For nearly half his life, 64-year-old Navy veteran Duane has used meth. He first tried it when partying with friends but said it quickly became a way to numb pain from troubled relationships and challenges transitioning out of the military in the 1970’s.
“Trying to block out what I was feeling and trying not to think about it,” said Duane, who asked that we not use his last name due to his illegal drug use.
Duane is a patient at the Orlando VA Medical Center and in 2020 became the first veteran to enter the hospital's syringe services program.
The program provides vets with clean needles, sterile water, test strips for fentanyl and other supplies. It's meant to reduce some of the risks that come with injecting illegal drugs. Patients typically receive a two-week supply. Whether a vet needs 10 needles or 50, staff members said they'll provide them without passing judgment.
“We're meeting patients where they are,” said Jacqueline Byrd, a clinical pharmacist practitioner and one of the program leaders.
“We're not endorsing drug use, we're not condoning drug use. But we do know that not everyone who utilizes the program is ready to stop right now,” she said.
Preventing infection
Needle exchange programs have existed for decades, but they are relatively new to the Department of Veterans Affairs. The first launched in Danville, Illinois, in 2017, followed by the one in Orlando. Now the VA said there are eight around the country and more are developing.
In addition to the supply kits, veterans like Duane can get mental health treatment and instructions about preventing overdoses, among other harm reduction services.
“You have the gear, you have the tools to work with and be safe about it,” said Duane. “And there were times I didn't have it and I was like fretting trying to think, that needle could go up in that vein and it's gone. So I had to learn those things, like, don't keep putting the same one in and out.”
Duane has HIV and could spread it to others if he shares supplies. According to the VA, syringe services programs are a “key component” of a federal initiative launched in 2019 to end the HIV epidemic.
Besides HIV, infectious disease physician Minh Ho said people who inject drugs could get hepatitis C or B, as well as skin abscesses, vein damage and inflammation of the heart known as endocarditis.
He added that people with drug addiction are more likely to engage in high-risk sexual behavior, which can contribute to the spread of infection.
“Those are the harms and of course the harms affect not just the veteran, but then the overall cost to health care as well too to take care of it,” Ho said.
Helping some vets get off drugs
In addition to the cost savings, research shows people who participate in syringe programs are five times more likely to enter drug treatment and about three times as likely to stop using drugs, according to the Centers for Disease Control and Prevention.
It's worked for Navy veteran Jose, whose last name we’re not sharing.
“It's a program that saved my life,” he said.
Jose, 39, served in the Iraq War and said he struggled with mental health challenges when he got back. He used drugs and alcohol as a way to cope and connected with VA care after he attempted suicide.
Jose eventually learned about the syringe services program when he told his doctors he injected drugs and was “terrified” of getting HIV or hepatitis. Like other veterans in the program, Jose was able to connect with substance use treatment and received PrEP, a medication to prevent HIV.
Jose said he is sober now but has a syringe kit in case he relapses.
“As anyone who is an alcoholic or a drug addict knows, it's a day-to-day, one day at a time kind of thing. So the fact that they have a program where I can be seen and heard and I'm trying to fight for my life and they have tools, it’s empowering for a veteran to know that they have these options out there. I wish more people knew about it,” he said.
Barriers to expansion
The VA is expanding its syringe services programs, but there are barriers. In about a dozen states, needle exchanges are illegal. Hospitals have also had to navigate federal restrictions on using government funds to buy items that could be considered drug paraphernalia.
The team in Orlando is helping other VA’s work through those challenges, according to Jacqueline Byrd. She wants more programs to open because she said they help reach vets who might otherwise avoid the VA.
“They need somewhere safe to know that I still can get healthcare and can still be treated even though I'm going through what is a very stigmatized disease state,” Byrd said.
VA hospitals in Miami and Tampa also have syringe services programs.
The James A. Haley Veterans' Hospital in launched its this year on the main campus in Tampa and at all of it's outpatient clinics in the region.
Given overdose deaths have been on the rise nationally, it was important that the hospital offer the service, said infectious disease physician Jamie Morano, who also advises a national VA committee on HIV and hepatitis.
"Giving clean needles and education can bring down those deaths and also prevent infectious disease spread," she said.
The Tampa VA will offer the service in person but can also arrange for telehealth care, which Morano said can help veterans who lack transportation or face other barriers.
Orlando can also offer virtual services and send supply kits to vets in the mail.
Even as one of the VA’s larger syringe programs, Minh Ho said Orlando has served only 18 veterans. Recruiting participants is another hurdle.
“There’s hesitancy for veterans to admit they use drugs and also I think there’s some hesitancy among providers to feel comfortable to ask about it,” he said.
Ho said program staff tell veterans that disclosing their drug use won’t cost them VA benefits. They’re also educating health workers to be more compassionate when talking with patients about substance use and sexual behaviors.
The next priority is to get out into the community to find veterans not currently in the VA system or who face barriers to care like lack of housing and transportation.
Of the 18 patients in the program so far, Jose is one of two vets who have quit using drugs.
Duane said he’s not there yet.
“I want to be myself again, but I don't even know who I am anymore because I’ve been through this cycle up and down, over and over. It's hard, it's a struggle.”
For now, Duane said he's taking advantage of art therapy at the VA, another service connected to his care in the program. He said painting is improving his mental health and is a healthy distraction to using meth.
Duane said he eventually wants to get off drugs, and staff at the VA syringe services program say they will stick with him until he's ready.
How to get help in Florida
The Orlando VA's syringe services program operates out of its Lake Nona location. Veterans interested can call 407-631-2267 or 407-631-2247 or 407-631-2040. They can also learn more online.
The Tampa VA encourages veterans to call 813-631-7100 to get connected with its syringe services program. They can also ask about it at urgent care or emergency departments.
Floridians can also access clean syringes at IDEA Exchange locations in Tampa and Miami.
Click here for more substance use disorder and infectious disease resources from the Department of Veterans Affairs
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