind, by purchasing online, you agree you are over 18 years of age AND that you intend to use these hypodermic needles for the treatment of diabetes or for another legit medical purpose.    If you meet these criteria, you can use the links below to order online.

Click on the size you prefer and a purchase window will open. The links will take you to Amazon, where you will find BD brand syringes.  BD brand is one of the most trusted healthcare suppliers in the world.

Short Tip Insulin Syringes

• 31 Gauge
• .5 CC
• 5/16 Inch Needle
• 1 box includes 90 syringes
• Price: 35.98

Long Tip Insulin Syringes

• 30 Gauge
• 1 CC
• 1/2 Inch Needle
• 1 box includes 90 syringes
• Price: 35.00

Here are some other products that help prevent infection:

• alcohol wipes (300 for ten dollars)
• Tourniquets aka ties (12.98 for 100 ties and they throw in 100 alcohol wipes)
• sterile water (100 5 ml bottles for less than 15 dollars)

IMPORTANT:  I am in no way encouraging the illegal use of these products.  I am simply providing links to sites where syringes may be purchased.  If you purchase syringes using these links, you agree to abide by Amazon’s policies and state law regarding syringes purchases.

Needle Disposal

Needles should always be discarded in sharps’ needle disposal containers. The containers are the same ones used for medical needle disposal. Containers can be purchased online. Needles should never be thrown straight into the garbage, even if they are capped.

I’d like to think if you do this, and a garbage man gets poked, you are in for some bad karma. However, you are probably just in for a pissed off garbage man. It’s just a crappy thing to do. If you can not afford to purchase a sharps’ disposal container, bring your used needles to a local emergency room for disposal. While using, I frequently took advantage of the needle disposal containers hanging on the bathroom wall in most casinos. They are there for diabetics, but no one will mind if you use them!

Click here to buy a syringe disposal container for less than ten dollars.

How to Clean Needles

I hope this post provides some helpful information for I.V. users looking to acquire clean needles. However, I am not jaded in any way. As scary as these statistics are, users will not stop sharing and reusing needles until clean needles are made more readily available.

In the meantime, if you do not have access to clean needles, the CDC has published the most effective way to clean needles. Steps include:

1. Fill the syringe with clean water, shake for 30 seconds, and rinse
2. Fill the syringe with PURE BLEACH, shake for 30 seconds, and empty.
3. Fill the syringe with clean water, shake for 30 seconds, and rinse.

Click here for the CDC’s recommended steps to clean needles.

Personally, I recommend leaving the bleach in the syringe for a few minutes and rinsing out the syringe 3-4 times with clean water after emptying the bleach from the syringe. This might be overkill, but what do you have to lose?

DISCLAIMER:

Many readers may be angry with me for writing this post, but I implore them to return to the statistics listed above. Until access to clean needles is permitted nationwide, the negative societal effects will persist. In the meantime, a user should be aware there are ways to get clean needles.

If a user is not ready to quit, forcing reuse of needles will do nothing to encourage a user to quit. In fact, contracting diseases and painful infections will do just the opposite.  Receiving a positive HIV test and or feeling the pain of having an abscess cut open will only work to force a user deeper into addiction.

Let’s make some changes focused on keeping our users healthy, so they have a future. Without a future, treatment becomes less likely. After all, how does one recover when DEAD?

If you are not ready to quit, please take the advice given. Safe shooting.