On a Thursday night in downtown San Diego, a white camper van is parked across the street from a discount store. A man walks into the van carrying a plastic shopping bag. He dumps the bag out, and starts counting out its contents.
"Eleven, twelve, thirteen, fourteen….."
He's counting used syringes. The man is a heroin user. And the van is San Diego's only clean syringe exchange program.
Katrina Flores is the program coordinator.
She watches as the man counts out his used needles. When he's done, they're tossed in a red biohazard container.
"And then as they count them out, whatever they brought in, if they brought in ten, we give them ten," says Flores.
Flores says she hands out some other items, too. She puts together a bag called a bleach kit.
"Which contains everything that a person needs in order to clean out their needles if they don't have a new one right at hand," Flores says. "There's some bleach in there, a tourniquet, a cooker and some water. There's also an alcohol wipe in there."
There's a steady stream of people coming into the van. Flores says the exchange doesn't make clients go through red tape to get what they need.
"They don't show any ID, they don't give their real name," Flores points out. "Sometimes they give us random, Mickey Mouse names. It's whatever they're comfortable with. We want to make sure that when they come here, that it's a safe, comfortable place for them to visit, because we want to continue to see them, so we can help them get access to services."
The concept behind syringe exchange is simple: people are going to shoot drugs. It's crucial to make sure they have access to clean equipment, so they don't spread blood-borne infections.
San Diego's syringe exchange operates downtown on Thursday nights and in North Park on Friday mornings.
Last year, this privately-funded exchange collected more than 183,000 used syringes. It handed out about 172,000 new ones.
But the program does much more than swap syringes. Staff offer screenings for HIV and Hepatitis C. And they give referrals to drug treatment.
Rick is 51-years-old.
He was hooked on heroin for years. Thanks to one of the counselors at the syringe exchange, he kicked his habit last year.
"I thought I was gonna die, and I came here one night, a regular night, a whole group of us, drug house, prostitutes the whole bit," recalls Ricky. "He just looked at me and said if you ever need help, let me know. And then the next time I came, I said I'm ready. He said, okay, be ready at eight in the morning. I'm like, oh-oh, am I ready? I was higher than a kite when he came at eight in the morning. But I went."
Rick has been clean ever since.
Jennette Lawrence is with Family Health Centers, a group of community clinics in San Diego. Her organization operates the syringe exchange.
Lawrence says last year alone, the program referred nearly 400 people to drug treatment.
"You never know what it's gonna take in a person's life, to make them decide that the time is now to try and get sober," Lawrence says. "So our goal is to be there for them, to be caring, and accepting, and respecting of them, so when they get to that point, we're ready to help them every step of the way."
The syringe exchange saw about 859 clients last year.
One study estimates San Diego County has nearly 26,000 injection drug users.
Jennette Lawrence worries that a lot of people don't have access to this service.
"I think there is greater need in San Diego for more clean syringe exchange," Lawrence says. "Each decision, though, to add a site or add hours, will only occur when there is political support from the leaders of that community to support the project."
San Diego's mayor and city council support the syringe exchange. In fact, the program wouldn't exist without their endorsement.
And it's illegal in San Diego for people to buy clean needles without a prescription.
So, for the thousands of drug users who can't access the mobile syringe exchange, there is no legal access to clean needles. And who knows where they throw away their dirty ones.
