Northwest now is supported in part by viewers like you.

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As if the fentanyl problem isn't bad enough, there's yet another new wrinkle that threatens to kill more people and make efforts to revive overdose cases even more difficult.

A witch's brew of industrial chemicals and pharmaceuticals are being mixed into street drugs, and the results threaten an even greater catastrophe on the streets of western Washington.

Tonight, our conversation with the man running Tacoma's groundbreaking needle exchange program and our Steve Kiggins with the story of how cutting fentanyl and other drugs with even worse toxics is making a bad problem.

Worse.

That's the discussion on this edition of northwest.

Now.

You.

A man named Dave Purchase founded the Tacoma Needle Exchange back in 1988, in response to the HIV Aids epidemic.

Since then, it has morphed into a so-called harm reduction service, aimed at trying to keep drug addicts from getting even more sick from using contaminated injection and smoking supplies.

The problem lately is that the number of chemical compounds that make up street drugs has gone from about a half dozen to more than 200.

Thanks to the underground synthetic manufacture of counterfeit and heavily adulterated pills, all kinds of new sedatives, more potent synthetic opioids like car fentanyl, and even toxic industrial chemicals are being found in the street drug supply.

and it poses a huge new threat to the addicted population.

Since the chemicals crash, blood pressure increased sedation and therefore blocked the effectiveness of Narcan.

The DEA tells The Seattle Times that law enforcement efforts are reportedly causing the per pill dosages of fentanyl to go down, but that has caused the Mexican cartels to just turn around and add all kinds of other super toxic chemicals.

Trying to give the product a potentially deadly boost.

As Steve Kiggins tells us now, these toxic additives have really thrown a wrench into an already desperate situation.

We have all kinds of safer sex supplies.

Condoms.

These are some of the harm reduction supplies that we hand out to all the shares.

A tour inside to come on needle exchanges, outreach on wheels.

We got this van in 2018.

Before that, we were operating out of a 1998 Ford Windstar van mix, the exchange's Outreach mobile building trust in the South Sound, delivering harm reduction tools.

Let's save lives.

There's no coercion, there's no bargaining.

You come in and say you need something, and if we have it, we'll provide that.

Where I'm standing will be the final resting place for my mortal remains.

I'm standing on my grave.

This is Dave Burgess.

In the late 1980s, he began exchanging used needles for sterile syringes among injection drug users in Tacoma, amidst the height of the HIV Aids crisis.

Purchases to come.

A needle exchange evolved and expanded into a nationwide buyers club.

There's nothing sinister about harm reduction.

Syringe exchange.

The exchange has since supplied millions of sterile needles and other materials from socks to clothes, to enhance health and serve people who otherwise rarely connect with health care professionals.

And then they can actually engage in that conversation towards, in a kind of implementing positive behavioral change in their life.

The exchange is part of the state's community drug checking network.

Testing what drug users are actually buying on the street.

Technicians across the state tested hundreds of samples and revealed last year that some illicit fentanyl spiked with dangerous chemicals.

Some included other drugs like benzodiazepines.

Others included the animal tranquilizer xylene, which can slow breathing and heart rates and cause difficult to heal open wounds on the skin.

Plus, some samples showed an industrial chemical used in plastics called BTM, a substance not approved or studied for human consumption.

Bottom line even as the supply remains volatile, it's really important for people to hopefully have relationships with folks providing harm reduction and health care services and really easy to access and kind locations.

Caleb Banta Green, research professor at University of Washington, says harm reduction efforts like syringe service programs were first to identify BTM in the illicit drug supply to come in needle exchange programs like clean needles and Narcan vending machines have saved thousands of lives.

Its mission to protect communities and prevent disease remains just as relevant today as it did when Dave Purchase helped lead Harm Reduction in 1988.

And so it's like we have to keep engaging folks in conversation to find out what we need to prepare for next.

In Tacoma, Steve Higgins Northwest now Joining us now is Pawlikowski, executive director of the Dave Purchase Project and the Takoma Needle Exchange.

fall.

Thanks so much for coming to northwest.

Now, the Tacoma Needle exchange has been on my list for a while, and I'm glad we can get you here to talk a little bit about about the program, what you're up to, and some of the current, current events happening out there right now.

Start us, though, with a little history of the organization, how it started, and kind of the several steps that that went along the way to get to where you are today.

Sure.

Thank you.

Tom.

The Tacoma Needle Exchange is the first legally sanctioned, community supported syringe exchange in the United States, and we're about 36 years old.

We started in August 9th of 1988.

We were started by our founder, Dave Purchase.

And Dave had help from others.

Dennis Flanagan, Michael Carroll and some others were the founding board members.

And Dave was a, he was a drug and alcohol counselor, and he realized that his clients were getting sick.

And so he was kind of wondering what was going on.

He read about, syringe exchange that was happening in Amsterdam.

And he thought that might be a good way to slow or stop the spread of of this new illness here in the United States.

And he was absolutely right when we're talking about Aids and HIV.

Yeah.

In Amsterdam they were, it was hepatitis.

They were trying to prevent the transmission of, and this was early on in the HIV epidemic, the worldwide pandemic in the United States.

So he wasn't really sure what was going on.

He just knew that his his participants, his clients who injected drugs were getting sick.

Talk a little bit about the North American needle exchange network.

Tacoma needle exchange morphed into into a larger piece.

How does that fit in and what does it do?

So not a lot of folks, first of all, they don't know that the Tacoma needle exchange is the first syringe exchange in the United States.

But what they also don't know is that the Tacoma needle exchange kind of gave birth to the North American syringe exchange network.

Nason, and Nason is essentially a clearinghouse for harm reduction supplies.

It started probably, you know, with the desire to get cheap syringes to for Dave and like 12 or 13 other syringe exchanges that were operating in the United States.

So in 1993, 92 or 93, they started nascent.

And essentially it's a harm reduction supply clearinghouse.

They used kind of their economic bargaining power to get cheap syringes.

And now we service and help facilitate syringe exchange, probably close to 700 syringe exchanges in the United States, probably about 80% of the syringe exchanges in the United States get supplies from us.

So this kind of little group of people on the pier, in the Foss Waterway, are kind of the infrastructure on which syringe exchange in the United States is built.

It's basically both buying.

You're the Costco.

We I have I've used that analogy before where the Costco of harm reduction supplies talk a little bit about the ssps, the syringe service programs.

How many are in Washington?

You were the first, not only here, but nationally, legally sanctioned.

What does it look like across the state of Washington?

So I think there are about 22 syringe exchanges that are supported by the Washington State Department of Health.

And we've been very fortunate in Washington and Tacoma, especially, that we've had good government support of our syringe exchange programs.

They're really I mean, they've recognized that public, that syringe exchanges are public health providers.

I was just actually speaking 20 minutes ago with Federico Cruz Uribe, who used to be the director of the health department here in Tacoma, and he was one of the first supporters of Dave in the syringe exchange.

And he was adamant that syringe exchange is public health.

Yeah, I think that's a good point to make is, is that not only is it public health, it frequently is the only point of contact and addicted person has with any health care.

They don't have a GP, they can't get in the car and do this or do that.

That is their health care is going to the the needle exchange.

You're absolutely correct.

And for a lot of the folks that we see, this is the only point of contact they have with any structured health infrastructure.

And so it's really important that we keep the trust with those folks and that we're able to integrate new services like vaccinations for Covid wound care.

We do some pregnancy counseling.

We need to be able to give those people the services that they need in an environment in which they feel comfortable and welcome, otherwise they're not going to get it at all.

I want to talk a little bit about the basic principle of harm reduction.

Is it supposed to reduce addiction or keep people healthy so they can buy themselves some time to get treatment?

I think that's a distinction that isn't often successfully made.

Yeah.

And I think there's an idea that that syringe exchanges are there to facilitate drug use, which is absolutely false.

A syringe exchanges there for a couple reasons.

One is to keep people connected to a system of care so that when they're ready to make positive change in their lives, they have a trusted group of people that they know they can go to.

The other is to reduce the individual suffering.

And the externality is, the cost externalities that occur with illicit drug use, drug use, the costs of drug use, illicit drug use ripple out through society.

If we can keep people healthy, if we can keep people from suffering, we keep people from going to the emergency room with septic infections.

We keep people from overdosing that reduce the costs and society of of drug use.

And we do not condone drug use at the syringe exchange, but we do not condemn drug use.

We we take a very pragmatic view that drug use is going to occur, whether we like it or not.

All kinds of drugs, whether it be alcohol, whether it be, nicotine.

And we just try to reduce the suffering, the individual suffering and the cost to society from that drug use.

I can tell you, you've been hit a lot with the.

Hey, aren't you just enabling?

I can tell you.

I can tell by how well you did that elevator speech there.

You've been hit with that a lot.

Yeah.

And that's I mean, and that's one of the major, I think one of the major misconceptions that we're facilitating drug use, we do not condone drug use at the syringe exchange.

We don't condemn it.

We are there to serve to to help people make positive change in the lives.

If they're coming to the exchange, they're already making positive changes.

They know that using UN sterile, unclean equipment can further the damage they do to their body, and the costs that they and society will have to pay for that care.

Devil's advocate question yes we can.

The average person can make the connection between having a clean needle or not, not necessarily a clean meth pipe.

True.

But if you look at it, most of the damage that occurs from injection drug use occurs from the injection practice itself.

So more than 70% of people who inject drugs regularly will have a skin or soft tissue infection at some point in their lives, the average cost.

And this is a research study I've done out at the University of Miami, the average cost to treat that person when they come in with that skin or soft tissue infection to the emergency room, is 30 to $40,000, because they have to be admitted and put on intravenous antibiotics.

And generally what will happen is once they're feeling better, they'll leave okay, because they can't get the palliative care for their substance abuse disorder that they're experiencing right there in the emergency room or the hospital.

That's it.

I have never heard that before.

And I think that is very interesting.

I know you don't want anybody taking drugs, but you do.

It almost sounds like the it would be better if they smoke the drugs as opposed to shooting them.

Yeah.

Well, so there are lots of differences.

There are lots of things we don't know about smoking, drugs and the impacts, the kind of the impacts on the lungs and things like.

But injection practices themselves are more physically damaging to an individual than smoking, drugs and the drugs that are available right now aren't the kinds of drugs generally that are injected.

They are more easily smoked.

And it's I, it's a smoking.

Drugs is a natural progression and harm reduction.

You can get away from the injection practices and into something that's less physically damaging.

Okay.

Yeah.

Yeah.

That's a that's an interesting point.

You make talk a little bit about you mentioned research for a moment there, but talk a little bit about the larger body of research when it comes to, the SSP.

What does the research say about harm reduction, about reducing secondary infections in the emergency rooms and some of those things?

What does the data tell us?

So there can be so there are a lot of arguments can be made against syringe exchange, but none of them are based in science.

If you look from a public health aspect, they reduce infections, they keep people healthy, they keep costs down, and they keep people connected to a system of care.

If you look at the, the economics of it, it's just it's much better to prevent an infection with someone.

So we have a free wound care clinic.

People can come in and get their wounds checked out and looked at before they get septic and non ambulatory and have to go to the emergency room and have very expensive acute care given to them.

If we can keep people coming in and getting vaccinations, if we can keep people coming in and giving them STD screenings and things like that, we can keep them healthy.

So there's a huge body of research.

One of the kind of interesting points of syringe exchanges in the United States when it first started, people were really hesitant and they said, okay, well, we'll let you do a syringe exchange, but you have to do it with the research institution because they thought no one's going to partner with a syringe exchange.

They were absolutely wrong.

Syringe exchange is one of the best researched and most effective HIV prevention interventions.

Hands down.

We have 30 years of empirical research.

It stops the transmission of HIV.

It stops the transmission of hepatitis.

It keeps people connected to systems of care.

So no good faith argument in terms of science can be made against syringe exchange.

Does it show does it show anything at all in terms of treating addiction or having an impact on people who have access to syringe exchanges are far more likely to actually enter into substance use treatment because they have that point of contact and they have people that they trust.

And you just don't have to take my word for it that is documented in the research literature.

What is happening right now?

With street drugs, one of the the main major points of this program and kind of what got us interested in this year's program on on substance abuse was some of the terrible things that are starting to show up in the street drug supply list of the street drug supplies already suspect.

Right.

It's it's not made by, you know, in controlled circumstances, but apparently, a horrible situation has been made even worse.

Talk a little bit about what's turning up in the drug supply.

And why do you think that is?

So we're part of a drug checking initiative out of the University of Washington.

We've been doing drug checking for about 18 months, I think.

And part of that is, is we we asked people to bring in a tiny sample of drugs, and we'll check the drugs for them.

We'll test the drugs and be able to tell them what is in the sample.

So we ask them, what did you think you were buying?

And then we'll run the sample and say, here's what was actually in the sample.

And so we're doing drug analysis.

And we're one of probably less than two dozen syringe exchanges in the United States who has that capacity.

So we have the, the FTA, our machine.

And then we have the, the technicians that are trained to analyze the samples.

And what they're finding in many cases is, is that what people thought they were buying?

They aren't buying.

In other cases, they find that there are adulterants that are in the drugs.

Usually it's things like acetaminophen or even drywall, but sometimes there are other compounds in there.

So we've probably heard about xylene, which is an animal tranquilizer.

It's meant for horses.

It's had some horrible effects on folks, especially in the on the East Coast.

Now, xylene has been present in the drug supply in Puerto Rico for the last 20 years, but it's been slowly marching its way westward.

The, the big one recently that we were really having trouble with the, drug checking folks in Washington discovered, a an industrial compound called BTM, which is a compound used to make plastic less susceptible to UV light.

And for some reason that we could not figure out and they still don't know why it was showing up in the drug supply, if it was deliberate or if it was accidental, but it was showing up on samples across Washington state.

And we found out partially because people were saying, I bought these drugs.

They they affected me very differently than they did last time.

I know you can check drugs when you when you test my drugs for me.

Yeah.

And so BTM was showing up in samples.

We tested several samples here at the Tacoma Needle Exchange that that tested positive.

And then we sent things down to the University of North Carolina and send them through a mass spectrometer, which is a much more sophisticated analysis.

And we still have not figured out why it was in the drug supply.

If it was deliberate, if it was accidental.

We just know that if people injected it, they had one, reaction.

And if they smoked it, they were having another reaction.

And it wasn't the reaction that they anticipated from the drugs.

Now, the drugs they purchased were in the sample, but they were also contaminated by this other industrial compound.

It's luckily I spoke with my drug tech this morning and he says it's it's not been present for a little while, but we still have no, we have no understanding of why it was introduced into the drug supply or to what the long term effects might be.

If.

Absolutely.

If you could wave a magic wand over somebody and get them on addicted, right, they will hopefully stair step back up to recovery.

Right?

But if in the meanwhile they've been ingesting something that's, you know, eating their liver or whatever it may be, they're in trouble no matter what.

Right.

And I think part of the drug checking initiative is, is we we clearly don't tell people these drugs are safe.

These drugs are unsafe.

We asked them what they thought they were purchasing.

And then we tell them exactly what's in the sample, and we educate them and let them make that determination.

Illicit drug supplies are inherently dangerous because they're not they're not produced under controlled circumstances.

And much of the damage that happens from illicit drug use is from the injection practices.

But it's also from the adulterants in the drugs.

Yeah.

There are countries that give you pharmaceutical grade drugs, and there are very few side effects from those drugs.

And it's, it's it's rare and it's in a very controlled circumstance to very particular individuals.

But these folks can go into the pharmacy, get their drug sample use in the morning, go to work, come back at the end of the day.

And that's really the impact that it's had on the system because they've become chemically dependent.

And so they take away the danger of the illicit drug use, give them a pharmaceutical grade sample, and they're actually to have much more quality of life with much less damage to themselves or society.

As a result of that, you maybe are more open to transitioning to buprenorphine and turning it into a chronic condition like diabetes or whatever you may have, where you don't even know that they're a drug addict necessarily.

They're they're recovering alcoholic or recovering whatever.

Pick your drug of choice, right?

That's how they appear to the rest of us.

If they can get on that kind of a program.

Yes.

And I think for some folks, they will be able to they'll be able to wean themselves off, Suboxone or buprenorphine or methadone, and at some point and be completely free for some folks, they're just never going to be able to.

But there's nothing wrong with them using Suboxone for the rest of their lives, if that's what keeps them from going into a chaotic drug use spiral and maintaining a quality of life that they can enjoy.

Yeah, losing all their friends, losing their jobs, losing their family, losing their health, losing everything.

Absolutely.

For some folks, there's this idea that abstinence from drugs means abstinence from all drugs, including things like buprenorphine and Suboxone.

And I just don't agree with that.

We don't ask diabetics to wean themselves off insulin at some point, or people with high cholesterol to wean themselves off their Lipitor.

It's a chronic, manageable condition.

It should be managed so here to make a bad problem worse, with some of these adulterants that are finding their way into the street drug supply, some of them are are heavy depressants apparently, and can blunt the effects of Narcan.

Narcan has just kind of started to get adopted and put out into the system.

There are vending machines, the whole nine yards keep them in the in the glove box of your car.

Well here you come to try to do a reversal and no go right.

So for things like xylene specifically which mimics an opioid overdose but is a non-opioid Narcan naloxone or that name brand version is Narcan will not work on reversing that.

The the issue is for a lot of folks, a lot of folks these days are poly substance users, and some of them are deliberate poly substance users, and some of them don't know that they're poly substance users.

And that's the bigger issue if you buy what you think is heroin, but it's adulterated with xylene, you're going to have a very different response.

And you may get, you may get enough heroin to actually overdose in the xylene may be exacerbating the, the physiological impact on your body.

So your, your, your peers who are trained to revive you may grab the Narcan and, and properly administer it, but you're not you're not coming to because what they think is a regular opioid overdose is really not an opioid overdose.

It's you've had psilocybin or something else introduced into the system.

Now giving someone Narcan when they're not experiencing an opioid overdose is not dangerous.

There are no contraindications from Narcan.

The woman in Chicago.

SARS Maxwell, who first started prescribing Narcan for folks, said the only way that you can hurt someone with Narcan is if you drown them in a bathtub full of it.

It has no physiological impacts for folks who are not experiencing an opiate overdose.

And for a lot of folks, they may be taking opioids with something else.

So you will, at the very least, ameliorate the impacts of the opioid.

While you can then tend to the things like oxygen is a great, you know, someone who's having a, an overdose, needs to have oxygen.

So if you can take care of the opioids, which reduce the, respiratory system, then you can address those other issues.

But we always recommend if someone is having an opioid overdose, give them some, Narcan and call 911.

I save my easiest questions for the last hour in the last two minutes here.

What do you think are ultimate solutions for this?

You've been in this game for a long time.

You've had a lot of contact with this population, ultimately optimistic.

Pessimistic.

Are we going to have to accept that the fact that a certain percentage of our population is going to be lost to narcotics?

What's your take on?

So, I mean, I have to be optimistic, and I and I refuse to accept the idea that a lot of folks are going to be lost in orthotics because we or drug use because we have not come up with practical solutions.

I'm a very pragmatic person when it comes to drug use.

Folks are going to use drugs whether I want them to or not.

I can't stop them.

So we have to think of ways that maybe heretofore, we hadn't even considered in order to contain this problem.

We're not going to make it go away.

We have to figure out how to contain it.

And that is going to require creative thinking, and it's going to require maybe folks to get a little bit uncomfortable with what the solutions are.

But if you're uncomfortable with the solutions for this, then you're going to have to become more comfortable with people dying needlessly in the street.

How about full legalization and government supplying the drugs?

I would go for that.

Talk about why?

Because it would reduce a lot of the harm that happens.

I mean, and before we even do that, we could talk about safe consumption spaces.

Safe consumption spaces have been around for more than 30 years throughout the world.

And if you want to reduce opioid overdose deaths, I'll give you a statistic that might surprise you.

In more than 30 years, with more than with millions of users worldwide, there has never been a documented opioid overdose in a safe consumption site, ever.

And talk a little bit about the economics.

I mean, we basically eliminate crime with that model two, right?

We eliminate a lot of the crime.

We eliminate a lot of the externalized cost to society from drug use.

We eliminate some of the, the, the, you know, the windows being smashed, the petty crime, the medical issues.

Because if someone is in a safe consumption space and they do experience an opioid overdose, there are medical staff right there that can treat them.

There are also people that can provide them with access to treatment services or medical services.

A lot of the costs from opioid use are the externalize costs, the cost for extra policing, the cost for hospital stays, the cost for other things.

If we bring that into a place where people can get their drugs, use them safely and then receive care, we've eliminated a lot of those.

Now, we're never going to eliminate crime because not all crime is associated with drug use.

But there is a lot of it that we would eliminate.

Yes.

Paul, thanks so much for coming to northwest.

Now, a lot of great food for thought.

We talked about the philosophy of the whole thing and also what's happening out there right now.

I really appreciate it.

Thank you so much for this opportunity.

Every time I think the drug problem can't possibly get any worse, sure as heck it does.

The bottom line the research shows harm reduction works even though many people see it as enabling.

But here's a way to think about it.

By the time addicts are injecting or smoking street drugs, the idea that a lack of harm reduction tools would somehow cause behavioral changes and the evaporation of addiction is just a fantasy viewed callously.

Preventing secondary infections saves money more benevolently.

Harm prevention may serve to buy addicts a little extra time to maybe get the help that leads them into recovery.

I hope this program got you thinking and talking.

You can find this program on the web at kbtc.org, stream it through the PBS app, or listen on Spotify and Apple Podcasts.

That's going to do it for this edition of northwest.

Now, until next time, I'm Tom Layson.

Thanks for watching.

You.