PSU Magazine Fall 1988

Cooperation has already been secured from a Seattle agency much like Outside In , said Maynard . In order to receive clean needles as part of the Portland project, participants must be self-admitted IV drug users age 18 and over, have physical evidence of needle tracks, and bring dirty needles to ex– change. They will also be invited to assist in the research project by agreeing to regular blood tests, a short questionnaire every three months and a long NIDA questionnaire every six months. Data will be collected on the subjects' recent drug and sexual behavior, including whether they shared needles or used condoms. "It's so important not just to give free needles and do nothing else," said Oliver. "That's why the educational component is absolutely crucial." The year-long, $67,000 research project will not be able to answer these questions definitively, admit Maynard and Oliver, but they see it as "a start" and "an icebreaker." Some of the ice that has jammed other needle exchange projects proposed in Boston, New York, and San Francisco was navigated easily by the Portland pro– ject. "The laws and the political climate are such that we can do it," said Oliver. Because the possession of needles and syringes is legal in Oregon, law enforce– ment officials "see no need to take a public stand ," said Oliver. Also adopting a wait-and-see attitude are the mayor, the governor, Multnomah County's Alcohol and Drug Program, and Outside In's funding sources. State and county health officials have offered technical assistance, and letters of support have arrived from the World Health Organization and the Surgeon General , reported Oliver. Opposition to the needle exchange project has come from the head of Oregon's alcohol and drug abuse programs, who advocates handing out bleach but not needles ; from Lyndon LaRouche supporters, who picketed Outside In this summer; and from the conservative Oregon Citizens Alliance, which has promised to focus on the needle exchange once it has finished challenging the governor's recent policy against sex discrimination. Perhaps because of the emotionally charged atmosphere that seems to envelop the concept of needle exchange, the Portland project is foundering on the problem of insurance. Not only has Oliver been unable to find affordable in– surance for the project, but Outside In's regular insurance carrier has said it will not renew its policy with the agency if the needle exchange is launched . During these start-up delays , the stalled New York needle exchange program was given the official go-ahead and may beat the Portland program into operation. ... it is common for a drug seller to inject heroin or cocaine into the buyer at the time of sale. .. That's okay with Maynard and Oliver, whose concern for a growing public health crisis transcends the notion of "firsts." "New York should have been first ," said Oliver. It has been estimated that 60 percent of that city's 200,000 IV drug users have already been infected by HIV, she said . That compares with a four to five percent infection rate among the 7,000 - 10,000 heroin , cocaine and "crack" injectors estimated to be in the Portland area , according to state and county health statistics. Given this comparatively favorable pic– ture of Portland , why a needle exchange project at all? "We have a real opportuni– ty to do prevention here," offered Oliver. Add to that the sobering fact that if Portland's infection rate continues to dou– ble every year as it did from 1986 to 1987, 100 percent of the IV drug users could be infected by the end of 1993, noted Maynard . " Everyone's eye is on the needle," remarked Maynard, "but that's the easy part. It's a problem of affecting the culture of the user, changing the behavior and habits that represent a kind of social bonding. Shooting up is a social behavior." (Cynthia D. Stowell, former PSU Magazine editor, is a Portland free-lance writer and photographer.) "We don't have the shooting galleries that they do in New York ," said Oliver. "But there's definitely sharing. The homeless people can trade sex for drugs, but coming up with the money for needles can be an obstacle. "And the street kids often function as sort of a family for each other. There's a lot of kinship and trust that goes on. I would think this would spill over to using needles. It's a sign this person is your friend - you trust them and they trust you." Both researchers agree that the fear of AIDS is not enough to discourage needle sharing and drug abuse. Said Oliver, " People will come in and say, 'Yeah , I know about AIDS so I'm careful never to share with anyone I think is gay.' There are lots of misconceptions about how the virus is or isn't transmitted." " I think the public is counting on the fright of getting AIDS to stop people from taking drugs," said Maynard . "But these people are often attracted to danger, titillated by it. And the penalty of AIDS is too deferred. For people who are used to the immediate risk of an overdose, the eight-year latency period for AIDS has no meaning." I n a state where hypodermic needles and syringes are readily available at pharmacies without prescription for 45 cents apiece, or as low as 14 cents in bulk quantities , why would free needles be attractive to addicts? "Strict legal ac– cessibility is not the same as true acces– sibility," said Maynard. "They are often harassed and refused outright (by phar– macists)." And the psychological process of denial may keep them out of the stores, said Maynard. "Many drug users maintain the personal fiction that they are not drug users." So, in reality, many IV drug users get their "works" on the streets for a dollar apiece and no guarantee of sterility. Or, said Maynard , in Portland it is common for a drug seller to inject heroin or co– caine into the buyer at the time of sale, using the same needle and syringe over and over. Opponents of needle exchange programs are apt to view experimental providers as little more than drug peddlers with clean needles. Both Maynard and Oliver are a PSU 19