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A big increase has occurred in drug users starting to inject amphetamines, an annual evaluation of the state's syringe exchange program reveals. Syringe exchange clients
boost amphetamine useIsland program makes gains
By Helen Altonn
Star-BulletinAbout 20.4 percent of syringe exchange clients reported injecting amphetamines last year compared with 6 percent or 7 percent the previous year, said Don Des Jarlais, who conducted the study.
He said he believes the increase is partly due to the availability of methamphetamine in Hawaii. He said he doesn't know if drug users chemically modify the drug before injecting it. Most of those injecting amphetamines also inject heroin, he added.
Des Jarlais, research director at the Chemical Dependency Institute at Beth Israel Medical Center in New York City, reported his findings today to the state's Syringe Exchange Oversight Committee.
The Community Health Outreach Work Project was established by the state Department of Health in 1989. Hawaii was the first state to start a syringe exchange program in 1990.
The law requires annual evaluations, which Des Jarlais has done for four years. "Things continue to go well," he said in an interview. "I would say even better."
He said 219,000 syringes were exchanged from September 1999 to September last year -- setting a new state record. The previous year's total was 193,000.
Peter Whiticar, chief of the Health Department's STD/AIDS Prevention Branch, said he's "always amazed at such an increase year after year." It's due to a number of factors, he said. "On Oahu, we're doing a better job of getting out to where users are because we have a fully mobile program. We're using vans a lot."
Also, the Big Island has a peer approach where injection drug users, particularly in rural areas, are telling other drug users they can and should benefit from exchanging needles, he said.
The peer program is reaching drug users who were avoiding the exchange program because of fears of confidentiality, Whiticar said. "We're looking at this as a national model for rural areas."
Des Jarlais agreed that it could be a national model. "We're in the process of writing it up to put in scientific literature because it's doing so well," he said.
Another development is what the Community Health Outreach Work Project calls "individually scheduled exchange services," he said. Outreach workers make contact with drug users, then set up a meeting for an exchange, he said. "That has sort of taken off in the last year."
About 50,000 of the total syringes exchanged last year were done through individually scheduled exchange services, he said.
It is a popular approach because of "confidentiality and convenience -- two very important things in any health-related service," he said.
Des Jarlais recommended that special attention be given to amphetamine injectors to try to make sure they always have clean needles and practice safe sex.
At some point, he said, additional drug use treatment probably should be developed for people injecting both amphetamine and heroin. He suggests continuing and replicating the peer education project from East Hawaii to other parts of the state and continuing and expanding ISES services if possible.
Among other findings in an annual evaluation of the state's syringe exchange program: Island program makes gains
About one-third of all AIDS cases nationally are related to injecting drug use. In Hawaii, it's about 17 percent or half of the national percentage.
It's declining because people with HIV infection and AIDS are dying and the rate of new infections appears to be very low, Des Jarlais said. "This is good news, particularly when one considers what's happening with HIV and drug-injectors in the rest of the world."