By Beverly Creamer
Advertiser Staff Writer
A jump of 29,000 needle exchanges last year could mean that the state is reaching as many as 1,000 to 2,000 more drug users in its life-saving syringe exchange program, according to the state’s independent consultant.
The needle exchange program is aimed at preventing the spread of HIV.
However, New York consultant Don Des Jarlais said there has been a big jump in the use of methamphetamine, or "ice," by that same group of people — Hawai‘i’s heroin addicts who inject their drugs.
"Heroin is still the dominant drug, but 20 percent of heroin users are now adding methamphetamine," said Des Jarlais, who has analyzed the program since its beginnings in 1990. It is estimated there are between 10,000 and 20,000 users who inject drugs in the state.
"There are reasons for concern," said Des Jarlais. "We haven’t seen it yet, but amphetamine (also known as ‘crystal meth’ or ‘ice’) is more likely to set off violent behavior than heroin ever would.
"It makes you crazy and it’s more likely to make you paranoid."
Des Jarlais said he thinks this group is looking for "a new high" because, a year earlier, only 6 percent of this population was "shooting" both drugs together.
The combo "may give a similar effect as the old ‘speedball,’ a combination of heroin and cocaine," because the neurochemistry is similar, he said.
"It’s been described as the best aspects of a cocaine ‘rush,’ with heroin taking off all of the unpleasantness and anxiety. It’s called going fast slow."
In his annual report, Des Jarlais said Hawai‘i’s successful syringe exchange program continues to keep the virus that causes AIDS from spreading beyond 1 percent of the targeted population.
And he said that workers are reaching even more users because of a new program called ISES — Individual Scheduled Exchange Services — that sets up individual exchanges at the user’s convenience.
Almost one-quarter of the annual 219,000 exchanges statewide were done by appointment.
"It reaches people who wouldn’t otherwise do nearly as much exchanging," said Des Jarlais, a professor of epidemiology at the Albert Einstein College of Medicine in New York and director of research for the Edmond de Rothschild Foundation Chemical Dependency Institute at Beth-Israel Medical Center, also in New York.
"It gets to those people further away and in more rural areas."
Des Jarlais said this is the first good documentation of how well this new appointment service works, and how much it can increase the number of dirty needles being exchanged for sterile ones.
"It has probably increased by 10 percent the numbers of people exchanging needles," he said.
While the numbers of needles exchanged have increased, Kaua‘i is just now getting an effective system, said Des Jarlais. The latest statistics show that only 167 syringes were exchanged on that island for the whole year, compared to 142,000 on O‘ahu, 34,000 on East Hawai‘i, 11,000 on West Hawai‘i and 31,000 on Maui.
"The program has already taken steps to improve the activity on Kaua‘i," said Des Jarlais. "They’ve gotten in new staff and the rates will definitely be going up.
"On the Neighbor Islands it’s a matter of the outreach workers making contact with drug users. You have to find the people and establish trust. On O‘ahu you can park a van in a spot and the drug users will find it."
In addition, Des Jarlais said the state is looking for money — it could cost $1 million or more — to vaccinate this high-risk population for hepatitis B.
Already the hepatitis B and hepatitis C viruses — both of which can cause liver failure — are spreading in this group. There are from 4 percent to 8 percent of users who inject drugs infected with hepatitis B and from 45-60 percent infected with hepatitis C.
The Centers for Disease Control and Prevention in Atlanta provides free hepatitis B vaccine for those 18 and under. There is no vaccination for hepatitis C.
"There are efforts being made at CDC to change that and get free vaccine for those over 18 and in high-risk categories," said Des Jarlais.
With little extra money for such programs, the state is instead trying to distribute more of the paraphernalia (bottle caps and cotton balls) used by those who inject drugs. The practice of sharing paraphernalia is likely responsible for spread of the deadly hepatitis viruses, he said.
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