Does Sioux Falls need a needle exchange?

Stray needles aren’t unheard of in Sioux Falls.

The state’s largest city has dealt with waves of methamphetamine use for years, and plenty of users prefer injection. Heroin arrests have inched up, too, as neighboring states cope with a surge in arrests for the injected opiates.

So it hasn’t been a complete shock to Julie Schoolmeester to see discarded needles on her runs through the city. She works in the recovery field, after all, so she knows Sioux Falls isn't Mayberry.

What’s surprised her recently has been the frequency of the needle sightings.

“It used to be something I’d see every once and a while,” said Schoolmeester, executive director of Face It Together Sioux Falls. “It seems like it’s everywhere now.”

Schoolmeester wants people to know that intravenous drug use is more widespread than the general public might imagine, and there's more than a handful of incidental needle sightings to bear that out.

Arrests for controlled substances in Sioux Falls – including methamphetamine and heroin – climbed from 496 in 2013 to 804 in 2015.

In 2013, there was one heroin arrest. Last year, there were eight. There have been six so far in 2016.

Attorney General Marty Jackley frequently cities a potential wave of opiate abuse in South Dakota during his discussions with reporters, and he pushed for legislation to allow first responders to carry and use an antidote. Last week’s confirmation of a fatal heroin overdose in Selby was a sign of things to come, he said last week.

“The addiction to heroin is devastating, and we must keep this drug out of our state," Jackley said.

South Dakota had 42 cases of accidental drug overdose deaths in 2014, and the news release said several were related to heroin.

Schoolmeester wonders if it might be time for the city to think about a needle exchange program, in which users can trade old needles for new ones without fear of prosecution. Such programs aim to cut HIV infections in communities where intravenous drug use is prevalent and to trim the number of needles thrown into the streets.

“It’s just disconcerting,” Schoolmeester said. “To me, it’s people getting high in a car and tossing the evidence.”

Hike in arrests concerning

Sioux Falls Police Chief Matt Burns is aware of the trends. Heroin is appearing on the police radar. Even without heroin factored in, however, IV drug use would have grown alongside meth arrests.

“I have to believe that the discarded needles are most likely coming from a methamphetamine user,” Burns said.

The SFPD has met the upward trend in controlled substance arrests with a ramp-up in activity from the Sioux Falls Area Drug Task Force, which investigates drug operations in a city, county, state and federal partnership. The 809 controlled substance arrests last year and the 4,333 grams of methamphetamine seized are signs that the problem is real.

“Those are numbers I’m not comfortable with,” Burns said.

The ripple effect of drug abuse can be more concerning, Burns said. Families suffer through bouts of meth-induced paranoid and violent outbursts and money disappears quickly, leaving many addicts ready to turn to crime to support their habits.

The city’s seen a series of shootings in 2016, and “we have very little doubt that those are drug rips,” Burns said.

“Those addictions don’t care, they want to be fed. Sometimes, people turn to criminal behavior to support that,” he said.

The heroin that’s showing up in Sioux Falls is coming mostly from Chicago, Minneapolis or the Pacific Northwest, Burns said, and represents a new challenge for drug investigators.

State braces for heroin epidemic

Needle exchanges part of drug discussion

The question of the law enforcement response to drug use is only one in a long series of questions communities ask themselves when drug use ramps up.

South Dakota already has realigned its criminal justice system to make room for drug courts through a 2013 criminal justice overhaul. The law also created a presumption of probation for low-level felonies and drug crimes and funneled money into treatment programs.

In Sioux Falls, the Second Judicial Circuit is poised to add a third drug court this fall to run along with two existing drug courts and a DUI court.

Needle exchanges have been in place in some parts of the country for decades. Such programs are part of an approach to drug abuse known as “harm reduction,” a concept that describes everything from methadone clinics for opiate addicts to SafeHome, the county-sponsored apartment complex for formerly homeless alcoholics that monitors but doesn’t ban alcohol consumption.

In Minnesota, the state health department coordinates needle exchanges through pharmacies. Its website says “no area of HIV prevention has been more thoroughly researched” than needle exchanges and says the programs don’t increase drug use and “can be implemented without harmful social repercussions.”

Advocates for needle exchanges say there are no drawbacks to be seen.

“There’s not a shred of evidence that needle exchanges promote people to move to injection drugs, but we have very solid evidence that they prevent HIV, and we have evidence that they prevent Hepatitis C,” Sharon Stancliff of the Harm Reduction Coalition said.

Exchanges are meant in part to prevent outbreaks in areas where IV drug use is prevalent. Indiana earned national headlines last year after more than 190 cases of HIV infection hit the town of Austin, which is home to fewer than 5,000 people.

Needle exchanges also help keep drug needles off the streets, Stancliff said, as users usually bring in old needles to trade. Police in cities with exchange programs also tend to call program employees for cleanup when needles are found in the community.

Volunteers in Fargo-Moorhead opened a needle exchange late last summer called the Good Neighbor Project. Moorhead Police Chief David Ebinger told the Fargo Forum that he endorsed the program, calling it “a response to a problem.”

No quick embrace of needle program

The same story from Fargo last fall had Clay County Sheriff Bill Bergquist saying he was “a little unsure” what to think of the needle exchange in Moorhead.

In Sioux Falls, discussions about a needle exchange haven’t started. Some pharmacies in Sioux Falls offer sharps disposal buckets, which can be filled with old needles and returned for disposal, but there aren’t trade-in locations.

Kari Benz, Director of Minnehaha County Human Services, says the question hasn’t appeared in any formal way yet within the public health community in Sioux Falls.

“Is it a possibility? Yes. But if there have been discussions about it, I haven’t been a part of them,” Benz said. “We just haven’t gotten there yet.”

Selby man died of heroin overdose

Benz doesn’t see an exchange as a program the community would jump into quickly. Police, health systems, elected officials and community partners need to be on the same page and agree that there’s a need. It took years of discussion and study to bring SafeHome to fruition, Benz said.

Burns said he’s willing to be a part of any discussion about the community’s approach to drug problems, but has serious doubts about needle exchanges. Alcohol is legal. Controlled substances are not. A program that offers safe spaces for people who might be breaking the law doesn’t sit right with the chief.

“It sends a contradictory message, and I’d have a hard time supporting it,” Burns said.

Burns and Benz both said statistics for diseases and arrests and the cost to the community need to be studied closely to determine a need.

There's more to the decision than arrest numbers. New HIV cases actually declined slightly from 2013 to 2015, dropping from 36 statewide to 25.

Dr. Andrew Solares, a physician with Avera Medical Group Emergency Medicine, said doctors in the ER aren’t seeing huge spikes in needle-related illness at this point. Even so, he said, concerns about heroin and increases in methamphetamine arrests shouldn’t be ignored.

Heroin antidote plan approved by medical board

A push for closer monitoring of prescription opiates and the resulting increase in price of the often-abused pain medications play into the recent wave of heroin use. The Centers for Disease Control recently released a set of guidelines for the management of chronic pain that call for more careful prescribing of painkillers, as well.

Addicts introduced to opiates through OxyCodone or Hydrocodone are now finding that street drugs are cheaper and easier to get.

Discussions about addiction, treatment, law enforcement and public health needn’t be reactive or polarizing, Solares said. All the options should be on the table, he said, and facts should dictate the response.

“It needs to be a community discussion that gets into the nitty-gritty,” Solares said. “We don’t need to politicize this.”

John Hult is the Reader's Watchdog reporter for Argus Leader Media. Contact him with questions and concerns at 605-331-2301, 605-370-8617, twitter.com/ArgusJHult   or  Facebook.com/ArgusReadersWatchdog.