A regional social services group says it’ll provide Ulster County addicts with clean needles, training in the use of anti-overdose medication, HIV testing and other services designed to stem the tide of death and disease caused by the raging local heroin epidemic.
The program, run by the multi-county Hudson Valley Community Services Inc., will use a mobile headquarters and teams of “peer delivery” workers to reach out to addicts in urban centers like Kingston as well as those living in hard-hit rural communities like Woodstock.
Hudson Valley Community Services’ “Project Reachout” is already active in Orange and Dutchess counties where they work with addicts in Poughkeepsie and Newburgh. The program uses street-level outreach to connect addicts with services ranging from inpatient rehabilitation to clean needles. The non-profit hopes to begin outreach operations in Ulster and Sullivan counties in May. Project Reachout recently established an office in Lake Katrine; staffers there are in the process of researching locations, particularly in Ellenville and Kingston, where a mobile clinic could set up shop a few days each week.
“We really want to make ourselves known in Ulster County,” said program director Melinda Pokela. “We’re trying to make a connection in those communities because there’s a real need for our services there.”
The mobile clinic is regulated by the state Health Department, which will also have to sign off on the times and locations where it can operate. The clinic will offer addicts a place to drop off used syringes and get new ones. Staff will also offer onsite testing for HIV and hepatitis C — diseases commonly transmitted by needle-sharing. Addicts can also get information on ways to reduce the damage caused by IV drug use and referrals to drug treatment programs.
“We can be a point of contact so that when people are ready to go into treatment, we can get those services in place,” said Jackie Perez, who runs the group’s Ulster County outreach effort.
The plan also calls for peer educators, often addicts themselves, to circulate among local IV drug users with backpacks holding 10 packs of fresh needles, containers for safe disposal of used syringes and educational materials. The peer educators, Perez said, would be able to reach addicts in more rural areas or those who might be unwilling to show up at a public clinic.
“Anybody can do syringe exchange,” said Perez of the peer delivery program. “But especially people who are familiar with the injecting drug population and where they are.”
First, do less harm
Project Reachout and similar programs embrace a philosophy known as “harm reduction.” Harm reduction, as the name implies, seeks to reduce the damage addicts do to themselves and society while recognizing that some may never reach a state of total abstinence or, if they do, only after a long disengagement process where periods of sobriety are punctuated with episodes of relapse. Harm reduction programs include needle exchange programs which seek to halt the spread of HIV and the danger posed by carelessly discarded syringes; methadone maintenance, which replaces heroin with a similarly addictive, but legally prescribed opiate substitute; and equipping heroin addicts with overdose-reversing medication like Narcan. In Europe, Canada and Australia, addicts can get high under medical supervision in “safe injection rooms” which also offer access to health and rehabilitation services. Such a room was proposed for Ithaca by that city’s mayor, Svante Myrick, last month. Advocates say harm reduction has proven more effective at saving lives and stopping the spread of disease than the traditional all-or-nothing approach of abstinence-based drug treatment.
“It would be great if no one used drugs at all, especially intravenously, but that’s reality,” said Shayna Micucci, a social worker and co-founder of the Route 212 Coalition, which helps coordinate drug education and treatment efforts in northern Ulster. “It’s also reality that there are some really bad, really scary diseases that come with needle-sharing.”
But harm reduction efforts have also faced criticism from those who believe accommodating addicts sends a mixed message about the consequences of drug abuse. Former U.S. attorney general John Ashcroft, for instance, once likened providing clean needles to addicts with handing bulletproof vests to bank robbers. But Daniel Raymond, policy director of the Harm Reduction Coalition, said those attitudes are fading in the face of the severe heroin epidemic hitting the nation’s suburbs. Raymond said the coalition was seeing an increase in suburban and rural communities emulating the kinds of harm reduction efforts that have been in place in big cities since the AIDS epidemic of the ’80s and ’90s.
“Most of the research on needle-exchange programs came out of the ’90s and all of the major questions [about their effectiveness] have been settled for a long time,” said Raymond. “But you have a lot of smaller cities, rural areas and suburbs that took a pass at that time because they thought it wasn’t a big problem in their communities. Now that’s changed.”
Calls to County Executive Mike Hein and the Ulster County Health Department for comment were not returned.