Fighting stigma and regulations, VA gives clean needles to veterans who use illegal drugs

For nearly half of his life, Duane, a 64-year-old Navy veteran, used methamphetamine. He first tried it at a party with friends, but said it quickly became a way to numb the pain of troubled relationships and the challenges of transitioning out of the military in the 1970s.

“Trying to block out what I was feeling and trying not to think about it,” said Duane, who asked that we not use his last name due to his illegal drug use.

Duane is a patient at Orlando VA Medical Center and in 2020 became the first veteran to enter the hospital’s syringe services program.

The program provides veterinarians with clean needles, sterile water, fentanyl test strips and other supplies. It aims to reduce some of the risks associated with injecting illicit drugs. Patients usually receive a two-week supply. Whether a vet needs ten needles or 50, staff members said they would provide them without judgment.

“We meet patients where they are,” said Jacqueline Byrd, clinical pharmacist and one of the program’s leaders.

“We don’t condone drug use, we don’t condone drug use. But we know that not everyone using the program is ready to quit now,” she said.

Infection prevention

Needle exchange programs have been around for decades, but they are relatively new to Veterans Affairs. The first launched in Danville, Illinois in 2017, followed by Orlando. The VA said there are now eight in the country and more are growing.

In addition to supply kits, veterans can get mental health treatment and overdose prevention instruction, among other harm reduction services.

“You have the equipment, you have the tools to work and be safe,” Duane said. “And there were times when I didn’t have it and I was worried trying to think the needle could come up in that vein, and it went away. So I had to learn those things, like not put in and take out the same.

Duane has HIV and could pass it on to others if he shares supplies. According to the VA, needle service programs are a “key component” of a federal initiative launched in 2019 to end the HIV epidemic.

Infectious disease doctor Minh Ho said people who inject drugs can also get hepatitis C or B, as well as skin abscesses, vein damage and inflammation of the heart known as heart disease. ‘endocarditis.

He added that people with drug addiction are more likely to engage in high-risk sexual behavior, which can contribute to the spread of infection.

It’s the harms, and of course the harms don’t just affect the veteran,” Ho said.

Helping some vets quit drugs

In addition to cost savings, research shows that people who participate in needle programs are five times more likely to enter drug treatment and about three times more likely to quit drug use, according to the Centers. for Disease Control and Prevention.

It worked for Navy veteran Jose, whose last name we don’t share.

“It’s a program that saved my life,” he says.

Jose, 39, served in the Iraq war and said he had mental health issues when he returned. He used drugs and alcohol to cope, and he connected with VA care after attempting suicide.

He learned about the needle services program when he told his doctors that he was injecting drugs and was “terrified” that he would get HIV or hepatitis. Like other veterans of the program, Jose was able to enter drug treatment and received PrEP, a drug to prevent HIV.

Jose said he’s sober now, but has a needle kit in case he relapses.

“As anyone who is an alcoholic or drug addict knows, it’s a day-to-day thing, one day at a time,” he said. “I’m trying to fight for my life, and they have tools. It’s empowering for a veteran to know they have those options out there.”

Barriers to expansion

The VA is expanding its needle service programs, but there are roadblocks. In about a dozen states, needle exchanges are illegal. Hospitals have also had to circumvent federal restrictions on using public funds to purchase items that could be considered drug paraphernalia.

The Orlando team helps other VAs meet these challenges, according to Byrd. She wants more programs to open up because she said they help reach vets who might otherwise avoid the VA.

“They need a safe place to know that I can still get health care and can still be cared for even though I’m going through a very stigmatized medical condition,” Byrd said.

Ho said Orlando only served 18 veterans. even though it is one of the most important programs of the VA.

“Veterans are reluctant to admit they use drugs, and I also think providers are reluctant to feel comfortable asking questions about it,” he said.

Ho said program staff tell veterans that disclosing their drug use will not cost them VA benefits. They are also educating health workers to be more compassionate when talking with patients about substance use and sexual behaviors. Their next priority is to get out into the community to find veterans who are not currently in the VA system or who face barriers to care like lack of housing and transportation.

Of the 18 patients in the program so far, Jose is one of two vets who have quit using drugs.

Duane said he wasn’t here yet. He eventually wants to quit drugs, and VA Needle Services Program staff said they will stay with him until he is ready.

“I want to be myself again, but I don’t even know who I am anymore because I’ve been through this cycle up and down over and over again,” Duane said. “It’s difficult, it’s a fight.”

This story was produced by the American Homefront Project, a public media collaboration that reports on American military life and veterans. Funding comes from the Corporation for Public Broadcasting.

Copyright 2022 North Carolina Public Radio – WUNC

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