It was hot and supplies were low. But people kept coming to folding tables set up on a Sunday evening on the side of a central Phoenix street.
They came on bicycles, in cars and on skateboards. Wearing heels, flip flops and running shoes, backpacks slung over bodies gritty with sweat and dust, they came to get clean needles and safely dispose of dirty ones.
They were allowed 10 needles each, but no more. Some asked for condoms, fentanyl strips and alcohol wipes. But there were none of those on this night.
“If you could donate a penny to a dollar, it would really help out,” said Lisa Price, 35, as she handed clean needles to clients.
Price is a volunteer for Shot in the Dark, an 8-year-old group that provides both clean needles and the opioid overdose reversal drug naloxone to people who inject drugs.
A funding shortfall may force Shot in the Dark to close because the all-volunteer group’s resources have not kept pace with increased demand. It recently stopped offering clean needles on Tuesday and Thursday nights and may have to close down another site this month.
Gov. Doug Ducey signed Arizona Opioid Epidemic Act in 2018 after a special legislative session on ways to combat the opioid crisis. Much to the dismay of many in the public health community, the act’s multiple components did not include legalizing needle exchanges.
In the meantime, deaths from opioid overdoses in Arizona continue. There were two per day in 2017 and nearly four suspected deaths per day last year, provisional data from the Arizona Department of Health Services shows.
Shot in the Dark is the oldest and largest needle exchange program in Phoenix, and because of its murky legal status, it must operate under the radar.
The group typically has more than 5,000 client interactions per month. Last year, the group handed out 1.4 million individual syringes and had reports that the naloxone it distributed reversed opioid overdoses on nearly 2,900 occasions.
On weekends, group volunteers drive their own cars around the Valley, delivering clean needles and naloxone to people who are too sick or disabled to make it to one of the exchange sites on their own.
Shot in the Dark is a non-profit needle-exchange program operating in the Phoenix area. Nick Oza/azcentral.com
‘People plead with us’
“People plead with us to give them more than 10 needles, but we need to have enough to help everyone,” Price said. “Unfortunately, that’s the position we’re in now.”
Over three hours, a plastic coffee container set out on one of the tables for donations slowly filled up with small handfuls of coins fished out of pockets, bags, backpacks and pouches. Occasionally, dollar bills were added.
“Wish I could do more,” said a man in his 20s wearing green shorts after emptying a zippered pouch containing coins into the plastic container.
A middle-aged couple driving a late model Chevy truck pulled up toward the end of the night, accepted one bag of needles each and dropped a fistful of bills into the container before silently walk-running, heads down, back to their vehicle.
Non-profit Shot in the Dark wants to help keep people with substance use disorder as healthy as possible. The clean needles they provide prevent Hepatitis C, HIV and other bloodborne diseases. The group’s premise is based on a philosophy known as “harm reduction” — treat people with love and compassion no matter what choices they make while helping them stay as healthy as possible.
Many of the 13 to 15 core volunteers have had their own struggles with misusing drugs. Some were helped by Shot in the Dark themselves and want to give back. But in recent weeks, Shot in the Dark has not only closed needle exchange sites, it has also run out of supplies like alcohol wipes that those who use its services have come to rely on.
“It’s unconditional love. No judgment,” Price said as she handed out a bag of clean needles to a young man who arrived on foot.
Arizona repeatedly spurns needle exchanges
Needle exchanges in Arizona are not specifically outlawed, but they violate the state’s drug-paraphernalia laws. Efforts to legalize them statewide have failed for two years in a row in the Arizona Legislature. Critics frequently argue that needle exchanges, which are also known as syringe services or syringe access programs, encourage illicit drug use.
Numerous evidence-based studies show needle exchanges have a positive public health effect. Research shows needle exchange programs save money by preventing expensive medical costs associated with treating bloodborne diseases that can be contracted by sharing needles.
Needle exchanges also help connect people misusing drugs to important health services, including counseling, drug treatment programs and HIV testing.
CDC director Dr. Robert Redfield, a Trump appointee who was in Phoenix this week to promote HIV prevention, concurred that needle exchanges are an effective way of stopping the spread of infectious diseases.
“When it comes to safe-syringe programs, there is evidence that shows that they do have benefits in preventing HIV and Hepatitis C,” he said. “Individuals who engage with those programs are more likely to go into treatment for their addiction, and if they go into treatment for their addiction, they are more likely to be successful.”
Redfield said it’s up to individual states and communities to make their own decisions on whether needle exchanges fit into their prevention strategies.
Maricopa County is one of the 50 jurisdictions with a high number of HIV infections that federal officials are targeting across the U.S. as part of a national initiative, and that was one of the reasons Redfield was in Phoenix.
Local HIV rates also brought U.S. Surgeon General Dr. Jerome Adams — another Trump appointee — to Phoenix earlier this year. The most recent state data shows there were 768 new diagnoses of HIV in 2017, and most of them were in Maricopa County.
Adams supports needle exchanges, too.
During his visit, Adams said the science is clear that needle exchanges connect people to care, get them into recovery, and prevent the spread of bloodborne diseases.
“Science is on our side,” said Sarah Saucedo, who is Shot in the Dark’s media coordinator. “How many people have to die or get a disease before the Legislature responds to this like the health crisis that it is? … It is beyond disappointing.”
She said, “Syringe access is health care, point blank. Certainly, there is a growing trend of states and cities taking this into their own hands …There is no reason it shouldn’t be legal in Arizona, besides stigma and a lack of political will and urgency.”
Utah, a historically conservative state, legalized syringe access/needle exchange programs three years ago. In California, the most recent budget included a new one-time appropriation of $15.2 million over four years to support syringe access programs across that state, the California Department of Public Health confirmed.
Cities and counties often take the matter into their own hands. In Tucson, for example, the Pima County Health Department continues to operate a needle exchange that began in 1987.
Some U.S. cities are considering offering safe, supervised injection sites where people can inject drugs in a medically supervised, secure environment. Such sites already exist in Canada, Switzerland, Australia and Norway.
Ducey’s office did not respond to phone and email requests about his stance on needle exchanges.
The aim of the Arizona Opioid Epidemic Act was to identify strategies to reduce deaths, such as increasing access to naloxone, said Chris Minnick, a spokesman for the Arizona Department of Health Services.
“While public health recognizes this (syringe services/needle exchanges) can be an effective harm reduction strategy, it does not have an immediate impact on reducing deaths,” Minnick wrote in an email.
‘Some of these people are so depressed’
Shot in the Dark has cut its monthly operating costs to $5,000 per month, but that doesn’t come close to meeting the need, Saucedo said. A recent social media campaign has helped spread the word about the funding shortfall and monthly donors have increased, but more donations are needed to keep the program operating, she said.
“We’ve had to cut things in half in order to be solvent,” she said. “The legal gray area is a constant barrier to growth.”
The group receives no government money, and grants are hard to come by.
“What we do is considered a felony crime. We know we’ve been lucky so far,” Saucedo said. “We’ve managed to fly under the radar and the police don’t mess with us.”
But it’s frustrating to see Arizona elected leaders tout their success fighting the state’s opioid problem while the number of overdoses and deaths continue, Saucedo said. The state’s approach to restrict doctors from prescribing opioids is not addressing the root causes of addiction, she said.
“What we need is for the public to support syringe access now,” she said. “Long-term stability cannot be guaranteed until it’s legal … This issue is life and death for our participants.”
While one syringe costs a few cents, she said, a lifetime of treating diseases like endocarditis and Hepatitis C that people contract through sharing needles cost tens of thousands of dollars, Price said.
And while pharmacies technically sell clean syringes, many people who use drugs are fearful that pharmacists will turn them down or call law enforcement, Saucedo said.
“Once you’ve shared a needle even once, you assume you will get Hep C, and then you stop caring,” said 34-year-old Shot in the Dark volunteer Chad Brownfield, who used to be a client and said he wanted to give back. “Some of these people are so depressed.”
Brownfield, a former football player, said he began using heroin after becoming dependent on pain medication after back surgery. He has scars on his legs from infections due to dirty needles, and says he’s lucky he didn’t lose his legs. He recently served a prison term related to heroin use.
Gloria Halas, 57, handed out cold bottles of water, bananas, watermelon slices and bunches of grapes to Shot in the Dark clients on Sunday night.
Halas, whose daughter-in-law died of an overdose, has been volunteering for five years and spends her own money on the food. Her son is in prison on drug-related charges, she said.
She looked over at the people picking up needles and naloxone and putting nickels, dimes and quarters into the donation container as they left. By the end of the night they’d collected more than $150. Volunteers have always had the container out but only recently began verbally asking clients for donations.
“People who have nothing, they give everything they have,” Halas said. “It’s beautiful.”
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