This story has been updated from its original version.
When Jason Townsend decides to inject heroin into his veins, he finds a place to hide, out of sight from those strolling down the Interstate 205 multi-use path, which around 3 p.m. on a recent Thursday included children on their way home from Oliver P. Lent Elementary School.
Then, he says he takes his used needles to a needle exchange. The nearest to the tent he's sleeping in beside the path would be the Clackamas Service Center on Southeast 80th Avenue, where exchange service occurs only on Thursdays between 2 and 5 p.m.
"I always take care of my (expletive)," Townsend says. Looking around the area near his tent, he said, "This (expletive) disgusts me ... What if some kid finds that?"
He was living on the path with his girlfriend and came to Oregon from Detroit, Michigan, about a year ago to try to get back his daughter, who he says was taken away by his ex.
But not all users are so careful. Less than half a mile away at Lents Park, a child encountered a publicly discarded syringe and was stuck in the face last year, according to East Precinct officer Sgt. Randy Teig. The child's mother didn't want to file a police report, he says.
Declaring Lents as being in a "livability crisis," some neighbors created a committee and have worked to draw the attention of city officials to its growing number of homeless camps, vacant, dilapidated homes known as "zombie" homes, abandoned RVs and cars, and biohazards, such as syringes, left by those living in those places.
"We're talking about a number of syringes that I've never seen in 25 years in the police bureau," Teig says. He started working with the Office of Neighborhood Involvement on the issue of "incivility" in neighborhoods, becoming especially empowered after the child was stuck in Lents Park.
Jennifer Young, a 20-year resident of Lents, mental health therapist and member of the livability committee, says many in the neighborhood are suffering from compassion fatigue for those on the streets.
"It's a public health crisis in Lents," she says. "(We) need a safe zone around schools so that people aren't injecting heroin and peeing and living on the bike path near the school."
Teig and Stephanie Reynolds, a crime prevention program manager at the Office of Neighborhood Involvement, hope to conduct a survey, starting in Lents, to get an understanding of what neighborhoods are fearful of so they can better address issues.
"What are the kinds of things that trigger fear of crime, and how much fear do they trigger? We know that people encountering discarded syringes is one thing that really freaks them out ... We know that in Lents, because of the Springwater (Corridor Trail, where hundreds of homeless people camped), they're especially sensitive to debris," Reynolds says.
They're coming up with survey questions and seeking advice from Portland State University on how they can be as scientific as possible, because they don't have a budget to hire a professional surveyor.
"The fear of crime is a big problem. When people are afraid of crime they tend to retreat in their homes, and that's not good for the community," Reynolds says.
The number of found syringes has dramatically risen in the city. The county attempted to mitigate the issue downtown specifically by placing two syringe drop boxes at Waterfront Park last year as part of a pilot program called "Healthy Streets." The program is a partnership between Parks and Recreation, Bureau of Transportation and the county health department.
"I think we've got an increase in heroin use happening and we have an increase in homelessness, and one fuels the other, and the other fuels the other," says Kim Toevs, director of the STD/HIV/HCV programs for the Multnomah County Health Department.
In 2015, 40 percent of needle exchange clients were homeless, while 27 percent reported an unstable housing situation, according to the 2016 Tri-County Region Opioid Trends report. Toevs says that the number of homeless people accessing syringes jumped to 45 percent from July through December 2016.
The numbers are combined with data from Outside In, a social service agency that partners with the county to administer the needle exchange program.
Oregon has one of the longest running needle exchange programs in the country. It was established in 1989 as a way to give drug users access to clean syringes to prevent spread of disease associated with the sharing of needles.
All together, more than 3 million syringes were exchanged through Multnomah County and Outside In's needle exchange program in 2015, a 59 percent increase since 2012, according to the report. Multnomah County observes 87 new clients accessing the needle exchange every month.
Multnomah County distributed 2,478,362 syringes during fiscal year 2015-2016, and took in 2,394,460, a difference of 83,902 needles.
Outside In separately reports that during fiscal year 2015-2016, of the 988,399 needles issued, 967,437 were returned — a difference of 20,962 needles. There were 132 HIV tests taken during that period.
Outside In caps the number of syringes it will exchange per person, while the county does not. Multnomah County will give up to 10 syringes to an individual who has none to exchange.
Clean and Safe, a program managed by the Portland Business Alliance that focuses on the core downtown business district, cleaned up close to double the number of needles in 2016 from 2015: 16,882, up from 9,897.
Reynolds' office frequently fields calls about found syringes, and while she applauds the county's Healthy Streets program, she would like to see it expand.
"That's a good thing, but they're only in one place in the city," she says.
The Healthy Streets program is down a box, since one was recently vandalized, and they're working to build a new one that's sturdier. A biohazard contractor picks up the syringes twice a week.
The goal by placing the boxes at the waterfront was to address the large number of homeless folks who were hanging around the area who are throwing syringes on the ground, in the bushes and the bank of the river.
"So that's why our focus was there. It doesn't cost a lot of money to have those units, but it does take some money and attention. So we don't currently have that funding or contracts or partnerships developed (to expand)," Toevs says.
Needle exchanges are available daily around the city, except on Sundays, but are in varying locations and between certain hours.
Toevs added that perhaps in a year or two, they could look at finding other sites in the city for the boxes.
There are other areas looking to clean up, too. Northeast neighborhoods, such as Eliot, have also become concerned with issues of needles and garbage. Adam Lyons, of the Northeast Neighborhood Coalition, says they hope Clean and Safe can extend its services to the east side. He said it would cost about $80,000 to have a full-time Clean and Safe staffer to go through the neighborhoods.
A combination of city employees, Multnomah County inmate crews and contractors coordinate homeless camp cleanups.
Clean and Safe employs many formerly homeless folks in a recovery program to clean up needles and garbage downtown.
The county mostly relies on word of mouth and good will to get the word out about bringing back needles.
211info.org, a resource used by many on the street, lists four needle exchange locations, including Clackamas Service Center, Multnomah County Health Department, Outside In, and Saint Peter and Paul Episcopal Church.
A schedule is listed on Multnomah County's website, which Toevs says they keep updated, and that Ouside In is usually good about keeping them posted of changes.
Portland Peoples Outreach Project (PPOP) provides clean syringes and doesn't require someone to hand in a dirty needle to get a new one.
Toevs says there are a lot of reasons someone might not bring a needle back to an exchange, including fear of being stopped by police if there is drug residue in the needle while they're transporting it in a backpack.
Teig, whose team has helped secure some of the city's zombie homes where they have found thousands of syringes, would like to see more accountability for the needles. He's working to put together a plan to present to other agencies about a way to color code the syringes in order to track "needles back to specific exchanges so they can clean up their own messes" and also help them determine, for example, "if a user from Hillsboro ends up on the trail down here (in Lents)" and trace potential outbreaks. He says that although there haven't been many reports of injury by publicly discarded syringes, there have been some, and he wants to decrease the odds that a child will be stuck.
The risk of actually being infected by a publicly discarded syringe is low. There has never been a case documented where someone was infected with HIV through a publicly discarded syringe, according to the Centers for Disease Control. Publicly discarded needles typically contain only limited amounts of blood, and the "infectiousness of any virus present might be low," according to the CDC. Toevs says there's medication people can take for a month to prevent HIV infection.
The bigger picture
Meanwhile, Toevs remains concerned about the larger opioid epidemic.
She said at some of the exchanges, they will have a line of young people "that look like they're at a rock concert."
"Part of that is coming from people who got addicted to pills first," she says, adding that once painkillers run out, they'll seek out heroin. More than half of the needle exchange program's clients reported first being hooked on prescription painkillers before turning to heroin.
"There are parts of our health system that are working really hard on a whole bunch of different ways to decrease people addicted to pain pills," Toevs says.
But, she cautions, it's not just heroin users accessing syringes.
Methamphetamine use among the county's and Outside In's syringe exchange clients spiked from 38 percent in 2010 to 83 percent in 2016, according to the opioid report.
She's worried about the level of stigma over drug use that inhibits folks from accessing programs that give social service workers the opportunity to tell users about safer practices.
"Some people ... feel they're going to be treated poorly or stigmatized, and to other people (buying syringes) is a cost barrier to them," Toevs says. In Oregon, it's legal for someone 18 or older to buy clean syringes from a pharmacy.
Officials have looked to exchange programs as a way to prevent spread of disease associated with needle sharing. Without it, Toevs indicates things could be much worse.
She pointed to a massive outbreak of 190 HIV cases in Indiana, a state that until the incident happened in 2014-2015 prohibited needle exchange programs.
However, she understands the fear of biohazards out in the open and general frustration of more trash.
"Often times people's fear and ick factor about seeing a syringe it's actually higher than the risk of getting infection," Toevs says. "Nonetheless, it's not zero, even though it's quite small, which is why it's important that we educate people about properly disposing of their syringes."
See a schedule of exchanges and find out how to dispose of needles at: multco.us/hiv-and-std-services/syringe-exchange-and-disposal
The story originally misattributed the 45 percent rise in homeless people accessing syringes to the opioid trends report. That statistic was reported separately by a health department employee.