There are twice as many hypodermic needles in the hands of Juneau intravenous drug users than a year ago. But that's not necessarily a bad thing.
Editor's note: This is the first in a three-day series that looks at drug trends in the capital city.
Sunday: IV drugs
Monday: The new problem drugs - Meth and OxyContin
Tuesday: Kids and drugs
"Does it mean that more people are using - or are more people are getting smarter about not sharing needles?" Eileen Wilson said. "I think it's people being safer."
Wilson is the executive director of Shanti of Southeast Alaska. Shanti is a national group fighting the spread of HIV, the virus that causes AIDS. HIV and diseases such as hepatitis are passed when users share needles. About one-third of all AIDS cases are linked to IV drug use. Among heterosexuals, 85 percent of AIDS cases are linked to injection drug use or sex with a needle-using partner.
Because of this, Wilson has a tie-in with Northern Exchange, a Juneau needle exchange program. In the past two years, the number of needles in Juneau has doubled, Wilson said. About 900 needles are given out each month, almost 10,000 in the past year.
The influx of clean needles is just one change in Juneau's IV drug community. The drugs of choice have changed as well. Drug users, as well as professionals in drug treatment and law enforcement offered a look into this circumspect, tight-knit underground community.
Users in treatment are telling Wilson they don't share needles like they used to.
Once a week Wilson talks about HIV with recovering addicts at the Juneau Recovery Hospital.
"It's really rare to find an IV user there who says they still share needles," she said. "They may have in the past, but now they just say, 'No way. I may use drugs but I'm not stupid.'"
Even sharing paraphernalia is dangerous.
"Needles, cookers, spoons, alcohol wipes, cotton is a big one. People should never share," she said.
Police are seeing clean needles too. Steve Hernandez, who supervises the drug unit for the Juneau Police Department, has seen plenty of people over the years carrying needles in their pockets, capped, but bent and dull. He still sees well-used needles, but these days he said more users have new needles and are mindful of being clean.
"Their house may be a mess, but they have their needles and Sharp container (a medical waste receptacle) right there," he said.
Heroin was the IV drug of choice in Juneau in the mid-1980s, when Hernandez started on the police force. That's changed, he said, and so have attitudes about shooting up. He said the old stereotype of the junkie hermit creeping from his crash pad once a week to score smack is not as prevalent anymore.
"IV drug use doesn't have the same stigma of the '60s and '70s," he said. "Younger individuals here are injecting coke, meth, OxyContin and heroin. We're seeing individuals who were inhalers - snorters - now experimenting with IV drug use. The more sustained users are moving into prescription drugs and IV drug use."
Meth is a powerful amphetamine similar to cocaine. OxyContin is a trade name for the prescription painkiller oxycodone hydrochloride.
Juneau has a small cadre of heroin users who don't mainline but snort the drug or inject it just under the skin - skin poppers.
"They are the kind of hard drug users using on weekends," said Matt Felix, director of the Juneau chapter of the National Council on Alcoholism and Drug Dependence. "These people have jobs and money and they budget for this. Generally they stay clean of the law, except for having drugs. That's not to say they don't have problems with drugs. They go to the hospital for medical problems related to their drug use, and we see them in rehab."
Where to get help in Juneau
National Council on Alcoholism and Drug Dependence: 4633755
NCADD Intervention Network: 5864859
NCADD Dependence Asset hotline: 5862657
Northern Exchange: 4635665
Northern Exchange pager: 7095457
Juneau Recovery Hospital: 586-5321
Narcotics Anonymous: 7904567
Alcoholics Anonymous: 5861161
Juneau Police drug tip hotline: 586-0646
Felix has kept tabs on the drug scene in Juneau for 25 years. He said the biggest change he's seen with IV drug users is the increase in OxyContin.
"Right now, this month we have a lot of OxyContin on the street, and methadone," he said. Methadone, used in treatment to ease withdrawal symptoms, is also abused. "In the past months there's been an unusual amount of prescription drugs on the street."
Most of the IV drug users in treatment in Juneau have been shooting a variety of drugs, including coke, heroin and meth. Larry Olson, a substance abuse counselor at the recovery hospital, said the biggest increase in use involves OxyContin.
Some abusers simply take the tablets, most clean off the time-release coating and crush the pills. Then they either snort the powder or cook it up and inject it.
About 10 percent of Olson's patients are drug users and 90 percent are alcoholics. Most of those drug users are not injecting drugs. They are smoking pot, snorting coke and meth, and abusing prescription drugs. But Olson does think IV drug use has grown over the past five years.
"There's greater IV use now than I've ever seen," Olson said. "There's a pretty big IV drug community in town."
Sustained drug users build a tolerance and find that snorting or smoking doesn't provide the same effect. So they begin injecting the drugs, delivering an immediate and intense high.
"I have so many people come in who tell me, 'I told myself I'd never shoot drugs, but here I am doing it,' " he said. "They come to us from the emergency room and they have pretty bad abscesses. Their veins weren't made to take three, four, five pokes a day. It's amazing all the places where people will hit a vein."
Like Hernandez, he's seeing a trend among the coke users - fewer who snort and more who smoke or inject the drug.
"It's my sense that among the more recreational users of coke is that snorting is passé. Used to be stories about folks snorting at work on a break, and you don't hear so much of that," Olson said. "Most that we are seeing are smoking it or shooting it. I think smoking and shooting becomes more prevalent and the lighter user, recreational users, are dropping out."
That's the trend that one former IV coke addict saw among the people she hung out with when she was using last winter. She asked to remain anonymous.
"I know people who were doing two or three grams a week and are now doing two or three grams a night," she said. "Everybody that was snorting coke a year ago is smoking and everyone who is smoking is shooting."
Riley Woodford can be reached at firstname.lastname@example.org.