The public is coming face to face with the opioid epidemic as used syringes appear in unprecedented numbers across beaches and parks in the United States.
As drug paraphernalia spills out across the country, opioid usage is becoming a public waste issue, as well as a health concern.
Last December, cleanup crews in Huntington Beach, Calif. worked along sections of waterfront littered with hypodermic needles.
In Santa Cruz, Calif., a woman reported that her daughter had put an old needle in her mouth, thinking it was a thermometer.
In March, San Francisco’s Department of Public Works collected more than 13,000 syringes from the streets — quadruple for the same time period a year earlier.
Sign of a larger problem
The sight of used needles in public places or in recreation areas — particularly where children are apt to play — is disturbing.
However, experts warn that these incidents should be treated as a symptom of the much larger effects of the opioid epidemic.
“A waste disposal strategy is probably the least efficient,” said Ricky Bluthenthal, PhD, a professor of preventive medicine at the University of Southern California.
“I’d be more focused on getting people housed and out of the river beds with appropriate services and support than on dealing with the debris,” he told Healthline.
Bluthenthal and others point to homelessness as one of the major causes of syringes showing up in public places.
The homeless usually lack appropriate access to areas for disposal of any type of waste, not just drug paraphernalia.
In an editorial for the San Francisco AIDS Foundation (SFAF), Syringe Access Services program manager, Terry Morris, said, “You can’t disconnect the issue of homelessness and syringe disposal.”
Bluthenthal also had another theory.
Opioid users are moving to injection as the primary method for ingestion more quickly than in previous years.
His new research concluded that the prescription opioid epidemic leads to a heroin epidemic, which leads to injection drug use.
Participants in the study born in the 1980s or 1990s took about six years to escalate from a first encounter with illicit drugs to injection drug use. Participants born in the 1970s took an average of nine years.
Impact of needle exchanges
One predominant method for keeping needles off the streets is exchange programs, or what the Centers for Disease Control and Prevention (CDC) call syringe services programs (SSPs).
These programs allow users access to sterile needles. Dirty needles can then be disposed of properly as well.
Dirty needles expose drug users to a significantly higher risk of blood-borne illnesses, such as HIV and hepatitis C, as well as the threat of infection from dirty needles.
In the long term, SSPs have also proven to be effective in getting users to enter treatment and stop using drugs entirely.
Laws regarding SSPs vary from state to state. Some make access for users difficult or impossible, depending on where they live.
In a statement from the CDC to Healthline, officials said that according to one recent study, “only three states have laws that support full access to both comprehensive SSPs and hepatitis C-related treatment and preventative services for people who inject drugs.”
Without SSPs and other appropriate ways to dispose of needles, the issue will continue to grow as a public waste problem.
Both local governments and groups like the SFAF take part in regular cleanups.
“We haven’t built out a robust system of support to people to get into treatment when they are at the opiate use stage or the heroine use stage,” said Bluthenthal. “We don’t have sufficient coverage of syringe exchange programs or drug consumption rooms or other responses that would keep hazardous materials out of streams, rivers, and oceans.”
“We’re falling behind,” he added.
Risk is still minimal
However, Bluthenthal said the actual risk that stray needles pose to the general public is quite minimal.
Although there is the potential for exposure to blood-borne illness or residual narcotics in a needle, it is unlikely.
“The odds of that having active transmissible material in it: pretty low. You’re probably more at risk of some basic bacterial infection because it might not be that clean than you would of HIV or hepatitis C,” said Bluthenthal.
Nonetheless, he admitted, “Getting stuck is an injury, so if that happens to anyone, that’s not good.”
As disturbing as the image of needles poking out of the sand on public beaches or littering sidewalks in San Francisco, Bluthenthal reiterated that this is not an isolated incident.
It should serve as a wake-up call to the realities of the opioid epidemic.
“Whether or not these problems, in terms of disposal, become more significant really is going to be related to these upstream challenges around housing and access to treatment and adequate harm reduction to keep waste disposal in controlled areas,” he said.