Needle Exchange
in Vermont
Needle Exchange in Vermont
by Mark Melchior
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Nevertheless, after overcoming other regulatory hurdles, two needle exchange sites have opened recently, one in Burlington and a second in Brattleboro. OITM wanted to find out how things are going with these fledgling programs. We decided to check in with Tom Dalton, coordinator of the Green Mountain Needle Coop for the Howard Center for Human Services in Burlington, and Lynn Martin, a prevention specialist who oversees the Brattleboro site for the AIDS Project of Southern Vermont [APSV]. We caught up with Tom and Lynn on a cloudless summer afternoon in Barre, at the recently renovated Alrich Public Library.
Getting Connected
OITM: Let’s start with your program, Tom, since it has been in place a little longer. If I needed to get clean needles, how would I do that in Burlington?
Tom Dalton: You’d probably begin by calling us. We have an outgoing message for our site with the time and place of the next exchange. We do print this information in our newsletter and other hand-out materials, but we’ve tried to be low-key about publicity. If you haven’t seen any of our literature, you should call and listen to our message. We are what is called a mobile, multi-site needle exchange and that means that the time and place varies week to week.
OITM: So let’s say I’ve called the number, gotten the information, and now am walking in the door at the exchange site, what can I expect?
TD: Well, it’s very informal, very low key. There are no lines to wait in. There are usually only one or two people exchanging at any one time. Usually, two staff people are on hand to welcome you. We ask you, first, if you have any needles, or other supplies to dispose of. If you do, you dispose of them first, in the sharps container next to the door.
If you are new to the site, we explain to you that your identity is kept confidential and anonymous. Then we ask you about what you need. Some people come just to pick up literature, or get information from us. If you come to exchange needles, we take time to answer any questions you might have about them or other supplies, and explain how to become a member of the needle exchange.
OITM: What’s involved in becoming a member?
TD: If you choose to become a member of the needle exchange, and pretty much everyone does, you get an I.D. card with a unique identifier. That card protects you against violating the paraphernalia law.
After people get their cards, they usually want to look around at the supplies we have, and ask questions.
OITM: It sounds as if you have a wide range of injection supplies?
TD: Yes, we do. And you know, many people don’t really know how to use them correctly. They may know not to share a syringe, but they don’t know that sharing a cooker, for example, puts them at risk, too. Heroin use in Vermont has grown so rapidly over the last couple of years that a lot of new users are not necessarily learning from experienced users.
As a consequence, there is a lot of misinformation and ignorance out there. Some users don’t know that when they stop using, they will experience withdrawal.
OITM: Lynn, let’s talk about what happens at the Brattleboro site.
LM: Well, it actually is very similar to what Tom described except that the Brattleboro site is open two evenings a week at a fixed site. It is very informal, anonymous and confidential. You come in, dispose of anything you may have brought to exchange in our sharps container at the front door. We ask you how we can help, and then enroll you as a member, if you agree, and issue your card. As Tom said, almost everyone wants to become a member, and it’s truly in your best interest to have the card.
When we were just getting started, I filled a bag full of the things that we were planning to have on hand at the site, and took it to the police. I met with the assistant police chief, and dumped the bag’s contents out onto his desk and said, Now if you picked me up and found this stuff on me, would you arrest me for possessing any of these things? He assured me that as long as I had the card from the needle exchange with me, that the police wouldn’t.
I should also mention that the Brattleboro exchange has peer educators on hand. They tend to be able to put people at ease very quickly. These are folks who have been there and know what folks who come through the door are experiencing.
OITM: Since it’s called a needle exchange, do you actually exchange needles one-for-one?
LM: We do exchange one-for-one but there is nothing in the guidelines to forbid other ways. If you are new, and don’t have anything to exchange, we will give out up to ten needles to start. We help people where they are at; it’s never been about a strict one-to-one exchange. I wouldn’t want the responsibility of turning someone away for not having needles.
And, of course, you don’t have to exchange needles to come to the exchange. You can come and get condoms, or find out about Hepatitis, or get referrals for treatment. You may want just to talk with a peer educator about whatever is going on in your life.
Harm reduction: What does it mean, How does it work?
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OITM: Let’s talk a little bit about the theory behind needle exchange? The folks who brought us the ‘drug wars’ would say that if we give needles to users then we are encouraging people to be addicts. Obviously, you don’t believe that. Tell us why.
LM: My priority is to prevent HIV. That’s my job, to keep people free of this virus. We who work on prevention [at the AIDS Project of Southern Vermont] practice what is called harm reduction. It involves asking the folks we serve — and we serve a number of different kinds of people at risk for transmission, what is first step you can take toward health? What are the tools you need to make that step? And, how can we support you in that?
If they tell us that what they need is clean needles, we help them to get clean needles. From there, we hope that we can start a conversation so that they feel comfortable coming to us when they have identified other ways that they can be healthy. Basically, my job is getting people to take care of themselves so that they can live healthier lives.
TD: I agree with everything Lynn said. Harm reduction focuses on those at risk making the best choices that they can about their health, and reducing drug-related harm. This approach differs from the use of law enforcement and some abstinence-based treatment which can focus simply on stopping drug use at all costs. When your sole goal is to end someone else’s drug use, you may end up putting that person, and the general public, at greater risk, because the user may not be able realistically to stop using drugs at the moment, and relapse or overdose.
OITM: So you both look at needle exchange from an HIV prevention perspective.
TD: Right. Just because someone is using injection drugs, it doesn’t mean that he or she is not concerned about their health. They know that there are steps they can take toward being more healthy. We try to support users through their relapses and elp them get back on track again as part of an overall harm reduction strategy for them that grows out of our concern about the transmission of HIV.
OITM: Has it been difficult to get people to come to your sites?
LM: Users are an invisible community, they cut across all demographics and they seldom identify themselves as a group. How do you get the word out about needle exchange to a group that doesn’t ever meet together, or consider themselves a community? We work closely with our peer educators but they only know who they know. We don’t know how many we have yet to reach.
I think we’ve had some difficulty getting people to our site because Brattleboro is a small town and people don’t feel as safe or as anonymous as they might in a larger city. It takes a lot more trust and a lot of time to build that trust.
OITM: Have you had better success in Burlington getting people to your site?
TD: Yes, and Burlington is obviously bigger [than Brattleboro] and maybe less threatening an environment. Plus our site has a lot of contact with people through the treatment side of things. That conduit has really helped us to reach people. We often get several calls a day, usually from people looking for treatment. Since we have a residential component at the Howard Center, I can meet people while they are staying there, and tell them about the needle exchange, and talk about relapse prevention and overdose prevention, too. I try to take that opportunity to tell users that relapse, for many people, is a part of their process of recovery, just like someone who goes on a diet, or quits smoking. A lot of people have to quit several times before it sticks.
OITM: Maybe Oprah should host a show …
LM: [laughing] Tom’s right. The medical research is showing is that the process is not one where someone gets addicted and then stops. It is more likely that this person will get addicted, stop, relapse, and stop again. That seems to be the pattern. Our model of harm reduction says, we will work with you wherever you may be in the recovery process.
Money and Politics (The short political history of needle exchange, and the prospects for continued funding)
OITM: Let’s back up a little. Could the two of you tell us how needle exchange actually got off the ground in Vermont?
TD: Well, Vermont was lucky in that it had a pre-existing law that allowed pharmacies to sell syringes without a prescription.
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LM: One important beginning came out of a certain AIDS Awareness Day at the Vermont State House. That is the day each year when the People with AIDS Coalition, Vermont CARES, the AIDS Project of Southern Vermont and other HIV/AIDS service organizations present their needs and concerns to the legislature. Part of the conversation that particular day involved Howard Dean. At some point, one of the many folks who had been advocating for needle exchange asked Dean point-blank if he would support needle exchange in Vermont, and he said that he would. From there, a group of people worked with the legislature to expand the then current law to allow AIDS service providers and hospitals to distribute injection supplies, and that’s where we started.
OITM: In terms of support, the Vermont Department of Health supervises your exchange programs but does not fund them. Who does?
TD: Most of our support in Burlington comes through private donations and from money that the Howard Center for Human Services, the sponsoring agency, scrapes together from funds not already tied to other programs.
LM: The AIDS Project in Brattleboro received a generous grant from a private foundation to start. I’m not sure that we will be able to reapply, and so future funding is not guaranteed. At this point, we do not have the numbers on the books yet that will qualify us for further funding. We compete with places in Miami and San Francisco for funds so you can see what we are up against.
TD: Neither of our needle exchanges get any federal, state or local money. In most places, that is not the norm; these sites are supported by state and local government. If these sites are to continue and to be successful, we are going to need to have state and local support, too.
What is success?
OITM: How do you measure success in these kinds of programs? And does your view of success match the views of your potential funding sources? TD: I consider every used syringe or other used injection supplies that we take in, and safely dispose of, is a success. Every time we hand someone clean injection supplies, making it possible for them to avoid HIV and Hepatitis C transmission — that’s success. And just making contact with people so that we can help them when they need it. If not now, then sometime down the road. Maybe it is with the criminal justice system because they’ve gotten arrested, or maybe they need help getting into treatment. You may not know it but getting into treatment is not easy these days. For a lot of folks, it feels like ‘I want help and no one will give it to me.’ We try to help people past such barriers, and at that, I think we have been very successful.
LM: I agree with Tom. And when I see a user advocating for him or herself, that for me is success.
But the groups who fund needle exchange want numbers, too. They want to know how many people we’ve seen, how many needles we’ve given out, how many referrals, etc. Our views of success don’t always match up neatly.
OITM: How would you characterize community response thus far?
LM: My experience as someone advocating for needle exchange in and around Brattleboro has been overwhelmingly positive. It seems to me that people are quite supportive when they know what they are supporting. But they usually have to be educated before they can be supportive.
There are all sorts of breakthrough moments, but I remember one particularly well. As we were getting ready to open the exchange, I had spoken to our chief of police several times as we were getting the site ready, and he seemed supportive but I didn’t really know how much. At one community meeting, he was asked whether he supported this work. And I held my breath, and then he said, “You know, this house [the site where the needle exchange is located] once belonged to my mother. And when I was a little boy, she used to feed hungry folks who came up from the railroad tracks at our back porch. Our neighbors did not like it, but that didn’t keep her from doing the right thing. And frankly, I feel like what the AIDS Project and the Needle Exchange are doing is just like what she was about.”
| Resources Green Mountain Needle Co-op Family and Friends of IDUs Support Group in Burlington Brattleboro Needle Exchange Vermont Harm Reduction Coalition and |
Mark Melchior is a freelance writer who lives in Guilford. You can contact him at marmel@sover.net.