The number of syringes exchanged under a Multnomah County-funded program jumped to 5.5 million last year, up from 2016's record of nearly 4 million.
Meanwhile, the number of used needles picked up on downtown sidewalks by Portland Clean and Safe workers has climbed from nearly 17,000 to 28,000 in one year.
And yet, nearly 30 years after needle exchange first began in the county — and as neighbors increasingly complain of the health risks of used syringes littering sidewalks, parks and neighborhoods in greater Portland — there remains only one publicly run open-air drop-box for disposal in the county, near the west side of the Burnside Bridge.
In part, that's because a second box on the Vera Katz Eastbank Esplanade was stolen late last year. But even had that not happened, other cities have pursued more ambitious programs with positive results.
Local officials from the county, the city of Portland and the Metro regional government are now looking to change the situation, discussing a plan to significantly increase the number of drop boxes around the county. But details of the discussion remain a closely guarded secret — so much so that while county officials have been pushing the initiative for months, Mayor Ted Wheeler and the Portland Business Alliance's Downtown Clean and Safe District say they aren't ready to say much.
"The city is in discussions with the county, Metro, TriMet and Clean and Safe to determine if there is a way we can better coordinate to reduce biohazardous waste caused by discarded syringes," said a Wheeler spokesman, Michael Cox. "Though talks are preliminary, we are exploring more syringe disposal boxes distributed across our community as part of the solution."
Click here for directions on safe syringe disposal
Drug use skyrocketing
The reason for the county's skyrocketing syringe-exchange market is simple: an increasing number of heroin and methamphetamine users. About two-thirds of the users of the county needle-exchange report unstable housing or homelessness.
The head of Portland Police Bureau's drug and vice division, Captain Mark Kruger, says heroin is more plentiful than ever, based on anecdotal information and national surveys. Meth, meanwhile, is cheaper than it's been in years.
The way things are going, "needles are going to replace the rose as the city of Portland's signature plant," Kruger remarked, speaking only for himself.
The contribution of the county's needle-exchange efforts to the problem of improperly discarded syringes is unclear, as the county reports just as many syringes are turned in as are distributed — and sometimes more. Under the needle-exchange program, users turn in bunches of used needles in exchange for roughly the equivalent number of clean ones.
To facilitate collection, county officials, working with the nonprofit Outside In, have gone to great lengths to distribute special portable containers for disposal of "sharps." Officials also note that biomedical waste disposal boxes have proliferated in public bathrooms downtown. And they say the benefits of preventing unsafe needle sharing pay off in preventing a costly human toll.
But they hope to do more to tackle the problem of waste disposal that stems from injection drug use.
County commissioners say they hoped to already have finalized plans for more drop boxes, and they aren't sure exactly what the holdup is.
But the players at the table show the potential reach of such a plan — including TriMet with its many transit stations.
Commissioner Jessica Vega Pederson said city fire stations could be part of the solution, and are reportedly being discussed as drop-box locations. The main question, she said: "Is there a way that we can leverage the public buildings and the public property that we have."
'Drowning in needles'
Meanwhile, the county still hasn't implemented plans to expand the number of its own drop boxes to five, which was approved 10 months ago.
"There's been neighborhoods that have reached out about wanting to have disposals in a park in their neighborhod, but there hasn't been any decisions yet," Vega Pederson said.
And whether the plans under negotiation go far enough to satisfy neighborhood activists in places like St. Johns, Montavilla, Lents and Richmond remains to be seen.
"We are drowning in the needles put out into the community by Multnomah County," said a letter complaining about the health department program that was sent to Commissioner Sharon Meieran by the Goose Hollow Foothills League last month. "Our residents are picking up hundreds of needles each week," the letter states. "Our neighborhood has experienced a shocking increase in unsafe and unsanitary levels of needles since MCHD started this program ... while keeping drug addicts safer, MCHD is risking the health of thousands more with this program.
"Our neighborhood is also filled with bloody cotton balls and feces-covered wipes that were given out at Outside In," added the letter, which was signed by Tracy Prince, the league's vice chair. "It is humane and necessary to hand out these items, but MCHD should put a plan in place so that these items aren't disposed of in our neighborhoods."
One study in Baltimore found that three drop-boxes were used often for syringe disposal. Though they did not result in a measurable decline in littered syringes in a two-year span, the study found that more than 10 percent of the syringes disposed of were infected with HIV, showing the health benefit.
Another study in Montreal looked at the effects of 12 drop-boxes over five years and found a significant impact on the reduction of used syringes littering the area.
For Multnomah County Health Officer Paul Lewis, the solution sought by the county is proven.
"To me the answer is multiple low-barrier options for discarding medical waste, and right now we don't have that," he said. "We just need multiple locations where it's easy to get rid of stuff for free."
Lewis said that there is no known case of a pin-prick from a used syringe leading to transmission of HIV. In contrast, he says, he says needle exchange prevents unsafe needle sharing. That keeps pregnant women who are users from transmitting disease to babies in the womb — a more common way of infecting children.
But what is the long-term solution for Portland's injection drug problem?
County officials say the push to restrict prescription painkillers is a good start, but will take years to have an effect on addiction rates.
Kruger, the Portland drug cop, said that personally, he thinks more accountability for drug users could be a "hammer" to ensure they get into drug treatment. But he said the supply of drug-treatment options just is not there.
Meieran doesn't think sanctions are the answer, but agrees a lack of treatment options is a major problem. An emergency room doctor who has focused on drug addiction and the opioid epidemic, Meieran said she regularly sees people in the ER who are ready to give up drugs or drinking. "I have to be the one to sit there and tell them that ... perhaps in six to eight weeks something will open up."
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