Dr. Joseph Iser Washoe County Health District Testimony SB410/April 4, 2013 Page 1 Introduction:

For the record, my name is Dr. Joseph Iser, and I’m the District Health Officer for the Washoe County Health District serving Reno, Sparks, and Washoe County, and I am in support of SB410.

I’m here today to discuss some of the issues related to the re-use of syringes and needles, to provide some of the medical and scientific evidence of the efficacy of syringe exchange, and to give you some of the information I provided to my then Board of Supervisors (equivalent to the Board of County Commissioners) in Yolo County about our work in a legal syringe exchange program at the Department of Health there.

Medical Issues:

There are more blood-borne diseases than these, but our major concern relates to the transmission of hepatitis B virus, hepatitis C virus, and HIV.

Over one-third of people with HIV in the United States were infected through injection drug use, more than 354,000 people (from reports by DHHS and JAMA).

Every year, another 8,000 people are newly infected with HIV through sharing contaminated syringes.

Every year, another 15,000 are newly infected with hepatitis C through sharing syringes & other injection equipment.

Younger injection drug users generally become infected with hepatitis C within two years if initiating drug use.

Hepatitis C is the most common blood-borne virus in the United States, with 3-4 million Americans infected. If left untreated, hepatitis C can cause serious liver disease, including cirrhosis and liver cancer. End-stage liver disease are among the leading causes of death in HIV infected persons, and the majority of Hepatitis C cases are related to injection drug use.

End stage liver disease from hepatitis B and C are among the leading causes of death in HIV-positive people in the United States.

Efficacy:

The Institute of Medicine has concluded that the cost-effectiveness of syringe exchange is estimated to save $3,000 to $50,000 per HIV infection prevented at a cost of less than $1 for a clean syringe.

The estimated lifetime cost of treating and HIV infected person is $385,000 to $618,900.

Syringe exchange is the cornerstone of hepatitis C prevention. The institution of a syringe exchange program in New York City cut the prevalence rate by almost 50%.

Clean syringe access does not encourage drug use.

Dr. Joseph Iser Washoe County Health District Testimony SB410/April 4, 2013 Page 2

Syringe access does not increase crime rates.

Syringe access does not increase needlestick injuries in the community.

Since the 1980s, Syringe Exchange Programs, in conjunction with other HIV prevention strategies, have resulted in reductions of up to 80% in HIV incidence among IDUs.

There are currently 203 exchange programs operating one or more exchange sites in 34 states, the District of Columbia, the Commonwealth of Puerto Rico, and the Indian Nations.

Syringe access DOES reduce HIV and hepatitis infections.

Syringe access DOES lead to an increase in drug treatment program admissions.

Syringe access DOES link participants to medical care, housing, and other services.

To summarize the efficacy issues, the National HIV/AIDS Strategy for the US states that studies have found that providing sterilized equipment to injection drug users substantially reduces the risk of HIV infection, increases the probability that users will initiate drug treatment, and does not increase drug use.

Experience running a syringe exchange program:

Our specific goals were to decrease the spread of blood-borne pathogens; increase education on harm reduction practices to the injection drug user; increase referrals for drug treatment and other services; and to decrease the number of used, potentially infected syringes in the community.

We worked with and authorized 2 community based organizations, provided the syringes and recovered the used ones. We provided almost 71,000 clean syringes and collected 54,000.

Harm reduction was provided at every one of our 412 contacts, but our impact was greater by finding and working with contacts. At that time, five of our contacts entered drug treatment programs. The training we provided to syringe users resulted in reversing 40 overdoses.

As a reminder, Yolo County is a very rural, agricultural county, and of our four incorporated entities, we won over the support of all mayors and police chiefs. They agreed that the parks were much cleaner (related to discarded syringes) than before.

Supporters:

Nevada State Medical Association

Washoe County Medical Society

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