Programs where drug users exchange dirty needles for clean ones benefit public health, the U.S. surgeon general said during a visit to Phoenix on Wednesday.

Needle exchanges cut down on the spread of diseases such as Hepatitis C and HIV, Dr. Jerome Adams told The Arizona Republic Wednesday morning during a visit to the Phoenix Indian Health Center.

The programs also get people misusing drugs into the treatment they need, he said. 

Needle exchanges, also called syringe services programs, remain illegal in Arizona. Some programs exist, but they operate largely under the radar.

‘The science is clear’

Arizona Rep. Tony Rivero, a Republican from Peoria, for a second consecutive year has introduced legislation that would decriminalize needle exchanges in Arizona.

Rivero’s bill also would require needle exchange programs to connect clients with needed services, including HIV education and mental-health counseling, and ensure that clients have access to the opioid-overdose-reversal drug naloxone.

Similar legislation failed last session. Critics frequently argue that needle exchanges encourage illicit drug use.

But the science is clear that needle exchanges connect people to care, get them into recovery, and prevent the spread of bloodborne diseases, said Adams, who was nominated by President Donald Trump and confirmed by Congress in 2017.

“I can’t tell Phoenix or Arizona what to do, but it is my job to say, ‘Here’s your data and here are some tools that might help you improve your outcomes,'” Adams said. 

“What I want communities to do is have a conversation about their burden of disease, in this case substance-use disorder, coupled with hepatitis and HIV, and talk about what is right for them. I hope that the science is a major part of that conversation.”

Adams was credited with helping to end a rural HIV epidemic in Indiana when he was that state’s health commissioner under then-Gov. Mike Pence by pushing to legalize needle exchanges there.

Asked whether Gov. Doug Ducey would support legalizing needle exchanges in Arizona, spokesman Patrick Ptak cited Rivero’s bill and said Ducey does not comment on pending legislation.

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Ptak added that Ducey has taken many other steps to address the opioid epidemic in Arizona.

Phoenix an HIV ‘hot spot’ 

Adams is working on a national initiative to reduce new infections of HIV by 75 percent in the next five years. Maricopa County is one of the 48 “hot spots” for new infections that federal officials are targeting across the U.S.

Hot spots were chosen based on federal data on where most new infections are occurring. While several factors are driving new cases, an emerging number are related to injection drug use, he said.

At least two Arizonans per day died of an opioid overdose in 2017, with heroin deaths 36 percent of the total. Though final numbers aren’t out yet, there’s no sign the number declined in 2018.

Investing in getting people diagnosed could make a huge difference in preventing more spread of the disease. And preventing HIV saves money in the long term, Adams said.

“If we can get them treated, we can also prevent new infections from occurring,” he said.

Phoenix residents can expect more “opt out” testing for HIV by health providers as part of the national initiative, Adams said.

Opt-out testing means patients are tested unless they say no — something already in practice at the Phoenix Indian Health Center’s HIV Center of Excellence.

Adams toured the Phoenix HIV center along with Rear Admiral Dr. Michael Toedt, Indian Health Service chief medical officer.

The local medical center in 2018 saw a decrease in the number of new HIV infections among its Alaska Native and American Indian patients, marking the first time in four years its number of new infections has declined.

On average, the center sees 25 new infections per year. Last year the number was 12, although the number of tests remained consistent with past years, center data show.

One difference could be that Indian Health Service last year began providing coverage for a medication for patients at risk of HIV infection. The medication is called pre-exposure prophylaxis, or PrEP.  PrEP can reduce the risk of HIV transmission if taken daily.

“If we can get more of our hot spots around the country to adopt the best practices that we are seeing here, then I am confident we will achieve our goal of 75 percent reduction in HIV infections in five years,” Adams said.

Toedt said one of the center’s keys to success is the way it addresses the “social determinants of health” by helping patients with transportation, jobs, spirituality and mental-health services while treating their physical ailments.

Personal stories and stigma

Earlier Wednesday, Adams told medical students and professionals at the University College of Medicine Phoenix that more of them need to be carrying naloxone.

They may know cardiopulmonary resuscitation, but carrying naloxone is becoming important, too, since so many opioid overdoses occur in private settings like homes, he said.

“We’ve got a long way to go to getting more people carrying naloxone,” he said. “Naloxone is not enabling drug use but saving a life and connecting people to care.”

He also told them about his younger brother, who is serving a 10-year prison sentence for a property crime related to his substance use disorder. His brother had been self-medicating for his anxiety and depression, he said. 

“One of the things we have to do is continue to share our stories and encourage other people to share theirs,” he told The Republic. “It’s easy to say that substance use disorder is a moral failing or a choice when you think it’s just these bad people who you have no relationship with.

“But when you hear that the brother of the Surgeon General, who grew up in the exact same house as the Surgeon General, who has the exact same parents as the Surgeon General, who had the exact same environment around him, succumbed to substance use disorder, then all of a sudden you start to re-think that.”

Addiction is a disease that changes the brain, Adams said.

“Yes, there are bad decisions involved. But in many cases, those bad decisions are much more likely when you are under the influence and when your brain has been changed by substance use,” he said.

“That’s one of the reasons I am so concerned about youth using e-cigarettes and youth using marijuana. We know that, particularly up to the age of 25, the brain is still developing and both nicotine and marijuana can prime the brain for future addiction. It sets you up to be susceptible. “

Do you have an opinion about needle exchanges? Reach the reporter at stephanie.innes@gannett.com or follow her on Twitter: @stephanieinnes

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