On a recent afternoon, a dark-haired woman picks out several syringes from a selection of injection drug paraphernalia setup in a downtown Missoula hallway. The state's first aboveground needle exchange includes everything from tourniquets to antiseptic wipes to tins known as "cookers."
At first glance, the woman doesn't look like anyone portrayed in the Montana Meth Project's jolting "Not Even Once" anti-drug ad campaign. She's not emaciated. Her clothes aren't dirty. She says she takes care of herself, eating and sleeping regularly.
"I'm hungry," she says sarcastically.
Upon closer inspection, however, subtle details betray her drug habit. A small line of needle marks are exposed on her right hand. She agrees to talk to a reporter, but only if granted anonymity for fear that she could be criminally prosecuted for speaking candidly about her drug use. We'll call her Shannon.
Shannon says she is a 43-year-old grandmother who first used IV drugs 26 years ago. While she's had clean stretches, she admits that these days she can't get out of bed without a fix. "It's a necessity after a while," she says. "I don't think I'll ever quit."
Before learning about the Missoula needle exchange, hosted by the nonprofit Open Aid Alliance, Shannon had an increasingly difficult time scoring sterile syringes. Old syringes are susceptible to bacteria buildup and can lead to dangerous infections.
"It's tougher and tougher," she says. "And the stigma just gets larger and larger."
It's legal to sell syringes without a prescription in Montana. Pharmacists, however, use discretion when distributing them. When Shannon's regular provider abruptly stopped selling her needles, she remembers thinking to herself, "So, I'll go find one in the garbage?"
Once Shannon resorted to using old syringes, she says that she developed a painful vein abscessone that was potentially life threatening. "I have vascular damage now," she says. "It is so devastating what can happen in a short amount of time."
Facing mounting health problems, Shannon was relieved to find the Open Aid Alliance's new Syringe Exchange Program. Since launching the program less than a year ago, staff say they have distributed approximately 25,000 needles to area drug users.
"We started very slowly, kind of just tipping our toes in the water," says Open Aid Alliance Prevention and Harm Reduction Specialist Stephanie Cole. "And then it blew up."
Clients include the young and old, affluent and poor. Though they're not required to disclose names, exchange clients are asked to detail their drug histories, including which drugs they've used, whether they've ever overdosed and if they know their hepatitis and HIV status. The intake form also asks whether the client would like to be tested for the viruses.
Social workers call the principle behind needle exchanges "harm reduction." The idea is to reduce the human and financial fallout associated with drug use, while linking clients to social services, if they desire help.
Bacterial infection like what Shannon developed constitutes just one problem associated with IV drug use. In Montana, the Department of Public Health and Human Services estimates 12 percent of the 652 HIV cases reported statewide between 1985 and 2012 stemmed from injection drugs.
The Centers for Disease Control and Prevention peg the lifetime cost of treating an HIV infection at $379,668. Nationally, the taxpayer-funded expenses associated with medicating and housing people infected with the virus, according to the Henry J. Kaiser Foundation, will top $19 billion this year.
Open Aid Alliance Executive Director Christa Weathers notes that it doesn't take much number crunching to realize the economic benefits of needle exchanges. For $800 a month, the Open Aid Alliance can distribute 4,000 syringes and other paraphernalia to help stop the spread of disease.
"It's crazy that this is the first visible syringe exchange in Montana," Weathers says.
Despite her incredulity, Weathers knows from firsthand experience that state and federal policies make launching a needle exchange anything but easy. Among the biggest barriers is funding. The U.S. Congress has for decades banned using federal dollars for needle exchanges, based on the argument that providing paraphernalia encourages drug use and, in doing so, fuels crime and disease.
Science doesn't reinforce that argument. The Office of the Surgeon General, CDC and National Academy of Sciences have found needle exchanges a cost-effective way of curbing infection, without increased drug use.
Locally, the Open Aid Alliance has overcome funding challenges with help from the Llewellyn and Wagon Mountain foundations and the United Way of Missoula County.
The second hurdle comes from state law. Montana statute criminalizes possession of syringes with even a trace amount of drug residue. That deters people from returning used needles, Weathers says. "People just don't want to bring them in," she says.
In response to concerns about returning needles to the exchange, Missoula Police Department Public Information Officer Travis Welsh says though MPD doesn't condone illegal drug use, city law enforcement has no intention of targeting the Open Aid Alliance. "It's much better that people have a place to dispose of these needles safely," Welsh says. "From the holistic community perspective, it makes a lot of sense."