July 2, 2020

Syringe Services Program Progressing During COVID-19

Everett Maroon, Executive Director at Blue Mountain Heart to Heart

From January 2 through present, Blue Mountain Heart to Heart has performed 2,149 syringe services program (SSP) transactions across all sites, including 310 new enrollments into the program. Site specific numbers for this time period are:
  • Kennewick: 1,529
  • Walla Walla: 1,397
  • Clarkston (opened in January 2020): 271 
Our enrollment surveys are conducted only once, when individuals first access a SSP site. They have been in place since September 2018. (We also see virtually no crossover in individuals accessing more than one SSP site). This enrollment survey asks questions about drug use and the individual's last thirty days; risk behavior, housing stability, frequency of use of drugs, and demographic information. Thus it represents a rolling snapshot of people entering the program and their last month. There are some interesting developments in these enrollment surveys.
 
Before COVID-19, housing stability numbers were very consistent, with 49-51 percent of respondents answering that they owned or rented their home. Post COVID-19, that number has dropped to 40 percent. More people report they are sleeping on the streets or are "not housed," but the largest increase describing unstable housing is "sleeping on someone else's couch," which legally does not meet the definition of homeless, but also describes people in housing distress.
 
Another significant shift in the enrollment data is with regard to frequency of drug use. Before COVID-19, these numbers were relatively stable, with only around 7-8 percent of respondents identifying that they use drugs five or more times a day, similar to the group saying they use drugs only once a day. Post COVID-19, we see 22 percent of new enrollees saying they use five or more times daily. This puts them in a much higher risk category for overdose, overdose death, and morbidity associated with injection drug use. We recommend no-cost wound care clinics to help support people with injection-related injuries and to divert these cases from medical centers during this pandemic.
 
Finally, although we have suspended HIV and hepatitis C testing until Phase 3 (this will be a county-by-county reopening), we did identify 40 new cases of HCV in 2019 and enrollment surveys continue to show approximately 25 percent of new SSP participants have shared used syringes (both loaning and borrowing) with others, and this rate continues into the COVID -19 pandemic. The likelihood of HCV transmission under these circumstances is high, and we recommend more HCV treatment resources be brought online across the GCACH catchment.
 
SSP demographics continue to skew male (58 percent male, 41 percent female, 1 percent transgender) and white (82 percent white, non-Hispanic, 12 percent Hispanic, 4 percent Native American), but age groups are all represented fairly evenly. We have made progress in seeing more SSP participants holding health insurance (82 percent, up from 59 percent in 2015), but would like to help continue helping these individuals navigate to insurance, especially since their drug use is likely to result in health complications at some point in the future.
 
We continue to encourage SSP participants to enter the Blue Mountain Heart to Heart or any opioid treatment and recovery program.