Fort Collins appears to have everything its residents could ever desire, charming bucolic scenery, easygoing inhabitants with a bent for the outdoors, and a premium ranking in the U.S. livability index year after year.
But not all of the city’s roughly 140,000 citizens are being best served by local authorities. Marginalized and misunderstood, Fort Collins’ intravenous drug users have been left without services that they are now legally entitled to.
In 2010 Colorado lawmakers added an exemption into the state’s drug paraphernalia laws that allowed counties to legally adopt syringe exchange programs. Boulder County jumped at the chance and now has their program fully out in the open (it ran covertly for 22 years prior to the law change), and Denver programs are following suit.
Fort Collins was tipped as the next breakthrough battleground in the war against disease being spread by shared needles and Larimer County found itself in the spotlight. But since then very little has happened. There is no official needle exchange, and talk of one is usually conducted in hushed tones. The biggest question has to be, why?
Jeff Basinger, executive director of the Northern Colorado AIDS Project, has a few ideas as to where the problem lies. “It starts with people who think that drug use is a choice, rather than an addiction. All addictions obviously start with a choice, but once it moves further along it becomes disease.”
From his office in the heart of Old Town in Fort Collins, Basinger spoke candidly about the mindset he finds himself up against, “It’s the attitude that drug use is bad, drug users are bad, and if you provide a needle exchange for them then the problem is just going to get worse. Which is of course the exact opposite of what research has actually shown.”
Basinger has been receiving Federal funding for about 5 years for an initiative called “Reaching Rural IDU” (IDU stands for Intravenous Drug Users) which Basinger renamed “Reaching Rural People Who Inject” due to his dislike of the original federal moniker.
The walk-in clinic has been functioning well according to Basinger, “We’ve been doing a social networking risk reduction program for people who inject drugs. Through that we knew that there was a very active injection drug population here in northern Colorado.”
The walk-in clinic provides multiple services to the clients that arrive on the doorstep; disease testing, bleach kits, counseling, and arrangement of services to help people get off drugs.
Basinger explained what the change in the Colorado law did for them, “It doesn’t legalize syringes or paraphernalia, it certainly doesn’t legalize possession of drugs, what it does is it decriminalizes a person who is enrolled as a participant within a syringe exchange program.”
All these good things should be pointing to Fort Collins quickly embracing its own needle exchange program. But the progress has been slow, as Basinger points out, “To operate legally, we need approval from the local board of health, and we have been hosting those conversations since July. We’ve met three times and provided them with information.” There is also another dimension to getting the exchange fully functional, “Ideally it has to have the cooperation of local law enforcement and other stakeholders, but that isn’t required.”
However, both of these things are proving to be easier said than done. “There’s a split in the health board vote, but the majority see this as an important strategy to meet their own 2011 goal of reducing blood-borne disease transmission among people who inject drugs within Larimer County,” said Basinger.
On top of this there is Larry Abrahamson, the Larimer County District Attorney, who has according to Basinger, “Philosophical concerns, is not convinced that there is an issue, or that any program will even work if there was one.” All of this leads to a situation that Basinger describes simply as a, “political minefield.”
Pushed further, Basinger explained that the needle exchange debate was drawing more attention to other things that Fort Collins authorities seemed to be in denial about, “social injustice, poverty, racism, homophobia, drug use, homelessness, illiteracy. Poverty is over twenty percent in Larimer County, illiteracy is over one-in-five people, it’s insane. There are some real issues here in Fort Collins, but people don’t like to talk about them, because it’s such a fabulous place to live.”
Boulder’s needle exchange has been running for over twenty years and they were the first in the state to take advantage of the change in the law. Carol Helwig, the Boulder County HIV/STI Outreach Coordinator, had a few opinions of her own as to why Larimer County was taking its time in moving forward, “First of all, the paraphernalia law has been there prohibiting progress, and then after the change in the law it takes a long time to build stakeholder support and to get all of your ducks in a row. Getting on an agenda for a local board of health takes time, it’s a big process.”
Boulder County also had the approval of the local District Attorney and other law enforcement entities, something Helwig saw as pivotal, “We’ve benefited from their cooperation, support and understanding.”
Helwig also saw the court system in Boulder as, “Very progressive and not interested in prosecuting non-violent drug offences in a criminal fashion, but rather taking a public health issue approach with the cases.”
Unfortunately when the Boulder County District Attorney’s office was contacted for an opinion on what the Larimer District Attorney should be taking into consideration, it declined to go on the record with any comments.
Looking into the future Helwig predicted that, “The services will become available, it’s just a matter of jumping through the required hoops.” She then went further, “Any new program, any change, is already difficult even when it’s not controversial. This program is full of controversy and stigma and as such is a really hard sell. Drug users are almost really the last group of people that it’s still OK to stigmatize and discriminate against.”
During the course of the interview Helwig addressed the notion that a slightly more liberal mindset in Boulder County, compared to the conservative leaning Fort Collins, had lead to a quicker take up of social healthcare programs such as needle exchanges, “I couldn’t say it is a different mentality, but I would say that in Boulder County there is a value placed on social justice, a value placed on reaching out to people who are vulnerable or marginalized, a value placed on evidence based practice, and I think that those values are what created the alignment between our programming and being able to operate in spite of those paraphernalia laws. I’m not making a judgment about what constitutes a value in Fort Collins, I’m just explaining how we have done it done here in Boulder.”
As if to prove a point that the need for a needle exchange program exists in Larimer County, people are regularly driving down to the Boulder needle exchange from Greeley, Fort Collins and other northern Colorado areas.
Clients of the Boulder needle exchange also took part in a focus group to discuss their feelings about the service. An unnamed client said, “It’s just an awesome program, I wish it could be everywhere in every city. It’s like I said, you can’t stop people from doing what they’re doing but you can reduce the harm.”
So as the weight stacks up in favor of these programs, entities like the Larimer County Health Board find themselves coming closer to actually having to make a decision.
Fortunately, neither Larimer County nor Colorado is the testing ground for initiatives such as Needle Exchange Programs. NEP’s have been around in the U.S. since the 1980s, and as such plentiful data is available about them. A report found on the Center for Disease Control website states that, “An impressive body of evidence suggests powerful effects from needle exchange programs. Studies show reduction in risk behavior as high as 80%, with estimates of a 30% or greater reduction of HIV in IDUs.”
For the more fiscally minded those figures can be interpreted as, “The cost per HIV infection prevented by SEPs (NEP’s) has been calculated at $4,000 to $12,000, considerably less than the estimated $190,000 medical costs of treating a person infected with HIV.”
So finally it comes down to the Larimer County Health Board to approve Fort Collins’ first openly operating needle exchange. The board members are appointed on rolling five-year terms by the County Commissioners.
Their terms are staggered, but reappointment is possible. Dr. Adrienne Lebailly is on the board and offered an insight into how far things are along in the quest to provide serious support to local intravenous drug users.
“Probably early 2012 there will be some sort of decision. In July all three county commissioners and all five board of health members went on a site visit to the NCAP offices. Jeff (Basinger) and his staff presented information about what they can currently do, and what they’d like to be able to do.” In October a similar presentation was organized by the Boulder NEP and seen by the majority of the health board.
However, the health board doesn’t get to make the decision based on their own input alone explained Lebailly, “We also have to consult with other entities including the District Attorney (Larry Abrahamson), he being the person who would prosecute people charged with crimes, along with local law enforcement. It’s going to focus more on the City of Fort Collins Police, rather than the County Sheriff, as the NCAP offices are physically located within the City of Fort Collins Police’s jurisdiction. Complicating it further is the fact that Fort Collins is at present looking for a new police chief.”
Making matters worse for the NCAP program is the division that exists on the health board. Lebailly’s prognosis wasn’t good, “I would say it’s split and I don’t know how it’s going to go.”
To Lebailly, the reasoning behind the split was multi-layered, “More conservative members tend to believe it sends a bad message. I think that public health comes at the issue from a harm reduction point of view, that we’re not endorsing drug use, but we’re trying to protect these people from getting a potentially fatal disease until such time as they’re ready to accept treatment. I think one of the important parts of the NCAP program is that every time someone comes in, they are offered treatment and they can choose to accept or decline it. People still interpret this as, you know, you’re just making it safer for people to inject drugs. It’s kind of the same argument that people have against providing condoms to teenagers.”
But it appears that all the blame can’t be laid on the shoulders of the more conservative members, “There were some people who have supported in the past, the medical marijuana amendment, and then they see what kind of businesses have sprung up and how it has changed the community, and they think that if you do this then this will be a great attraction and bring all kinds of drug users to Larimer County or Fort Collins. The data also doesn’t support that, but it’s really, sometimes it’s hard to persuade people who think that their perception is more compelling than any data you show them,” rued Dr. Lebailly.
In addition to this there is also a split on the board of county commissioners that, even though they don’t have voting rights, concerns Lebailly.
To Lebailly that meant addressing the question that, “Even if the health department isn’t going to offer it, and no tax dollars are going into it, and not even if you like the idea or not, but whether you think it’s such a bad, such a terrible idea that you won’t let a reputable organization like NCAP take this additional step in protecting their clients?”
As the issue nears its conclusion early in the New Year, Larry Abrahamson, the Larimer County District Attorney, articulated his position on the matter, “The needle exchange program is primarily a Department of Health initiative, which is basically more of a health concern than a public safety concern at this point, so we are not taking any formal position. I think it’s probably utilized more effectively in areas where they have maybe a lot of Hepatitis as a result of dirty needles or HIV spread, or something like this, in larger jurisdictions. I don’t see necessarily that as an issue here. But, I know it’s a Department of Health issue and it’s something that they are promoting. From our perspective it hasn’t risen to the level of a public safety concern that we would necessarily be taking a strong stand on at this point.”
Whether or not the District Attorney or other law enforcement entities get on board with the program remains to be seen. But with so much at stake, and with such polar opposite views being held by many of the prospective stakeholders, it appears that early 2012 will be crunch time for many working to help some of Fort Collins’ most underserved residents.
(A version of this article appeared in print on December 11, 2011, on page A1 of The Rocky Mountain Collegian with the headline: Heroin Deaths in Fort Collins Inspire a Need for Needle Exchange Program.)
© 2012 Jamie M. Bradley All Rights Reserved