Ben Vanhunnik and his Research Team Supervisor, Mark, who is a member of the Sociology Department at the University of Colorado work with Project Safe, run through the University of Colorado Health Sciences Center. Mark is speaking unless noted.

Q: Tell me about Project Safe,

Just a quick overview- we’ve been around since 1987. We’ve been working primarily with injection drug users, doing interventions to reduce risk and assist in facilitating drug treatment. We are a research facility through the University of Colorado. What we have done is, we have looked at different forms and types and strategies of intervening with current IDU’s to do two things; one is to reduce the risk of infectious disease, HIV being the big one, but also Hepatitis B and C, syphilis and other STD’s; and also to look at factors that will assists them in entering and maintaining treatment.

Q: What is your relation to a harm reduction strategy?

Some of the strategies we use are based on harm reduction. We use the term risk reduction more than harm reduction. Simply because some of the definitions of harm reduction and what that means is that there are some things that may or may not reduce harm but may reduce risk. So we use the term risk reduction instead of harm reduction.

Q: Overall, what is this agency’s perspective on HR as an approach?

We embrace harm reduction and risk reduction. We think we have been able to verify through research through 1987 that IDU’s who were tested in 1987- about 5% were positive for HIV. Today it is commonly accepted that that number is two and a half percent.

B: With the peer education sessions that we do, one part we are looking at is if we educate index members, people who are part of a network, will they teach the people in their network about risk reduction and things like that. In there, that’s a big part of our presentation. Somebody shares six times and they reduce to three, that’s a good thing. So we definitely embrace that. Ideally, you don’t want it to happen at all.

Q: How many IDU’s in the Denver area?

About 25,000 in the metro area; Aurora, Lakewood, Goldin...I suppose you could say it’s the seven county area.

Q: How many drug addicts in area?

I don’t know.

B: Much higher, with crack especially.

Crystal meth…

B: I don’t think we realized how big of a problem Denver had until we did a study where we had to recruit people who just inject crystal meth. Now we know it’s a major problem.

Most of our money comes from NIDA. By submitting a grant that looks at reducing drug abuse and also reducing high risk behaviors that lead to infectious disease, we have a better chance of getting a good grant. We also have a grant through SAMHSA for working with women of color smoking crack cocaine. It’s pretty new, but we have recruited about 250 women in a year and a half for that study.

Q: What do you attribute the two and a half percentage figure to?

We’d like to think… hahaha. If you compare Denver to a lot of other cities- two big factors: One, there has been a lot of education on risk reduction in Denver for a long time. For 25 or 30 years there’ve been programs called Teach Bleach. Even though we don’t “have needle exchange,” there’ve been underground needle exchange programs. But mostly, there has been a lot of teaching to teach IDU’s to use their own rigs and not share. The other thing that probably makes a difference is that the drugs that are used here, the heroin used here, is cooked. On the east coast, they mix the heroin cold, they don’t cook it. But most of the drug here is a brown tar that is cooked and by cooking it, it makes a difference in the way that it is shared and possibly even in reducing the spread of the virus itself. They are less likely to share because they are cooking it, because they are cooking their own mix. Once they cook it, it will only be dissolved for so long. Whereas just mixing it in lemon juice or something, it will last longer and so more people can share it.

Q: Have pharmacy sales played a role?

It does make a difference because when clients come in, they ask where they can buy needles. And we know of at least 25 pharmacies that sell without requiring a prescription. They’ll even sell a single syringe for twenty five cents.B: They sell them pretty cheap. Since that study though, it does seem there are less places that will do that. Some places in Denver I have seen switch to now requiring a prescription compared to three years ago. But there are some rock solid places that will sell that are good with that.

Q: What is street value of syringe around here?

Fifty cents or a dollar.

B: I didn’t realize the extent of the problem with meth use. I remember reading a police report about a year ago, they busted three times as many meth labs. They ask is that because we’re more effective or because there’s three times as many? They just started coming out of the woodwork. I remember hearing from users that meth is way more prevalent than you would think. It seems like with meth, it’s in every county- south, more prominent places, north in the more industrial areas, in Denver itself. Crack is becoming more widespread, too, but heroin seems to be isolated to certain areas, but meth is all over the place.

Q: Through your research, have you found that injectors will change their behavior when you give them this information?

They do. The project Ben’s working on now with the peer education, we just started, so we don’t have any outcomes yet. What we do know, is that a risk reduction intervention is effective in both helping people reduce their risk and it does affect their network. So the reason we were interested in doing this new study, is that we really wanted to monitor that by recruiting networks by looking at index members, train them about how to disseminate information and see how that information actually is disseminated. We are just now getting information back.

We do know that risk reduction is kind of the king of intervention right now. Motivational interviewing, strength based case management, therapeutic alliance, other interventions are more costly, time-consuming, more taxing on staff, and they may show some slight increase in drug treatment entry, or reducing risky behavior, but not significant. Risk reduction is the best bang for your buck.

Q: Do you know savings for every dollar invested numbers?

I don’t know. This new study that we are writing now, we are actually going to include that. Our consultant will include an economic result.

B: I think with the study we are doing- there will be some positive things you will find. Especially with Hepatitis C. They think they know everything about HIV and Hepatitis C. But they realize they don’t know as much. Re-infection is actually something that almost no one knows about. Re-infection can cause problems for treatment, and that’s getting everybody’s attention. I am really curious what will happen in several years from that, to see if it has been spread [the knowledge].

Q: What is the Hepatitis C rate like?

About 88% of the IDU’s we see test positive for Hepatitis C.

Q: What have been some of the major findings over the 17 years now you have been working on different projects?

A risk reduction intervention- you can call it harm reduction- but basic HIV, Hep. C education, discussing the individual’s place in the hierarchy of risk, helping them develop a simple, reasonable plan for risk reduction- not anything that involves a lot of time or money or energy, is the most effective intervention.

Q: Is treatment available for people in Denver?

Treatment and methadone treatment is available for opiate use. There are methadone clinics, outpatient mental health services available to some extent. Certain qualifications need to be met. There is no free methadone treatment in Denver. So you have to have insurance or pay out of pocket.

B: that is a problem with a lot of our clients. They have back payments for every methadone place in town and then they’re screwed because they aren’t going to come up with $400.

Our connection with the university clinic is that we can get people in without an intake fee, but it’s seven dollars a day after. They have to pay $180 up front for the first month and then after that it’s seven dollars a day or $150 a month if they pay up front. Not many of our clients do that. Of course, that is the population we are working with. If you have a person who has the financial means to get treatment, they probably won’t be participating in our program.

B: Why risk being associated with some place that deals with drugs? We don’t see too many people who work in the buildings downtown.

Q: What treatment exists for meth users?

There’s crystal meth anonymous and if you have the money, in-patient and out-patient programs. It’s your basic addiction counselor. The great benefit of opiate addiction is that we have methadone. It can help with people’s withdrawal and you can gradually take them off of it.

Q: Is buprenorphine available?

The university does offer, but we don’t work with those patients.

B: My personal opinion- because buprenorphine blocks the receptors for getting high, a lot of people who use methadone and use on top of it to get high, I don’t think that many people will rush to use buprenorphine. Seeing so many people on methadone and using on top of it, it makes you think they like getting high.

And it’s a lot more expensive.

Q: Is there adequate dosing around here?

B: I have seen some people on 150mg- people falling asleep at every question you ask them. For around here, that’s very high for some people.

I’ve seen even higher- around 200. It’s higher than when methadone treatment was first started. When methadone treatment first started, they were pinching it. Some of the older counselors feel like it’s abused now. I know one counselor in a program and he’s always ranting and raving about dosing too high.

They have been doing methadone in the jail for about one year now.

Q: What is the role of police around here? Alternative sentencing?

B: My opinion is that I think people end up going to jail for a long time when they go to jail and then go on parole and have to do UA's and for a good number of them, that’s a problem. If you fail them all of a sudden you might go away for five years. If you’re not selling it, they give you chances; maybe they’ll give you a year before sending you back.

I worked with the campaign attempting to cement needle exchange in the legislature- but we couldn’t even get it out of committee for a vote, but the Denver police department was adamantly opposed to it. The mayor gave us his support, but he didn’t necessarily stand up against the chief of police either. There’s another group now that is trying to present it, but the police have always seemed to be the group that has opposed needle exchange. It doesn’t make sense to me, because if I was a police officer, I wouldn’t want to search somebody if my personal risk was higher. Needle exchange would make it safer. There’s a lot of research that shows that needle injection does go down when needle exchange programs are available.

B: They don’t want to hear that though.

Q: What are some of the major misconceptions out there among the public?

What I hear most often is that many people who are not familiar with drug addiction assume that people addicted to drugs are violent. That’s not the case. It is probably more the case with people using crystal meth because of the reaction of the drug itself. But especially for people using opiates, they’re not violent people. The average opiate use we see has been using for 18 years. Very, very few of them have any type of assault charge or violent behavior or crime. Most of them do have anti-social personality disorder, but they’re not violent. There’s this perception that if we have needle exchange we will be working with people who are out of control or violent, that’s not the case.

B: People I talk to, just think it must be out of control, crazy, working with drug users. It’s not. One misconception is that drug injectors don’t take on the traits of a human being. Some of them are nice, some are not nice. Some have a lot of love for people that they care about. Some are anti-social. I find those same things in people who aren’t drug injectors. That’s probably one of the things I realized after I started working here- you go to a funeral and see a lot of people crying. That doesn’t make any sense- he was a drug injector, not a human being. That’s not true. That is a huge, huge misconception, at least with people I’ve interacted with.

Q: At this point, what is most needed?

Needle exchange and treatment.

B: I think the privatizing of methadone in the short run may have seemed alright, but in the long run, I don’t think it was a good thing. I know a few people where methadone works well for them. But a lot of people have problems with it, see it as a conspiracy theory, to get you hooked and take your money. If you have to give money for it… it’s just the legal dopeman some people say.

B: I just think in the long run it’s going to be a problem.

Q: Do you see a lot of gang activity around Denver?

We see older clients here primarily. The average age of our clients is between 35 and 40. Most of them are not gang members. My perspective is that at least with the type of research that we do and the clients we involve, it’s not a really big issue. It’s an issue, but I think if anything, the clients we work with fear the gangs. They fear the violence. They would rather not have the violence.

B: I hear about gang stuff through some of the clients.

Probably most of the clients who have been in and out of prison have been affiliated with a gang. But we are not seeing the stereotypical twenty year old gang banger- that’s just not our client.