Mickey Weiss visits Bethany Place to keep himself and his drug-using friends alive.
Weiss is a 34-year-old drug addict who lives in Collinsville. Once a week, he goes to the Belleville nonprofit agency to pick up new needles, a vial of the overdose reversal drug naloxone and an injection kit.
The kit comes in a black plastic bag that contains the other tools he needs to shoot up speed and heroin: a tourniquet, alcohol wipes, filters and a cooker to liquefy the drug. Taxpayers spent $15,000 on the Belleville program last year.
The needles and kit help prevent Weiss from contracting and spreading blood-transmitted diseases such as HIV and hepatitis C. The naloxone has helped him save lives.
In a single week, Weiss injected naloxone into three overdosing people who had injected heroin mixed with fentanyl. One got mad because he killed her high.
"The bottom line -- she wasn't dead, either," Weiss said.
Weiss is one of 317 participants in Southern Illinois' only needle exchange program. Intravenous drug users can pick up the free needle supplies, 24 hours a day, seven days a week at Bethany Place, 821 W. A. St. in Belleville. The program also provides needle disposal bins, condoms and information about drug treatment services.
Since its inception in 2009, the confidential program has dispensed thousands of needles and collected 58,134 used needles, according to Executive Director Angela Barnes.
"Our goal is to stop the spread of HIV," Barnes said.
Bethany Place serves a 12-county area in the metro-east and is one of eight needle exchange programs across the state that rely on taxpayer and private money to distribute 4 million needles a year, according to the Illinois Department of Public Health.
Bethany Place's naloxone is provided through the Chicago Recovery Alliance, which buys it with private money from the North American Syringe Exchange Network. The local program has had 145 participants who have reversed 50 overdoses, Barnes said.
The criticisms that have dogged needle exchange programs since they began decades ago are shared by some community members and law enforcement officers who are concerned about the drug overdose epidemic that has gripped the metro-east.
"Sounds like legalized drug dealing," Madison County Sheriff Robert Hertz said when told of the program. "At what point are they going to hand out the heroin, too?"
Susanne Dashner, of Belleville, said the program encourages addicts such as her 27-year-old son to continue to use.
"The problem is that not only do they give them syringes, they give them the little cooking cup, they give them the filters, and they give them a tourniquet so they got everything they need to use to illegally shoot up heroin," said Dashner. "And if that doesn't top it off, they give them the generic form of Narcan."
Public and private health officials counter that needle exchange programs neither facilitate nor encourage drug use, citing years of research to the contrary. They also explained that disease can spread through the shared use and re-use of tourniquets, filters and cookers.
"We are helping them prevent infection," said Stephenie Koester, Bethany Place's community education and prevention coordinator. "We are not helping them use."
But even someone understanding of the program voiced concerns after a Belleville woman overdosed on heroin Feb. 8 in one of Bethany Place's bathrooms. She was revived by staff but was later charged with possessing heroin.
"I think it's quite clear to many people in the community that Bethany Place does great work in terms of protecting public health and preventing the spread of diseases like HIV and hepatitis," St. Clair County State's Attorney Brendan Kelly said. "But again I have a concern that their needle exchange program be tightly administered in a way that doesn't conflict with the mission of law enforcement."
"It's a tricky balance between public health and public safety."
Solution sought Belleville
It wasn't Bethany Place's idea to start handing out needles and injection kits to drug addicts.
In 2009, the AIDS Foundation of Chicago asked Bethany Place to become the first needle exchange program south of Springfield because of St. Clair County's high rate of HIV, said Jessica Terlikowski, the AIDS Foundation's director of regional organizing. The foundation was paying for needle exchange programs through a state grant.
St. Clair County had the fifth-highest rate of new diagnoses of HIV and AIDS cases the past six years among Illinois counties, according to an October 2011 report by the Illinois Public Health Department.
"There wasn't a program down there," Terlikowski said. "And there was a need down there."
Needle exchange programs in Illinois have ties to Chicago organizations that started programs in the 1990s in reaction to the AIDS epidemic.
The Chicago Recovery Alliance established the state's first needle exchange program in 1992 solely using private donations. Within the next decade, it developed a naloxone program.
Illinois needle exchange programs are covered by an exemption in the Illinois Hypodermic Syringes and Needles Act that allows participants in scientific research programs to carry an unspecified number of needles. An amendment added in 2003 allows anyone 18 or older to buy needles from a pharmacy without a prescription and possess up to 20 needles.
The law does not protect anybody who has illegal drugs in either their needles or injection equipment, Kelly said.
Bethany Place participants carry around a card citing the exemption that allows them to carry needles. Barnes said she has had to ask Kelly to dismiss charges in a couple of cases where participants have been wrongly charged by officers.
"My concern is, what is the scientific value in handing out needles beyond the permitted amount of 20 or below?" Kelly said.
Chicago Recovery Alliance Executive Director Dan Bigg said research shows needle exchange participants will pick up needles for their acquaintances, therefore spreading the use of clean needles and preventing disease.
Why don't addicts just buy their supplies from pharmacies?
Weiss said he dreaded that awkward purchase so much he would find someone who didn't look like a junkie to buy needles for him. Also, some addicts may also be reluctant to spend money on needles that could otherwise be used to buy drugs.
"The bottom line is you want me to have this," Weiss said. "It's a community health risk to not have this."
Programs curb disease
Since the 1990s, needle exchange programs have garnered the support of federal health agencies, including the federal Department of Health and Human Services, the Centers for Disease Control and Prevention and the surgeon general. They have certified that years of research show needle exchange programs do not encourage drug abuse and help curb the risk of HIV infection.
Illinois started paying for needle exchange programs in 2007, only after research showed that the HIV infection rate had decreased mainly because of a decrease in the number of infections among intravenous drug users, Bigg said. Bigg had turned to the state after his organization lost some of its money from the City of Chicago.
It was "do or die time for the state," Bigg said.
At the time, needle exchange programs were isolated to Chicago, Rockford and a Quad Cities organization that served cities along Interstate 74 as far east as Champaign, Bigg said. The Quad Cities program has since closed, but programs now exist in every other region of the state, except for the far southern counties.
Needle exchange programs are also in 32 other states, according to the North American Syringe Exchange Network.
The Illinois Department of Public Health estimated about $360,000 in taxpayer and private money is spent on needles annually. Last year, Bethany Place's needle exchange program was completely state-paid and cost $15,000, about 2 percent of its total budget, according to Barnes.
Advocates for the programs point to a decrease in the rate of HIV infections among intravenous drug users in Illinois. Between 2001 and 2009, annually reported HIV cases among injection drug users declined by 62 percent, from 202 to 77 cases, according to the Illinois Department of Public Health.
"No other group has seen such a decline," Terlikowski said.
The programs are also cost-effective, according to the Illinois Department of Public Health. The average cost of lifetime treatment of an HIV patient is approximately $300,000, the department estimates. It only costs $131 a year at 9 cents a needle to provide supplies for an addict who uses four needles a day.
A decades-old ban on using federal money for needle exchange programs has meant no federal tax money has ever gone to the programs, Bigg said.
The federal ban was lifted in 2009 under President Barack Obama but reinstated by Congress in December.
Needles around town
Granite City Police Chief Rich Miller wasn't interested in learning about Bethany Place's program when they came calling last year.
Miller compared the programs to a law signed by Gov. Pat Quinn earlier this month that provides limited immunity to people found with small amounts of drugs who call 911 on behalf of an overdose victim.
"It's saying you got a free ride now," he said.
On one hand, the state is saying these drugs are illegal and people who use them should be prosecuted. On the other, the state is helping to supply drug users with the means to do drugs.
"It's almost hypocritical," he said. "I'm more concerned with stopping the use of it, period."
Barnes and Bigg anticipated some of this antipathy by police when they started the program so they met with dozens of St. Clair County officers to explain the program. They said the officers were friendly and receptive.
One St. Clair County exception has been the Belleville Police Department.
"I'm not happy with Bethany Place and I let it be known," Police Chief William Clay said.
Clay said some participants have thrown their needles around town, and his officers have seen people shoot up in front of Bethany Place.
"I think they fail to consider law enforcement's point of view and the community's point of view," he said.
Former Belleville Alderwoman Donna Mauno and her neighbors who live near Bethany Place have found used needles in their yards in recent months and are concerned about heroin addicts coming into the area.
"Why have the needle exchange program in a residential neighborhood?" she asked.
Barnes said heroin and needles were in the city long before the needle exchange program, noting that local pharmacies have been allowed to dispense needles for years and don't necessarily collect used ones as her program does. She also questioned the validity of Clay's claim that his officers have seen drug use on her organization's property.
"The Belleville chief of police and I have one thing in common -- protecting the citizens," she said. "He protects the city of Belleville, and I not only protect the city of Belleville but the surrounding 12 counties, including St. Clair."
Clay isn't sure what the answer is to the problems Bethany Place is dealing with, but he isn't sure handing out needles and injection kits at all hours of the day is the solution.
"There's not a simple solution," he said.
Contact reporter Kevin Bersett at firstname.lastname@example.org or 239-2535.