El Paso County needle exchange appears dead after hitting Board of Health roadblock

By: Jakob Rodgers
December 4, 2017

In this March 24, 2016 photo, Paula Maupin, the public health nurse for eastern Indiana’s Fayette County, holds one of the syringes provided to intravenous drug users taking part in the county’s state-approved needle exchange program, which is housed in the county courthouse in Connersville, Ind. The cash-strapped rural county, which is facing a hepatitis C outbreak among IV drug users, is one of the Indiana counties to win state approval for the programs that provide those users with clean needles to reduce needle-sharing as a way to stop the spread of HIV, hepatitis C and other diseases. But Indiana’s counties have to find their own funding for their exchanges because state funding is banned from supporting them. (AP Photo/Rick Callahan)

A needle exchange won’t be opening in El Paso County for the foreseeable future.

The proposed program met swift opposition from most of the county’s nine Board of Health members during their meeting Monday morning, running aground over the same concerns of enabled drug use that doomed a similar proposal four years ago.

Though no formal vote was held this time, a majority of the board directed El Paso County Public Health employees not to work with a nonprofit seeking to create an exchange on Colorado Springs’ west side – effectively killing the proposal. “There are other compassionate ways to address this that need to be brought forward,” said El Paso County Commissioner Longinos Gonzalez.

The move came despite pleas from infectious-disease doctors and other health care professionals who called the program crucial to stemming the rising tide of hepatitis C cases, which have more than doubled since 2013.

Leaders of the Colorado Health Network, whose southern chapter proposed running the exchange, reacted with fatigued disappointment Monday.

“Anything that we said today wasn’t going to matter,” said Darrell Vigil, the nonprofit’s CEO, speaking specifically of Gonzalez.

They vowed to hold a community meeting and to continue advocating for a Colorado Springs exchange. But money set aside for a location here will be spent elsewhere in the state, they said.

“These programs save lives, they protect citizens,” Vigil told the board. “It is the responsibility of the Board of Health to protect citizens.”

The decision marked the latest chapter in the nonprofit’s five-year effort to bring an exchange to Colorado Springs – the only major city along Colorado’s Front Range not to have such a program.

Advocates – typically doctors and health care professionals – called the program a vital resource amid a nationwide epidemic of heroin and illicit-opioid use.

“What we have to do is take the risk necessary and realize this is a benefit to this community,” said Dr. Erik Wallace, who leads the University of Colorado School of Medicine’s Colorado Springs Branch.

The Centers for Disease Control and Prevention touts the concept as a proven means to cut down on bloodborne diseases, reducing overdose deaths and needle stick injuries among firefighters, police officers and sheriff’s deputies.

Still, some Board of Health members said they wanted more proof the program would work, particularly since hepatitis C rates are rising across the state, including in counties where needle exchanges exist.

The number of hepatitis C infections across the state rose by more than 60 percent from 2013 through 2016, reaching 4,906 cases.

Cases in El Paso County, however, have more than doubled in that time, alarming El Paso County Public Health’s medical director, Dr. Christine Nevin-Woods. New cases jumped from 247 in 2013 to 576 last year, and another 635 cases have been reported through Nov. 30 this year.

Meanwhile, new infections of HIV – an autoimmune disease that’s much more difficult to transmit – have largely hovered between 28 and 42 new infections every year.

Some experts pointed out that the some of the increase may be due to the epidemic of heroin and illicit opioid use gripping the nation. And they argued that drug users risked sepsis by not having access to clean needles.

“The cost of treating the complications of IV drug use far outweigh the cost of prevention,” said Dr. Betsy Kleiner, of the practice Infectious Disease Specialists. “So if we are interested in conserving taxpayer money, its in our best interest to proceed with preventative care.”

Such advocates were outnumbered, however, by opponents of the exchange – many of them neighbors who feared it would lead to more people using drugs and littering the community with their syringes.

“This is so in my opinion absolutely foolish,” said Luke Fallentine, 24, who identified himself as a recovering heroin user. “It’s telling people there’s a safer way to do drugs.”

Daniel Mutek told the board that he sees needles often on his runs throughout town, and he feared seeing more with an exchange in town.

“Additional needles in our community is only going to mean additional users,” he said.

El Paso County Sheriff Bill Elder dispatched one of his lieutenants Monday to drive home his opposition. He has taken issue with the program not operating on a one-to-one exchange rate for needles.

At Pueblo’s exchange, for example, visitors who bring back used syringes – no matter how many – can get 70 unused needles in return. Those who bring nothing can get 40.

“This is a community problem,” said El Paso County sheriff’s Lt. Bill Huffor. “But if this passes, the burden will be shifted to law enforcement, just like homelessness is. It’s a significant public safety risk.”

But one-to-one exchanges are not best practice and are “unlikely to be realistic in any case,” according to Dr. Daniel Shodell, medical director for the state health department’s disease control and environmental epidemiology division. “You want to provide a service that folks will use,” said Shodell, who did not attend Monday’s meeting. “It’s sort of self defeating to be too strict about it.”

The Southern Colorado Health Network, formerly known as the Southern Colorado AIDS Project, began reaching out to El Paso County leaders in 2012 about a possible exchange near Eighth and Cimarron streets – an effort that ended a year later with the board’s 6-3 vote against it.

It revived the idea in 2016, and it arranged for five of the board’s members to view a similar exchange at work in Pueblo last year. The idea also has been informally discussed in several meetings over the past year and a half.

On Monday, the nonprofit brought its first formal proposal in four years to the board – proposing a new location more than 2 miles to the northwest, at Pikes Peak Metropolitan Community Church, 1102 S. 21st St.

It would have operated one day a week and allow visitors to pick up unused syringes, as well as drop off used needles for safe disposal. It also would have included several other services, including disease tests and treatment referrals, and the drug naloxone, which can quickly reverse an opioid overdose.

The odds of a proposed exchange reappearing before the board anytime soon appear slim. One of the board’s three proponents, Manitou Springs City Councilwoman Coreen Toll, will leave the board in January when her term expires. And new Board of Health members are selected by El Paso County commissioners, who have passed a resolution unanimously opposing any such exchanges.

“It’s pretty likely that whoever they’re going to seat is going to be against this as well,” Board of Health President Kari Kilroy said.

“This matter is dead,” Kilroy added.

Board members in addition to Gonzales who opposed the exchange were Commissioner Peggy Littleton; Dr. James Terbush; Victoria Broerman, a registered nurse; and Doris Ralston, the Colorado Springs Osteopathic Foundation’s executive director and CEO.

Colorado Springs City Council President Richard Skorman voiced concerns about its location and implementation, among other issues. But he also noted a desire to save lives and said he wanted more information on the issue, and sought another meeting.

Advocates included Toll, El Paso County Coroner Robert Bux and Kilroy.

EDITOR’S NOTE: This story has been updated to correctly reflect Richard Skorman’s position on the issue.