Making The Best of a Bad Habit
Eighteen-year-old Oliver shuffles toward a row of red plastic bins lined up at the corner of Selma and Cosmo in Hollywood. As the sun dips behind the buildings, he drops 65 used syringes into a bucket marked "medical waste."
Elizabeth Valenzuela, 19, fills a paper bag with an equal number of clean needles and hands it to Oliver as he bends down to gather bottles of bleach and cotton balls from another bucket at his feet.
"Do you have any food?" he asks politely, smoothing one hand over his blond dreadlocks. Elizabeth offers him a peanut-butter-and-jelly sandwich, and Oliver crouches against the brick wall of a nightclub across the street to enjoy the first meal he's had all day.
This needle-exchange program, Clean Needles Now, is a weekly ritual for Oliver, who has been shooting drugs on and off since he dropped out of school in Iowa at age 12. Since then, he's crisscrossed the country more than a dozen times, drifting from abandoned buildings to freeway underpasses. He says that needle exchanges--where injection drug users trade dirty syringes for clean ones--have kept him alive. He knows that sharing needles can spread the human immunodeficiency virus, which causes AIDS.
"I am here to be safe. I never shoot drugs with needles that aren't clean," he says, inspecting the bag of clear plastic syringes he will use tonight to inject crystal methamphetamine--a type of "speed."
On any given week, C.N.N. serves several hundred injection drug users at three evening exchanges across the city. The clients represent a cross section of the cityhomeless people, middle-class professionals, college students, Valley girls. And nearly a third of them are adolescents: Most are street youths, gang members, runaways. But many are middle-class teenagers who go to school, live at home with their folks, and shoot drugs recreationally.
Most of these young users go out of their way to get to the C.N.N. needle exchange. They take buses through rush-hour traffic or walk from their shelters across town to the Hollywood street corner because they prefer to pick up their clean "works" from people their own age.
Seventeen-year-old Vicki drives her white Toyota, which doubles as her home, to the exchange every week. She says she likes to show up early to chat with her buddies, young people who seem to understand her. Since her mother evicted her from the house last year, the tough-looking teenager says she's dropped out of school and made her heroin habit a priority. "If I got off drugs, then what would I have to look forward to?" she asks matter-of-factly.
But not all of the young people who show up at the needle exchange are drug users. Eight of the regulars--some of whom are former users themselves--have joined the ranks as volunteers. They, too, come from across the city to unload supplies from C.N.N.'s red Ford Bronco, to set up the Rubbermaid canisters on the sidewalk, to tally on clipboards the number of needles exchanged, and just to be there when their peers show up.
Renee Edgington, who launched the street-based needle exchange two years ago, actively recruits young people because, she says, they are knowledgeable and nonjudgmental advocates for users.
Elizabeth, who lived on the streets, using speed, before she became a volunteer at the exchange last year, says she sees her role as an informed ally, a health worker. Though she no longer takes drugs, she knows the dangers of injecting them firsthand and wants to help young people protect themselves against AIDS.
"I always stress that I am not a cop and I'm not their parent," she says. "I got involved in needle exchange because there is an H.I.V. risk out there and kids can't wait to get educated. They need to know now."
Los Angeles County has the second largest population of injection drug users in the country--nearly 190,000 in 1992--according to Wesley Ford, an epidemiologist at the L.A. County Health Department. He estimates that some 10 percent of them are under 18.
The U.S. Centers for Disease Control and Prevention has attributed one-third of all reported AIDS cases nationwide to intravenous drug use. And IV drug use among young people across the country--particularly of speed, lsd, and heroin--continues to rise.
Currently, weekly needle exchanges operate in 30 cities across the country. At most sites, including Los Angeles, local hospitals donate the supplies, and community activists run the programs. Most operate illegally, under state laws that prohibit the distribution of drug paraphernalia.
A 1986 California law bans the distribution of needles here. But like many other exchanges that are technically illegal, C.N.N. is tolerated by city officials who view the operation as promoting healthy behaviors. Even so, police have shut down C.N.N.'s program three times in two years--mostly in response to public pressure.
But as early as this week, the situation may change. The Los Angeles City Council voted recently to ask Mayor Richard J. Riordan to declare a state of health emergency that would legalize the exchange and put an end to police involvement.
Since it began, C.N.N. has been operating on a meager budget, but just last month the program received a financial boost. The Chicago-based Comer Foundation, which provides money to youth and education groups, awarded C.N.N. a three-year $150,000 grant to continue its work.
To boost the number of young people using the needle-exchange program, a handful of C.N.N. volunteers have turned to even more unconventional methods.
Elizabeth ventures into places where social-service workers rarely go to attract at-risk youths to the needle exchange. Armed with clean needles, cotton, bottles of bleach, and sign-up cards, she goes into the squats--abandoned buildings that are home to hundreds of the city's runaways and homeless youths--and doles out advice: Sharing needles can be dangerous. Always clean your works.
Even though the squats can be daunting to outsiders, Elizabeth is confident navigating the maze of encampments. After all, they were once her home. An arrest last year for shoplifting--and the opportunity to participate in a National Institute on Drug Abuse research project on drug education--jolted her into changing her life style and moving back in with her mother.
But Elizabeth has vowed to stay connected to that community. So far, she's enrolled more than 100 young drug users in the exchange. "Some junkies have really low self-esteem," she says knowingly. "And they need to know how to take care of themselves."
To this end, Elizabeth and some of her C.N.N. co-workers have joined forces with volunteers from other needle exchanges to develop a medical handbook for individual injection drug users. Also funded by the Comer Foundation, the manual will explain how and where to inject drugs, how to avoid an overdose, and the facts about H.I.V. and AIDS. Clean Needles Now and the foundation hope to publish the handbook later this year.
"It's basically a safe-shooting guide," one volunteer says. "All the questions about shooting up that you were afraid to ask."
Although C.N.N. has no formal link with area schools, some local educators are strong supporters of the effort.
Dorris Dent, the principal of Selma Elementary School in Hollywood, sees the needle-exchange program--which comes to a street corner just outside her school once a week--as a simple matter of public health.
"I don't condone drug use, but if they are using drugs, they should be able to do it in a safe manner," says Dent, who believes street-based outreach is often the only way to reach young drug addicts.
"They are not going to come to us and ask, 'Do you have any pamphlets on AIDS?'"
Even when schools do teach AIDS education, they rarely discuss the dangers of sharing needles, says Vicki Karlan, who runs a school-based clinic at Culver City Senior High School and volunteers at the exchange. "Schools have gotten to the point where they can finally address condom use," she says. "Needle use gets into a whole other arena." And even if that information were available, she adds, students would probably still feel reluctant about approaching teachers for advice.
But C.N.N. and other needle-exchange programs across the country have attracted their share of critics, as well. Opponents fear that handing a needle to a drug addict only encourages drug use.
"I don't want to give our young people mixed messages," says Fred W. Garcia, the deputy director of the federal Office of National Drug Control Policy. "That on the one hand drugs are harmful and can disrupt your life, and on the other hand here's a clean needle."
C.N.N.'s Edgington rejects that argument. "That's like saying if condoms weren't available, people wouldn't have sex," she says. "I doubt it."
In fact, a growing body of evidence suggests that the exchanges curb--not fan--drug use and can even provide a bridge to treatment for addicts who want to quit. In a study published in the Journal of the American Medical Association this year, researchers found that a San Francisco needle-exchange program did not increase the frequency of injection drug use. In fact, over the six-year period studied, the percentage of the exchange's clients who said they were new injection drug users actually decreased from 3 percent to 1 percent.
Health experts also say the exchanges are an ideal way to channel other health-related information--especially about H.I.V. and AIDS--to these hard-to-reach groups. A recent study of a New York City program, for example, found that its street-based needle exchanges were successful in slowing the spread of H.I.V. among IV drug users. And that, say organizers, is the ultimate goal of the exchange.
A week later, Oliver and five of his friends slowly walk back down the narrow Hollywood street to the exchange, sandwiched between a nightclub and a recording studio. The steady drum beat emanating from the building is foreboding.
Oliver's 18-year-old friend Ryan inspects his bag of needles as he leans against the paint-splattered brick wall of the club.
"If it weren't for the exchange, I'd be sticking something duller than a stapler in my arm," he says, exposing the faint track marks in his pale skin.
He and Oliver are killing time waiting for some friends to come down from Canada before they start hitchhiking east this fall.
"I'll probably be traveling for a while," Ryan says, looking down at the brown knapsack at his feet containing everything he owns. "Hollywood's not the place I'm going to die."