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Prevention Point is working its own needs assessment, says the organization's chief, Roslyn Allen, so "injectors can tell us what, when, and where" to do exchanges. Allen, with a master's in clinical psychology, has headed the group since January. She says Prevention Point is establishing a program to screen active injectors and teach them proper injection techniques, with the goal of having them teach their comrades - in a phrase, peer-group education. But this program requires funding that Prevention Point has not yet received, she says.
The exchanges are also "a conduit for all kinds of information," Sheigla Murphy, a researcher for the Institute for Scientific Analysis. "People are able to access information about social services [and] drug treatment programs," she adds. ISA is completing a three-year qualitative study on how needle exchanges work or don't work. Key among the successful programs are those that teach people the correct way to self-inject, as well as overall safety tips, she adds. The information is getting to IDUs, Murphy says, to the point that "you're really seeing people, especially the younger users, who wouldn't even think of sharing [a needle]." And if they do share, she adds, they know to disinfect them with bleach.
There's time to observe people's routines at Webster Street. A couple of guys walk up and one starts counting points out. Kral notices that each one has a little X,C, or O on it.
"Hey, what's your system? I always like to ask," Kral says to the client, who makes a response I don't catch, gets his fresh points, and walks away.
I ask Kral what was up. He tells me that sometimes when people live in a house with several users, they mark their needles so that no one shares a needle with anyone else.
Good system, I remark.
Sure, Kral says, they love that. He maintains that heroin users are very ritualistic, and part of doing the drug is doing the ritual. Lay things out just so, in this order, cook things, mark things, clean things. It's part of the process, he says.
Like a superstitious baseball pitcher? Yup, Kral says, saying that one reason the "Bleachman" ad campaign was so succesful a couple of years back - with its cartoon-superhero bleach bottle and no-nonsense safety instructions - is that addicts were open to adding another intricacy to the heroin ritual. Ah-hah. Now we flush each point with Clorox, then with water. That's the drill. Got it.
A clearly wacked citizen pulls up in a mid-' 70s Mercury to exchange his points. I mentally note that his motor control is impaired, which is a polite way to say he's reeling. On what I have no clue.
"Hey, the car!" Pearson says.
"That's the car," the client slurs.
"We've been hearing about this car, and here it is," Pearson says to me. "How's it running?"
"Coils, man. Coils keep burning out."
Pearson, the client, and the nurse practitioner commence a Guy Car Talk that's indistinguishable from any other conversation guys have about cars. The needles are almost, but not quite, an aside.
Prevention Point must be doing something right to keep attracting IDUs but what do heroin users themselves think about needle exchange? It's hard to tell from just talking with them. THe dozen or so IDUs I spoke to acknowledged that the needle exchange makes their lives a little easier, but they are so "universally reviled," in John Watters' words, that they keep a low profile in the face of the System, including reporters, and talk only reluctantly.
One night at an exchange, a pale, unshaven man in jeans and a sweat shirt approaches. He turns in his points, and while he does so I ask some questions. He says he does injectable amphetamines rather than heroin. How often, I ask? "Maybe twice a week," he explains, clearly ill at ease, then walks away. A volunteer asks me what the client said, and then seems impressed that he has maintained a consistent story from week to week. I remark that twice a week seems like too low a number to require 20 syringes, until the volunteer explains that those two episodes could be two - to three-day binges or injections at 30-minute to one-hour intervals.
While there are no hard and fast numbers on heroin-related crime or mortality in San Francisco, needle exchange isn't making a dent in those statistics. The SFPD does not parse heroin arrests from other opiate arrests; its figures show that total opiate arrests have crept upward since 1990 when there were 5,157 arrests for crimes relating to opiate drugs. Last year there were 6,363 arrests.
Heroin-related deaths are on the rise in San Francisco, reports Donna Allison, forensic lab manager at the San Francisco medical examiner's office. During fiscal year 1990-91 there were 48 heroin-related deaths in the city compared to 113 in 1993-94. But it would be a mistake to link the increase in heroin-related deaths to the much-ballyhooes increase in heroin purity. SFPD Capt. Greg Corrales reports that over the last two decades, the purity of street heroin in San Francisco has only gradually risen from the 3 percent range to an average 35 percent purity.