After dark at Mesa’s Pioneer Park, the playscape emptied, and drug users lingered.
Yards away from a bright green spiral tower with cascading slides and rope netting, they lay on metal picnic benches after shooting up heroin. It was a Wednesday.
Some of the five or six people were high; some were in pain. One woman crooned “Tennessee Whiskey” from YouTube, on a phone that was about to die. Asked how they were, a gaunt, bleary-eyed man replied for the group: “Hanging in there."
Momma, a heavyset woman known for taking care of others in the park, said she tries to make sure their dirty needles end up in the trash.
“I’m bossy,” she said, leaning on her metal walker piled with bags. “I go chaos on the people around. I tell them, ‘Throw that shit away.’”
But inevitably, some sharps end up getting reused, shared, or dumped in the bushes. And the ones that do get thrown away, though out of public view, can still poke waste management employees, police, or curious kids that get too close to the garbage the next morning.
As the opioid epidemic sweeps across the country, many cities and states have implemented solutions to this problem. They’ve installed secure sharps containers in public places where drug use runs rampant, and authorized needle exchange programs, sometimes called syringe service programs, that let people safely swap out dirty needles for clean ones. Studies show such programs drastically reduce the number of stray needles lying around.
But in the Valley, cities haven’t made any such sharps programs publicly available, and state law still considers it a Class 6 felony to collect needles or transport them to a safe place. Some syringe service programs operate underground, but they are forced to tread carefully, since they are technically breaking the law.
That leaves people who live on the streets and inject drugs with a lose-lose choice, advocates say: Carry used needles and face the constant threat of a felony conviction, or dispose of them inadequately, putting the public at risk.
Here’s what Arizona tells diabetics and other residents who inject medicine or drugs to do with their used sharps.
Step one: Drop them into a sharps container, and if you don’t have a sharps container, find a puncture-proof plastic container. Think thick plastic, like a laundry detergent bottle.
Step two: Seal it up with duct tape. No holes.
Step three: Use a thick, black, permanent marker to write “NOT RECYCLABLE” across the side.
Step four: Throw it away in your home trash.
Easy enough. But only if you have a thick plastic container, and duct tape, and a marker, and a home.
“In order to have a laundry detergent bottle, you need to do your laundry,” said Haley Coles, founder and executive director of the harm-reduction nonprofit Sonoran Prevention Works. "That also requires resources."
For homeless people who inject drugs, safe, free, and legal options for needle disposal are often inaccessible. So, Coles says, “Of course people end up ditching them in bushes. People throw them in the trash.”
Some IV drug users in the Valley seek out grassroots needle exchange programs, like the one run by the nonprofit group Shot in the Dark. Volunteers do weekly outreach in various neighborhoods so people can drop off used needles, pick up new ones, and get condoms, Narcan, and other harm-reduction resources. But since those groups are in a legal gray area and unable to operate in permanent, 24/7 locations, they’re limited in their scope.
Though police departments or health clinics in some Arizona counties, such as Pinal and Cochise counties, offer syringe drop-off options, Maricopa County has no official disposal programs, according to Jeanene Fowler, spokesperson for the Maricopa County Department of Public Health. Representatives for Phoenix, Scottsdale, Mesa, and Tempe told Phoenix New Times they didn’t know of any city resources devoted to syringe disposal.
“We are not even set up to incinerate, so we can’t safely accept sharps,” said Shannon Reed, a public information officer for the city of Tempe.
Meanwhile, advocates argue this gap leads to improperly disposed-of sharps that become a hazard to everyone. One example is the two 6-year-olds in Tempe whose classmate stabbed them with a found needle on Valentine’s Day.
Another concern is that littered needles can exacerbate Maricopa County’s already worsening drug overdose and infection crises, Coles said. That’s because people in the throes of addiction will pick up and use used needles, putting themselves in danger of contracting infections like HIV and hepatitis C. Sharps programs and easy disposal options can help eradicate that problem.
“I’ve absolutely known people who have picked up syringes in alleys and used them,” Coles said.
"V," an eight-year IV drug user in Mesa who New Times agreed to call by his first initial, used to be one of them.
The tattooed 30-something said he contracted two “massive blood infections” and a bacterial infection in his heart because of it. Sharing needles “is more common than you think” among addicts, he said.
Now, he visits a Shot in the Dark syringe access site weekly to avoid sharing needles, and carries his used ones with him in his backpack throughout the week to protect others from getting stuck — even though he knows it's a felony.
“It’s really hard because you can get busted with them and stuff,” he said. “But I would rather get busted than have a kid step on one.”
Arizona’s public health community agrees that the lack of resources available to reduce harm among IV drug users is a problem.
That’s part of the reason why syringe access programs like Shot in the Dark have been able to operate locally without getting in trouble, said Will Humble, executive director of the Arizona Public Health Association.
But the state’s law against giving out needles “has a definite chilling effect on nonprofits that are wanting to do that kind of public health work,” he said.
Only two main needle exchange groups, Shot in the Dark and Southwest Recovery Alliance, serve the Valley. Efforts to pass bills legalizing such programs have failed in the state Legislature the past few years, Coles said.
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Meanwhile, other large urban areas, such as New York, Los Angeles, San Francisco, and Chicago have passed legislation authorizing needle exchanges and even helped fund such programs.
Drug users and advocates in Arizona both say more sharps containers in public would be a step in the right direction, but they argue that syringe service programs, especially ones with permanent sites, are the best way to reduce harm in the community.
“People go to these programs and they are five times more likely to access treatment than people who just self-refer,” Coles said. “Syringe service programs utilize harm reduction tactics. They give people alternative ways to use. Ways that are, perhaps, less risky.”
Coles and others plan to present a new bill for consideration in the 2020 legislative session.