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Jefferson County Syringe Exchange Program (SEP)
Annual Report 2015
Jefferson County Public Health has provided a Syringe Exchange Program (SEP) since 2000 to reduce the
risk of HIV and other blood-borne infections among injection drug users (IDU), their families, and
communities. SEP services include access to clean syringes, disposal of used syringes, prevention
materials, risk reduction education, and referral services. Education includes verbal and printed
information on HIV, hepatitis, STDs, overdose prevention, encouraging one time use of needles, health
alerts (for example, wound botulism and recent heroin overdoses/deaths), and immunizations. Internal
referrals include STD, HIV, and Hepatitis C screening, tuberculosis screening, family planning, and
immunizations. External referrals include drug and alcohol treatment, medical care, mental health care,
domestic violence aid, food, clothing, and shelter.
State HIV prevention dollars helped fund the SEP from 2000 – 2011. CDC guidelines shifted in 2011,
focusing HIV Prevention Program funding on high-risk populations based on local HIV prevalence.
Jefferson County is a low prevalence county. No State funding has been available since 2011. The State
has provided one bulk order of supplies for county SEPs each year since 2012.
Jefferson County’s syringe exchange program success is not easily measured in disease prevention
numbers, but the number of clients seen and syringes exchanged reflect the disease transmission
prevention capacity of this program. SEP utilization decreased from 2014 to 2015, but 2015 utilization
was higher than 2013 and earlier. There were 238 client visits and 35,328 syringes dispensed in 2015,
compared to 350 and 42,809 in 2014 respectively. See tables and graphs on following pages for details.
Throughout 2015 staff encouraged uninsured clients to apply for health insurance through
www.wahealthplanfinder.org and offered appointments to assist clients. Many clients signed up for
Apple Health in 2014.
The State Public Health Lab has provided a limited number of free OraSure oral swab HIV tests for
uninsured high risk clients. Most SEP clients now have Apple Health and can be tested through Quest
lab. However, this test requires a blood draw, which many clients decline during the SEP visit. Many
clients do report being tested during a recent medical visit. The State lab will no longer offer the OraSure
test in 2016.
State funding for free Hepatitis C testing of high-risk clients, using a finger-stick test, ended in 2012. The
State piloted a new Hepatitis C testing program in a few counties in 2014-2015 and JCPH had hoped to
join this program in 2015, but, because the program is designed for counties doing high-volume testing
and would be difficult to implement in Jefferson County, decided to continue to explore Hepatitis C
testing options for SEP clients.
Naloxone is a medication used to reverse opioid overdose and provide time for transportation to the ER
for additional overdose treatment. JCPH worked with the Center for Opioid Safety Education (COSE) at
the University of Washington to develop protocols and training for a naloxone distribution program.
COSE thought they would have funding for naloxone in the fall, but required more time to work out the
details. An initial supply of naloxone will be available from COSE in early 2016. It is unknown if funding
for naloxone will continue.
Jefferson County SEP Clinics/Demographics
SEP
Visits1
New
Clients
Returning
Client
Visits1
Secondary
Exchange
Visits1
Female
Client
Visits1
Male
Client
Visits1
2015 238 36 202 152 77 158
2014 350 50 300 227 199 145
2013 185 28 157 126 115 70
2012 150 18 132 96 NA NA
2011 142 19 123 110 NA NA
2010 81 13 68 40 NA NA
2009 65 12 53 35 NA NA
2008 68 6 64 67 NA NA
2007 65 9 56 58 NA NA
2006 54 8 50 49 NA NA
2005 36 6 30 29 NA NA
2004 64 12 48 45 NA NA
2003 63 9 55 53 NA NA
2002 41 11 29 25 NA NA
2001 16 6 9 5 NA NA
2000 14 3 7 3 NA NA
Note: 1Represents duplicate clients
New Client Visits, by Age
Female
< 20 yr
Female
20-29 yr
Female
30+ yr
Total
Female
Male
< 20 yr
Male
20-29 yr
Male
30+ yr
Total
Male
2015 0 4 9 13 0 11 12 23
2014 2 7 11 20 3 8 18 29
2013 6 4 3 13 2 6 7 15
Total Client Visits by Age
< 20 years 20 -29 years 30+ years
2015 9 (4%) 68 (29%) 158 (67%)
2014 53 (15%) 100 (29%) 191 (56%)
2013 23 (12%) 77 (42%) 84 (46%)
14 16
41 63 64
36 58 65 70 65
81
142 150
185
350
238
506 2,076
4,206
9,222
18,060
13,716
17,905
24,585
21,133
14,044
9,156
17,726 17,405
24,596
42,809
35,328
-
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
45,000
-
50
100
150
200
250
300
350
400
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
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Syringe Exchange Utilization, 2000-2015
Jefferson County Washington
Number of client visits
Number of syringes exchanged
2011 – 2015 SEP Clinic Participant Visits by Zip Code
2011 – 2014 SEP Clinic Participant Reported Syringe Use
2015 SEP Clinic Participant Reported Syringe Use
59%
29%
11%
60%
34%
5%
59%
38%
3%
57%
41%
2%
46%
51%
3%
0%
10%
20%
30%
40%
50%
60%
70%
98368 Other within Jefferson Cty Outside Jefferson Cty
2011
2012
2013
2014
2015
49%
22%
3%
26%
64%
12%
2%
22%
64%
21%
1%
14%
67%
25%
1%
7%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Each syringe used
once
Each syringe used 2-
5 times
Each syringe used
6+ times
Unknown
2011
2012
2013
2014
72%
17%
11%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Each syringe used once Each syringe used twice Each syringe used 3+
times
2011 – 2015 SEP Clinic Participant Secondary Exchange
2015 SEP Clinic Participant Reported Drug of Choice
Most participants reporting “other” for drug of choice report they are using prescription medications, usually
opioids. Some report having their own prescription, some do not.
17%18%
38%
22%
5%
32%
9%
49%
6%4%
31%
11%
47%
10%
1%
35%
17%
39%
8%
1%
35%
21%
32%
12%
0%
0%
10%
20%
30%
40%
50%
60%
No secondary
exchange
Exchanging for
one other
person
Exchanging for
2-5 other
people
Exchanging for
6+ other people
Unknown
2011
2012
2013
2014
2015
96 (56%)
33 (19%)
30 (18%)
12 (7%)0
0
20
40
60
80
100
120
Meth Only Heroin Only Meth and
Heroin
Other Meth Heroin
and Other
17
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2015 March -December
Materials Distributed by Jefferson County SEP
Syringes
Exchanged
IDU
Prevention
Materials1
Condoms/
Latex
Barriers2
HIV Tests
Offered
Educational
Materials3
Provided
Referral
Information4
Outreach
Education5
2015 35,328 15,414 692 75 19 86 109
2014 42,809 18,373 625 114 52 139 177
2013 24,596 15,984 377 90 18 129 105
2012 17,405 11,535 406 49 28 128 90
2011 17,726 16,512 319 41 10 142 86
2010 9,156 11,024 102 36 7 67 29
2009 14,044 7,098 271 31 26 51 33
2008 21,330 7,941 140 27 32 35 32
2007 24,585 9,988 20 22 18 23 N/R7
2006 17,905 9,000 0 2 3 2 N/R
2005 13,716 7,611 20 0 6 11 N/R
2004 18,060 7,265 228 N/O6 48 11 N/R
2003 9,222 1424 800 N/O 42 18 N/R
2002 4,206 1,026 427 N/O 50 NA N/R
2001 2,076 3 14 N/O 9 5 N/R
2000 506 11 33 N/O 10 2 N/R
Notes
1 IDU Prevention Materials include: Tourniquets, cookers, cottons, sterile water, sharps containers, alcohol preps, antibiotic
ointment, band aids and sterile pads for wounds, tape. Individual items are given on an as needed basis.
2 This number is for condoms dispensed in SEP only, condoms may also be picked up in the lobby.
3 Educational Materials include information on hepatitis, HIV, STDs, health alerts (ex. wound botulism, overdose), care of
abscesses, street drugs, tattoo safety, needle reuse, IDU safety, domestic violence, immunizations, Apple Health application.
4 Referrals: Internal referrals include STD, HIV and Hepatitis C screening and counseling, tuberculosis screening, family
planning and immunizations. External referrals include drug treatment, medical care, mental health care, domestic violence,
food, clothing and shelter.
5 Outreach education is defined as face-to-face education on blood borne pathogens, risk reduction methods, safe injecting
practices, vein care, and other as needed.
6 N/O: Not offered
7 N/R: Not reported
2016 Goals
Continue anonymous, safe services to reduce the risk of HIV infection in our communities by promoting
revisits by clients and to encourage clients to tell others about SEP.
Continue to educate clients on the importance and rationale of using each syringe one time only.
Offer naloxone overdose prevention program to clients at risk for opioid overdose and update program
procedures as needed.
Continue to inform clients at each visit of resources available at JCPH and in the community.
Encourage uninsured clients to sign up for health insurance through www.wahealthplanfinder.org
Explore new approaches to HIV and Hepatitis C testing of clients.
Prioritize supplies to be stocked, keeping only those deemed necessary to maintain safe practices among
IDU clients. Inform clients of alternative safe materials, such as using soda bottles for the collection of
used needles in lieu of sharps containers.
Develop staffing plan for the last 6 months of the year, adjusting for the retirement of one SEP staff
member.
3/7/2016