BALTIMORE SHARP SAFE
B A LT I
SHARP SAFE MORE
FROM THE CITY OF BALTIMORE:
A NEW COMMUNITY SPONSORED SHARPS PROGRAM
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Baltimore Breaking the Stereotypes
645,000 POPULATION
60,000
DRUG ADDICTS
48,000
OF THEM HOOKED ON HEROIN.
IT'S AN OLD HEROIN TOWN. THERE IS AN APPETITE FOR HEROIN IN BALTIMORE. IT'S ACCEPTED BY TOO MANY PEOPLE AS SOMETHING THAT'S NORMAL BEHAVIOR. 2
BALTIMORE SHARP SAFE
he problem in the city is so acute that the federal government has desig-nated Baltimore part of what it calls a High Intensity Drug Trafficking Area, making it eligible for special federal assistance to local police. Tom Carr, the director of the Washington/ Baltimore HIDTA program — a joint federal, state and local effort — says the heroin epidemic in Baltimore dates back to the 1950s and is now an engrained part of the city's culture. “It's an old 'heroin town,” says Carr. “There is an appetite for heroin in Baltimore. It's accepted by all too many people down there as something that's normal behavior.” The narcotic white powder that, according to a February report by the HIDTA, one in every 10 residents of the city snorts, smokes or, more commonly, heats and then injects with needles is significantly more potent than the heroin sold in many other areas of the country. WHY ARE SYRINGE DISPOSAL PROGRAMS NEEDED? It is estimated that an individual injection drug user injects about 1,000 times a year. This adds up to millions of injections, requiring millions of syringes every year. Providing ways for injection drug users to safely dispose of used syringes is an important public health priority. The problem is much larger than just injection drug users, though, for an estimated 2.4 million diabetics also make about 1 billion injections of insulin each year. A 1990 survey of diabetics who inject insulin reported that 93% of them threw their used syringes in the trash, 3% disposed of them in the toilet, and only 4% of them placed them in puncture safe containers. IS THE PUBLIC CONCERNED ABOUT SYRINGE DISPOSAL? With the advent of AIDS, used syringes discovered on the streets and in parks have created a high level of public concern. Several instances in the late 1980s of medical waste, including syringes, washing up on the beaches of New York focused intense attention on the need to regulate and improve the safe disposal of used syringes and other “sharps” to prevent both needle stick injuries and the possible transmission of blood-borne diseases, such as HIV and viral hepatitis. Federal, state, and local agencies have taken some steps to address this problem by passing laws and regulations controlling syringe and other hazardous waste disposal in health care settings. the sheer volume of syringes used every year and the high level of public concern mean that communities must address the issue of safe disposal of used syringes. The sheer volume of syringes used every year and the high level of public concern mean that communities must address the issue of safe disposal of used syringes. This is also important in light of the fact that the potential for used syringes to be discarded on streets and in neighborhoods is a primary factor in community opposition to programs that are intended to increase IDUs’ access to sterile syringes, such as pharmacy sales and syringe exchange programs.
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WORD ON THE STREET: What are the barriers to safe syringe disposal?
Most states have drug paraphernalia laws, which establish criminal penalties for the possession of any item used to consume illegal drugs. Injection drug users have realistic concerns that they will be arrested if they save used syringes or carry them to a disposal site. A qualitative study of users and community attitudes toward various methods of syringe disposal gave them a chance to describe these fears:
THE POLICE They’d catch you with a dirty syringe and you’d go to jail for possession, so people ain’t hardly gonna keep ‘em laying around, keep ‘em in a container or whatever.
ARRESTS They know they can stop you, and if you come and dispose of them, they got a case there.
GOING TO JAIL I’m not going to risk that. That’s me. I got a probation, so I can’t take the chance at all. I’m so scared now. Then I’d have to go back and do all that time. 4
BALTIMORE SHARP SAFE
Safe Disposal Initiatives
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Syringe Exchanges
Sharps Containers
* Syringe exchange programs provide an important way for injection drug users to safely dispose of used syringes. Injection drug users report a distinct preference for syringe exchange programs compared to other safe disposal methods, because they receive a sterile syringe in exchange for every used one.
* Providing sharps containers and designating drop-off sites in pharmacies, hospitals, and health departments. The containers are then picked up as part of ongoing biohazard disposal programs. San Francisco’s Safe Needle Disposal Program has used this method in pharmacies to collect about 1.5 million used syringes a year.
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Non-Puncture Container
Drop Boxes
* Placing used syringes in punctureresistant containers, such as bleach or soda bottles, which are then thrown in the trash. This approach also has little to offer homeless persons who have no place to store containers, and it presents some risk to sanitation workers because even heavyduty bleach bottles will break under sufficient pressure.
* Drop boxes have been supported by the communities in which they have been tried because they are “one-way only”—syringes go into the box but cannot be retrieved. This reduces the reuse of con-taminated syringes and the risk of accidental needle sticks.
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Implementation of the Sharp Safe needle disposal boxes will make Baltimore a safe and better place.
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BALTIMORE SHARP SAFE
Know the Numbers Last year, there were
According to a February report by the HIDTA,
one in every 10 residents of the city snorts, smokes or, more commonly, heats and then injects heroin with needles.
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for the cities in the US with the top HIV/ AIDS rate.
As of 2004, injection drug use accounted for about
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304
fatal heroin-related overdoses in Baltimore and a similar number of heroin-related hospital emergencies.
No.
of all HIV infections and most hepatitis C infections in the United States.
The heroin epidemic in Baltimore dates back to the
1950s
The higher potency, combined with an increased availability and a reduced street price,
$100 $120 to
per gram, is fueling the city’s scourge of addiction.
It is estimated that an individual injection drug user injects about
1000 times a year.
Source: ABC News, Centers for Disease Control and Prevention
More Concerns
ANOTHER POTENTIAL BARRIER is that many local, state, and federal laws govern the handling and disposal of infectious waste. They are critically important in determining whether a disposal program is workable, but they differ substantially from community to community. This makes it difficult to develop programs that could be adopted in more than one community.
DRUG PARAPHERNALIA LAWS and the resulting fear of arrest, make it less likely that syringes will be safely disposed of, make it harder to implement safe disposal programs, and consequently, contribute to unsafe disposal of used syringes.
FINALLY, COMMUNITY OPPOSITION to syringe disposal programs can be an important barrier. This opposition centers around fears that such pro-grams may create a public safety and health problem, appear to condone drug use, make communities where they are located look bad, attract more drug users and dealers, and present opportunities for vandalism.
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OPERATION
RED BOX
PILOT PROJECT
IN JUNE 1996, A PILOT PROGRAM RAN FOR TEN MONTHS WHERE THREE SURPLUS U.S. MAIL COLLECTION BOXES WERE PAINTED RED AND USED AS A SYRINGE AND NEEDLE DROP BOXES IN LOCATIONS WITH HIGH DRUG USE IN EAST BALTIMORE. The Operation Red Box Pilot Project Brought together members from the Department of Epidemiology from the Johns Hopkins School of Hygiene and Public Health, the Baltimore City Health Department, the National Center for HIV, STD and TB Prevention, and the Centers for Disease Control and Prevention to assess the acceptability and the use of a community-based needle and syringe disposal project designed to serve injection drug users. In June 1996, three surplus U.S. mail collection boxes were painted red and used as a syringe and needle drop boxes in locations with high drug use in East Baltimore. Acceptance of the drop boxes was measured by focus groups of residents, drug users, and police, held before and after implementation. Use was measured by weekly counts of needles recovered from the red boxes. A sample of all deposited needles was randomly chosen for needle washing and subsequent HIV antibody testing. Community impact was measured by systematic surveys of needles discarded on public sidewalks in areas with and areas without drop boxes.
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Baltimore has its own Needle Exchange program that consists of two mobile health vehicles that situate themselves at different neighborhoods in Baltimore everyday.
Before implementation members of focus groups expressed concerns that drop boxes could convey mixed messages to youth (e.g. seeming to condone drug use), might result in increased loitering, and could further community stigmatization. After implementation, all focus groups supported project expansion.
BALTIMORE SHARP SAFE
Red Box Case Study Research Results: AFTER PROJECT IMPLEMENTATION, ALL FOCUS GROUPS EXPRESSED SUPPORT FOR PROJECT EXPANSION.
In the first 10 months, 2971 needles were collected.
Approximately 7980 used needles would be generated by injection drug users in the a given month.
The population of the East Baltimore Midway Community is 11,403 (1.5% of Baltimore’s total population), 5% of Baltimore’s total population are Injection Drug Users.
Baltimore injectors use one needle a median of three times.
Knowing that the EBMC is an area of high drug use, we estimated that 7% (798) of its 11,403 residents inject drugs.
Baltimore injectors inject an average of once daily.
Of 156 needles, 17 of them (10.9%) tested positive for the HIV antibody. 9
SHARP SAFE
Baltimore currently has no known community sponsored sharps disposal drop off service, and any known sharps disposal services are located at healthcare facilities that often won’t accept public drop offs because of the cost that incurs to dispose of medical waste. Maryland does have it’s own mail back programs and the Baltimore Needle Exchange program that consists of two mobile health vehicles that situate themselves at different neighborhoods in Baltimore everyday. Individuals can exchange used needles for sterile needles on a “one-for-one” exchange basis. The program also provides free and confidential HIV testing and counseling and syphilis screening. The mobile van offers vaccines for influenza. Individuals can receive counseling about drug treatment programs and education regarding HIV, tuberculosis and sexually transmitted diseases. Users can also purchase at home needle destruction kits or needle incinerators for self disposal, however these options can also be very costly. Sharp Safe is a public sharps disposal service that is unobtrusive but still conspicuous and safe so it becomes a viable option for users who can’t otherwise dispose of their sharps safely. It will not serve to blame or shame users but to bring awareness to the use of needles in the community and offer a way to keep others safe.
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SHARP SAFE IS A PUBLIC, UNOBTRUSIVE BUT STILL CONSPICUOUS SHARPS DISPOSAL SERVICE.
Source: Centers for Disease Control and Prevention, Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology
A NEW NEEDLE DISPOSAL PROGRAM THAT UTILIZES DATA FROM PREVIOUS PILOT PROGRAMS TO HELP THE COMMUNITIES THAT NEED IT THE MOST
BALTIMORE SHARP SAFE
THE KIOSK THE SHARP SAFE CONTAINERS will be placed in neighborhoods of high drug activity and be emptied out every week by authorized personnel. The kiosk will function like a mail drop box, with a compartment that opens up with a hinge that keeps the rest of the container inaccessible. The kisok will be bolted to the ground so it cannot be displaced. When collected, these sharps will also be tested and cleaned and donated to needle exchange programs like the Baltimore Needle Exchange, so they are recycled back into the community. Along with the kiosk boxes, sharp safe will also have other resources that accompany the service. Through the Sharp Safe website, users can connect to free centers and programs that offer confidential HIV testing and counseling and syphilis screening. Individuals can also find information on how to receive counseling about drug treatment programs and education regarding HIV, tuberculosis and sexually transmitted diseases.
B A LT I
SHARP SAFE MORE
SHARPS DISPOSAL KIOSK
NEEDLES AND SYRINGES ONLY PLEASE
SHARPS DISPOSAL KIOSK How much have we collected?
DO NOT DEPOSIT CONTAINERS LARGER THAN TWO QUARTS
2 QT
Where are other boxes located?
PARENTS: DO NOT ALLOW CHILDREN TO PLAY WITH OR AROUND BOX
What other resources are available?
NO GARBAGE NEEDLES AND SYRINGES ONLY
Find out at SharpSafe.com
A heat map displaying research from Debra Holden, an associate professor at Johns Hopkins Bloomberg School of Public Heath, that shows the amount of drug abuse in Baltimore City. Red displays the most amount of drug abuse and green the least.
B A LT I
SHARP SAFE MORE
Sharp Safe is a community sponsored sharps disposal program brought to you by the City of Baltimore. It offers a clean and safe way to dispose of used needles so you dont have to worry about them!
SharpSafe.com
SharpSafe.com
B A LT I
SHARP SAFE M O RE
BIOHA Z A RD
B IOH A Z ARD
B IOH A Z ARD
These steel kiosks, will stand at 44” tall and 12” wide.
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MAP+KIOSK LOCATIONS