The last time we reported about the Fresno Needle Exchange, it was an illegal program, operating without support from policymakers and under threat of police intervention. It became legal in 2012 under a state law. Now, the program is more popular than ever, and new research suggests it’s making the community safer.
Michael lives in north Fresno. He’s 56. He studied social work and he’s now self-employed. He has a daughter in nearby Dinuba.
He doesn’t want to share his last name, though, because he’s addicted to meth. A few years ago, he was in a pretty tight spot when he couldn’t find a clean needle. “When I lived in Hollywood,” he says, “I remember one time I had to cut the needle in half, I had to glue the rubber back onto the plunger, and had to sharpen the needle with a matchbook in order to use it again.”
Needle sharing and reuse are huge problems. They can spread infections and disease—especially here in Fresno, ranked among the top 25 U.S. cities for HIV prevalence. And a 2004 study estimated Fresno has the highest rate of injected drug use of any city in the country.
Michael says he hasn’t shared or reused a needle in about three years. That’s when he started visiting the Fresno Needle Exchange, a grassroots program that trades dirty syringes for unused, sterile ones.
Part needle bank, part clinic, the exchange takes place in a quiet cul-de-sac near Fresno’s Roeding Park, in a line of tents propped up against a big yellow 1960s-era school bus. It’s open from 1-3 p.m. every Saturday, all year round. In just two hours, this all-volunteer program serves around 200 people, primarily users of heroin or meth. They drop their needles onto a metal tray that empties into a biohazard bin, and they pick up clean needles—sometimes hundreds of syringes for multiple people.
“We average 16,800 syringes every Saturday,” says needle exchange director Dallas Blanchard. “Our record is just under 24,000 in a 2-hour period.”
For its first 18 years, the program operated illegally. Its location changed frequently, volunteers were occasionally arrested, and funding was unstable. Now, four years after a state law made it legal, it’s got state funding, and a new study shows it’s succeeding in improving public health.
The program’s mission is to slow the spread of infectious diseases like HIV and hepatitis C, and to reduce infections from reused needles. After clients pick up their clean syringes, they’re offered alcohol wipes, cotton balls, clean cookers, and sometimes condoms and pocket-sized biohazard containers.
Next door, inside the bus, is a free medical clinic, with seats ripped out to make cubicles, file cabinets, and exam tables for Dr. Marc Lasher. During the week, Lasher runs a methadone clinic; here, on Saturdays, he treats complications from dirty needles and helps patients manage mental illnesses and diseases like diabetes.
One woman, a 30-year-old culinary school graduate who prefers not to use her name, is seeking treatment for an infection where she injected meth near her thumb. “The swelling was creeping up my arm and it got to about here,” she says, pointing to her elbow. “Everybody was begging me to go to the hospital but they treat you so badly, and I said, ‘if I could just make it till Saturday and I could come see Dr. Lasher, then I would feel a lot better.’”
When she tells him she injected into her hands because she’s got too much scar tissue elsewhere, Lasher suggests an alternative: rehab. “I’ve heard of that; I’ve read it in books,” she laughs. “I would like that.” He advises her to ditch her friends who use drugs and load up on Gatorade to get her through the first hardest days.
Forty-seven-year-old David Saldana, also seeing Lasher for an infection, doesn’t know if he wants to get sober. But he struggles with the idea that, perhaps, his addiction is being enabled. “That's the double sided sword of this,” says Saldana; “that we want to quit, but then we're taught how to do it better.”
Lasher asserts he’s not enabling; he’s addressing David’s immediate medical need—as directed by the U.S. surgeon general. If David doesn’t want rehab, Lasher will make doing drugs as safe as possible.
And according to a new study, the program has done that. Researchers surveyed 106 needle exchange users about their habits and needs. Almost half reported they used to share needles and no longer do. Close to 20 percent no longer reuse needles.
Kris Clarke. a social work professor at Fresno State and the study’s lead author, says the research uncovered other interesting patterns, too. For some clients, the program was their only access point to social services and health care. And that’s because they say it’s one of the only spaces where they feel accepted for who they are. “It’s a good space,” she says. “Many people said it had changed their behavior, it had made them feel safer, it kept them in some way connected with services.”
This year, the needle exchange is on track to hand out close to 900,000 syringes, marking its biggest year yet. And just think: that’s 900,000 times HIV won’t be shared.