New skills

I untwist the paperclip, bending it carefully around the shiny silver bottle cap, making a handle. With a plastic spoon, I scoop a small amount of the white powder from the Ziploc bag, pouring it into the bottle cap, careful not to spill any.

It looks so harmless.

Next, I tear the tip off of a squeeze tube of sterile water. Squeezing at the middle I fill the bottle cap half full of water, add a wee tightly spun cotton ball, and I’m ready to go.

Holding the “works” in my right hand, I flip a Bic, and begin cooking, holding the tip of flame under the bottom of the cap. Its silver surface turns sooty. In half a minute, bubbles appear. The handle is getting hot in my fingers. The solution starts to boil. I’m supposed to cook it at least 45 seconds.

I always thought that if I did something like this, it would be under a dark bridge somewhere on a foggy night, not a brightly lit conference room on a work day.

Life is full of surprises.

The power dissolved, it’s time. I uncap an insulin syringe, harpoon the mini cotton ball with the tip of the needle, and draw up the warm fluid. The cotton ball is a low tech filter, keeping any un-dissolved crystals out of the syringe.

It’s full.

I roll the syringe between my fingers, feeling it’s warmth. The cold, sterile plastic has become a living thing. I marvel at the feel. How many cold syringes and room temperature syringes have I held in my hands in my life? Too many to count. But this one . . . wow. It’s special. Alluring. Magical. Wonderful.

Even the ritual is addictive.

I tap out the bubbles to the top of the syringe with an expert thump of my finger and gently advance the plunger to get them out without wasting too much of the clear fluid.

I swab the inside of my elbow with an alcohol pad, starting above the vein and swirling outwards. Quickly, I grip the end of the tourniquet in my teeth, wrapping the other end around my bicep, around, under, over. The baby-blue tourniquet is tight around my arm. The vein bulges. It’s ready. It’s time.

I hold the syringe in my left hand, bevel of the needle upwards, 45 degree angle to my arm, and then I slowly lower the needle. It gently kisses my skin above the swollen vein . . .



“Good!” shouts the instructor, “now if this was real, you’d slide the needle into the vein, pull back on the plunger until you see a flash of blood, release the tourniquet (I pull back on the tourniquet by pulling my head up and to the side—the tourniquet snaps off), and shoot up.”

Yep. The State of New Mexico is teaching me how to shoot heroin.

Say what?!

OK, remember how I told you the world is not black and white? But rather, it is a million shades of gray? Well, my world just got grayer.

My clinic is in the process of becoming a certified needle exchange center for intravenous drug abusers. Now hear me out before you freak out. I’ll be first to admit that this is a controversial subject, and it took my boss a full year to convince our community board to go along with it.

So what is needle exchange? Well, it’s what it sounds like. We give junkies brand new clean, sterile needles in exchange for used ones.

Why on earth would we do that?

Because junkies share needles. And sharing needles shares blood. And you should never, ever, ever share blood with anybody. Ever. All kinds of bad shit lives in blood. Hepatitis lives in blood. All three kinds. HIV lives in blood. Need I go on?

And like you can’t judge a book by its cover, you can’t judge a persons’ blood by their looks. There are skuzzy folks with clean blood and sweet little old ladies with AIDS.

Our state has done needle exchange since 1997. Of course we’re not idiots. We call it “Harm Reduction,” instead of “needle exchange.”

Last year we gave out 2.9 million BD insulin syringes to IV drug users. Yeah, that blew my mind too. We also give out pocket sharps holders. We used to give out tourniquets, cookers, cotton balls—everything a proper junkie needs. It’s almost as much paraphernalia as it takes to be diabetic. But State budget cuts have us reduced to the bare-bones basics right now.

So why was I being trained how to properly shoot up heroin? So I can teach others, of course. OK, here’s the thing. There is a right way and a wrong way to shoot heroin into your veins. Do it wrong and you trash your body more than just the heroin alone will do. You blow out your veins. You get ulcers. You cost the tax payers extra money at the ER.

One of my nurses was outraged. She felt we were encouraging drug use. A lot of people feel that way. But you know what? If people choose to use heroin, they are going to do it. With access to help or not.

Now, I used the word “junkie” for dramatic effect in this post. I don’t really feel that way about drug users. They’re just people. And people get addicted to all kinds of things that are bad for them. Tobacco, too much alcohol, excess food, sex with strangers. But they—we—are all still just people. I don’t care what color your skin is. I don’t care what your sex or age is. I don’t care how much or little school you’ve had. If you are a member of the human race, you deserve something as basic as health care.

So needle exchange actually is harm reduction. If we accept you as you are, and treat you to minimize the harm you are doing to yourself, we help us as much as we help you. We lower our society’s health care costs by keeping you as healthy as possible. We reduce the spread of pathogens that may someday spread to us if we ignore you. Or to our children. The availability of clean needles reduces the risk our children will play with dirty ones they find in our parks, our alleys, and our vacant lots.

Users can enroll in our program anonymously. They are literally just a number. They also get a “get out of jail free” card. Any one enrolled with the state’s Harm Reduction program can’t be arrested for carrying their gear. We also give out Narcan, a nasal mist that brings an overdose back from the other side. It’s the opiate addicts’ version of Glucagon.

The State’s program has also had an unexpected consequence. Every site that has been established sees a drop in drug use within 18 months.

Why?

Because junkies become people. They develop relationships and trust with the staff at the clinics. While we give needles we have the chance to bandage scraped knees, treat illnesses, and begin to mend broken hearts and minds. We have a chance, one little step at a time to bring those on our fringes back into the fold. And when they are ready, and not a second before, we will be there to help them beat their addictions.