The Tip of the Needle

Although he’s never used it himself, Kevin Santry can teach you how to shoot up heroin. Packed into his SUV, Santry has everything you need (well, almost) to do the job: the little round metal cups you use for cooking the drug, dental cottons to strain out the gunk, alcohol swabs, rubber tourniquets for tying around your arm and, of course, needles. Santry will give you these things for free; he’ll even deliver them straight to your door. While he’s there, he might give you a pamphlet advising what to do if a friend overdoses while you’re shooting up together and you’re scared of the cops ("Stay until you hear the sirens get really close, then split").

Santry is director of the state-funded syringe exchange program operated out of Youth Development Incorporated, a 30-year-old community organization in Albuquerque’s South Valley. He’s a foot soldier in the battle to keep New Mexico’s drug users, and ultimately the rest of the population, healthy. He teaches heroin users to shoot up correctly because those who don’t know how to inject into a vein get infections that can spread to the heart and become fatal. He hands out complete drug kits because infectious diseases such as Hepatitis C and HIV can be spread through contaminated works. Besides drug paraphernalia, he dispenses vaccinations against Hepatitis A and B, soap, razor blades and Pampers, as well as referrals to a host of services, including drug and alcohol programs. He delivers syringes door to door to avoid conflicts with neighborhood associations that don’t want bunches of drug users near their homes and because it gives him a chance to interact with his clients.

Today, the clients include a man and woman who meet Santry outside their westside apartment with a red plastic "bio bucket" full of used needles. Both are Jesus-on-the-cross skinny. The man has had Hepatitis C for 14 years.

"I guess I’ve got it by now, too," says the woman with a shrug. They like the needle exchange program just fine. "We used to sharpen ’em on the floor," the man says.

This needle exchange work is not for the faint-hearted, but then again, public health work never was. In 1902, New York City health officials arrested an Irish immigrant cook named Mary Mallon whom they had determined was spreading typhoid fever to the people she cooked for. After Mallon was released and went back to work as a cook using a false name, public health officials re-arrested her and exiled her to an island in the East River for the rest of her life. She went down in history as Typhoid Mary.

A hundred years later, it’s hard to imagine public health officials wielding such power. As Laurie Garrett recounts in her masterful tome, "Betrayal of Trust," public health has been losing ground ever since its glory days at the turn of the last century, when zealous sanitarians could order diseased people into quarantine. Privatization of health care, erosion of federal funding, morality, politics and even civil liberties, as in the case of Typhoid Mary, can be at odds with public health goals.

But New Mexico, at or near the bottom of just about all of those health and well-being indicator lists, appears to be a leader in the public health arena, especially on issues related to drugs. New Mexico is one of two states that funds needle exchange (Hawaii is the other). Last year, New Mexico was the first state to distribute Narcan, an antidote to overdoses which state health officials say is responsible for nine "saves" so far. Since 2001, pharmacists can legally sell syringes to drug users without fear of prosecution. Health officials are currently negotiating to get methadone treatment into jails.

"The other states see us as treading new ground," says Don Torres, a 16-year veteran of the department who heads the Hepatitis, HIV and AIDS programs. Some credit for these changes is due to our fearless leader, Gary Johnson (Puff Daddy to his dueling partner, former drug czar Barry McCaffrey), though the political story is more complicated than that. The sheer number of injection drug users and their obvious impact on the state is probably another factor. (The Office of Epidemiology estimates the numbers at 14,000, but Torres believes the real number is at least double that).

How the Johnson-era programs and any further reform proposals will fare under a new governor is a subject of speculation. "Keeping Injection Drug Users Free of HIV and Hepatitis" is not a campaign message you’re likely to see on billboards this election season. Given Johnson’s almost single-minded pursuit of the drug issue, the gubernatorial candidates, unsurprisingly, just don’t want to talk about it.

"I can guarantee you that whatever they feel about it personally, drug reform is not going to be a central campaign platform," says Sen. Cisco McSorley, D-Albuquerque, a member of Johnson’s drug task force. "This is not going to be the dummy distracter issue of the season."

If public health crusaders of yesteryear were Victorians bent on bringing hygiene to the masses in order to prevent disease from spreading into their own middle-class neighborhoods, today’s crusaders are from a decidedly different subculture. Some are former or current drug users, and many, like Santry, distributed needles when doing so was still illegal. About 15 years ago, supplying clean needles was illegal just about everywhere. That didn’t stop Santry, then living in his native Jersey City. Heroin use was rampant, and for a time the city had the highest AIDS rate in the country.

"I was watching all my high school friends die of AIDS, so I guess you could say I got politically motivated," he says. But underground programs like the one in Jersey City couldn’t get enough needles to addicts. "There were not enough syringes to go around," Santry recalls. "If we gave out a syringe, we knew it was still going to get used many, many times. So it was symbolic, a political statement more than anything else."

All that changed when Santry moved to New Mexico and took a job with an above-ground needle exchange program here. New Mexico, compared to New Jersey, was needle heaven. Registered users bearing laminated ID cards could turn in dirty needles and get an equal number of clean ones. "We give people all the syringes they need," Santry says.

"That’s the only way you can ensure they use a clean one every time." And, remarkably, given a program that uses taxpayer money to provide addicts with beaucoup needles, complete drug kits ("Get your Kits on Route 66" was the slogan of a national syringe exchange conference held in Albuquerque in April), information on how to avoid getting busted and training in how to shoot up, New Mexicans, for the most part, have not freaked out.

There have been conflicts, however, between syringe exchange programs and their neighbors. As a result of an Albuquerque City Council vote last December, syringe exchange programs in the Duke City are now restricted to mobile units. However, the moral and political rhetoric of the type argued nationally by conservative groups such as Concerned Women of America ("Needle exchange programs put government in the role of subsidizing bad and addictive behavior") has been muted or absent.

Law enforcement, often an opponent, has also supported the program, or at least not opposed it. "We’re against legalization, but needle exchange seems to help people get off drug use and maybe eventually to become productive members of society again" was the mild comment of Albuquerque police spokesman Jeff Arbogast. The state’s district attorneys, who adopted a wait-and-see attitude at the outset, according to Torres, have come around to support the program.

Darren White, the former Department of Public Safety secretary who quit because of his opposition to Johnson’s drug reform proposals, says the health department needs to prove that syringe exchange in New Mexico is actually working. "In theory, [needle exchange] is great. But what is this program doing? Is it reducing diseases or is it just supplying clean needles to addicts?" White, now running as a Republican in the Bernalillo County Sheriff’s race, is also concerned that needle exchange is adding to the overall number of discarded dirty needles found on the street. "It goes without saying that not everybody’s going to be responsible," White says.

State Secretary of Health Alex Valdez says the generally positive response can be explained in part because New Mexicans have gotten more sophisticated about drug policy during the last four years. "People hear the term ‘legalization’ and that’s incendiary. They hear the phrase ‘drug reform’ and that’s kind of inflammatory. But talk about sound public health principles and you can build a fair degree of consensus around that," says Valdez, who says he’s convinced that his programs will be supported by the next governor.

But scientific evidence in favor of syringe exchange hasn’t necessarily translated into well-funded programs around the country. Syringe exchange is supported by the American Medical Association, the Centers for Disease Control and the National Academy of Sciences, all of which believe it decreases disease transmission while not increasing drug use, but 48 states don’t have legislation allowing for statewide funded programs. Many of the 200 programs around the country operate without authorization and face shortages, which undermine their effectiveness, according to a report by the Ford Foundation. Congress has renewed a ban on federal funding for needle exchange seven times. President Clinton didn’t act to lift the ban despite the urging of his Secretary of Health and Human Services, Donna Shalala, and President Bush is even less likely to do so.

Perhaps New Mexico has been more accepting of needle exchange because, says Torres, "It seems like everybody knows someone who is affected by this."

After four years of watching Johnson dueling drug czars on national television, it may be difficult to recall a time when the governor’s position on drugs was unknown. But that was the case in 1997 when Steve Jenison, the physician administrator for the infectious diseases bureau, testified before the Legislature on syringe exchange. Jenison reported on a study he’d directed on disease rates among injection drug users. Jenison’s study found that New Mexico is different from New Jersey in another respect. At the time of the study, less than one percent of injection drug users carried HIV, but 82 percent carried Hepatitis C. That meant that drug users were clearly spreading Hepatitis C through contaminated needles to other drug users. But HIV, which is more easily spread to the general population through sexual contact, hadn’t appeared yet.

The state health office saw it had a window of opportunity to ward off an increase in HIV. "(Syringe exchange) wasn’t Johnson’s baby in any way. It came out of the Department of Health," says Katharine Huffman, director of state-based projects for the Drug Policy Alliance, formerly the Lindesmith Center. But no one knew whether Johnson, who didn’t come out in favor of drug reform until after he was re-elected in 1998, would sign the bill. He did, of course, and later went on to give keynote speeches at needle exchange confabs.

Santry passionately believes that drug users’ access to clean needles has forestalled an AIDS epidemic among drug users. "It hasn’t happened here, and it hasn’t happened because of syringe exchange," he says, pounding the steering wheel, as he drives to his next delivery.

But health officials know that proving a negative is a hard thing to do. "The onus is on us to show how effective the program has been," says Vivian Amelunxen, HIV prevention program manager for the Department of Health. "It’s like asking how many people have not gotten HIV because you did this particular outreach. And that’s very difficult to answer."

A new study of infection rates among drug users could provide evidence that the program is helping slow disease transmission. The department hasn’t had the money to do such a survey, though given the very high rates of Hepatitis C and very low rates of HIV in 1996 Torres predicts there would not be much change.

The health department is preparing a "transition statement" on syringe exchange and other harm reduction in defense of the programs. "It’s unknown how a new governor is going to react to these programs, so we’re trying to anticipate that," says Steve Jenison. Says Torres, "We’ll cross our fingers."

"We’re no Gary Johnson," says Dave Contarino, campaign manager for Bill Richardson, a bit wearily. Contarino sounds like the last thing he wants to talk about is heroin and needles. He will grant, however, that the would-be Democratic governor wants to look at "creative and innovative ideas" for dealing with drug abuse and wants to continue with programs that have "proven to be effective."

Even if these programs are worthwhile, Johnson’s single-minded devotion to drug reform has been largely a waste of time in Contarino’s view. "If all that effort that went into drugs had been spent on education, on the economy, we might be somewhere by now," he says.

All of which was more forthcoming than the John Sanchez campaign, which didn’t call back at all. (Richardson has said he would support medical marijuana and Sanchez, while in the House, voted against it).

Green Party gubernatorial candidate David Bacon, who believes in expanding treatment and decriminalizing "at least marijuana," says, "If we put that money [spent on enforcement] into treatment and education then we wouldn’t solve the problem entirely, but we could get to a lot better place."

Johnson might have seemed a fumbling spokesman for the cause when in 1999 he first casually let it drop that he advocated the legalization of heroin. But Huffman says that as Johnson refined his message, he, and the drug reform movement, gained credibility.

"What sounded, because of the way it was first expressed, just sort of extreme and impossible and ridiculous evolved into a nuanced debate over a whole range of issues. He really did go out of his way to try to educate himself," says Huffman, who set up an office across from the Roundhouse expressly for that purpose.

She says the drug reform movement has gained enough momentum to continue post-Johnson. "It’s not going to be a high priority or high visibility issue for the next governor," she says, "but that may be better from a policy standpoint."

For Democrat McSorley the big hole in Johnson’s plan has been his lack of support for funding a major drug treatment initiative.

"The issue that still needs to be faced is funds for rehabilitation," McSorley says. McSorley believes more legislators would have supported both public health and sentencing reforms had Johnson been willing to spend more money for drug treatment.

In the last session, legislators and the governor compromised on a $9 million increase in treatment spending, to be split between the Department of Corrections and the Behavioral Health Services Division. Valdez points out that the additional funds represented a 30 percent increase in the treatment budget. But McSorley insists that is only a fifth of what’s needed to address the problem comprehensively.

"And he even balked at that amount," McSorley complains. "He wanted to spend $5 million and take it out of the tobacco settlement money, which would have created all kinds of problems for us. And this was in a year when we still had surpluses."

Since Johnson avoided campaigning on the drug reform issues, and the current round of candidates are, for the most part, avoiding talking about it, McSorley says the state still hasn’t had a real political debate about drug reform.

"But what we’ve seen is that it doesn’t seem to be a third rail issue either way," he says. "It crosses all kinds of ideological lines." Republicans who opposed Johnson on drug reform were re-elected, as were Republicans who supported the governor.

Nevertheless, McSorley is pessimistic that the next governor will want to take up the issue, given the perception that Johnson has been overly devoted to it, and given the price tag. "This isn’t something individual legislators can do on their own. We need the full-on support of a governor." For the public health crusaders, Johnson’s support has been "amazing," in the words of the state’s harm reduction coordinator, Phillip Fiuty, who distributed needles and even Narcan before it was legal. "It’s having someone in a position of authority who acknowledges what people do as opposed to just denying that it’s here."

Santry’s next delivery stop is a shooting gallery outside a dilapidated house. The woman who owns the house wants help fixing it up, but Santry tells her she needs to deal with her addiction first and reminds her to call the alcohol program he’s already referred her to.

"The City Council wants to know ‘how many needles did you get in, how many did you give out?’" Santry says, ducking under the open tailgate of his truck to get out of the broiling sun. "They leave the people out of the equation."

"At a certain point I figured out I was put on earth to limit suffering," he says with a Jersey accent and a shrug. "I guess I figure that’s what this is all about."

Barbara Ferry is a freelance print and radio journalist based in Santa Fe. She is working on a series of public radio documentaries about the Mexican border for Homelands Productions.

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