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615 Sheridan Street
Port Townsend, WA 98368
www.JeffersonCountyPublicHealth.org
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360-385-9401 (f) (f) 360-379-4487
Jefferson County Syringe Exchange Program (SEP)
Annual Report 2017
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, naloxone overdose prevention, and referral services. Education
includes 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, HIV, hepatitis C, and STD screening, family planning, tuberculosis screening,
and immunizations. External referrals include drug and alcohol treatment, medical care, dental care,
mental health care, domestic violence, food, clothing, and shelter.
State HIV prevention dollars partially funded 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, so JCPH hasn’t received direct State Department of Health
(DOH) SEP funding since 2011. Currently, DOH has given each SEP a fixed budget and supply list from
which we can order supplies. We expect this to continue for 2018.
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 increased in 2017, with 308 client visits and 91,290
syringes dispensed. See tables and graphs on the following pages for details.
Naloxone is a medication used to reverse opioid overdose, providing time for transportation to the ER
for additional treatment if needed. JCPH worked with the Center for Opioid Safety Education (COSE) at
the University of Washington in 2015 and 2016 to develop protocols and training for a naloxone
distribution program. JCPH started dispensing naloxone kits supplied by COSE in February, 2016. COSE
received a grant from SAMHSA in 2017 to be able to continue to supply naloxone to SEPs. We expect
this supply to continue through 2018.
In January 2017, JCPH provided 40 Evzio kits (auto-injector naloxone product), and training for their use,
to the Jefferson County Sheriff’s Department. These kits were obtained through a Kaleo naloxone
donation grant. JCPH distributed 135 naloxone kits in 2017, along with training, to SEP clients, their
friends, and family. Forty one of these kits were reported as used for treatment of an overdose. In 2016,
JCPH distributed 61 naloxone kits, six were reported as used for treatment of an overdose.
Throughout 2017 staff continued to encourage uninsured clients to apply for health insurance through
www.wahealthplanfinder.org/ . Many clients signed up for Apple Health in 2014 and 2015.
2017 Annual SEP Report 2
2018 Goals
Continue anonymous, safe, services to reduce the risk of HIV and hepatitis C infection in our communities
by providing clean supplies, risk reduction education, referrals for healthcare and treatment services,
promoting revisits by clients, and encouraging clients to tell others about SEP.
Continue to educate clients on the importance of using each syringe one time only.
Offer the 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 as long
as this option is available.
Refer clients internally for HIV and Hepatitis C testing, STD screening, and Family Planning services.
If State DOH support for purchasing supplies is discontinued, explore other possible funding options.
If SAMHSA funding for naloxone is discontinued, explore other possible funding options.
If State support for purchasing supplies is discontinued, prioritize supplies to be stocked, keeping only
those deemed most necessary to maintain safer practices among IDU clients. Inform clients of alternative
safe materials, such as using plastic bottles for the collection of used syringes in lieu of sharps containers.
Continue to advocate for increased access for opioid treatment, including local access to medication-
assisted treatment (MAT). The lack of local access to MAT from providers that accept Medicaid is a
recurring issue brought up by SEP clients. SEP staff will continue to request updates from the Community
Health Improvement Plan (CHIP) Substance Abuse and Mental Health work group, and from the Olympic
Community of Health (OCH) Regional Opioid Response Project.
2017 Annual SEP Report 3
Figure 1: Syringe Exchange Utilization, 2004 – 2017
Table 1: Jefferson County SEP Clinic Visits/Demographics
SEP Visits1 New Clients Returning
Client Visits1
Secondary
Exchange Visits1
Female Client
Visits1
Male Client
Visits1
2017 308 58 250 236 113 195
2016 242 28 214 159 66 173
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
64 36 58 65 70 65
81
142 150 185
350
238
242
308
18,060
13,716 17,905
24,585
21,133
14,044
9,156
17,726
17,405
24,596
42,809
35,328
47,790
91,290
-
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000
100,000
-
50
100
150
200
250
300
350
400
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Nu
m
b
e
r
o
f
S
y
r
i
n
g
e
s
E
x
c
h
a
n
g
e
d
Nu
m
b
e
r
o
f
c
l
i
n
i
c
v
i
s
i
t
s
Number of client visits
Number of syringes exchanged
2017 Annual SEP Report 4
Table 2: New Client Visits by Age and Gender
Female
< 20 yr
Female
20-29 yr
Female
30+ yr
Total
Female
Male
< 20 yr
Male
20-29 yr
Male
30+ yr
Total
Male
2017 0 15 11 26 0 13 19 32
2016 2 5 2 9 1 5 13 19
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
Table 3: Total Client Visits by Age
< 20 years 20 -29 years 30+ years
2017 11 (4%) 142 (46%) 155 (50%)
2016 9 (4%) 71 (30%) 159 (66%)
2015 9 (4%) 68 (29%) 158 (67%)
2014 53 (15%) 100 (29%) 191 (56%)
2013 23 (12%) 77 (42%) 84 (46%)
Figure 2: SEP Participant Visits by Zip Code
Figure 3: SEP Participant Secondary Exchange
34%
40%
26%
0%
10%
20%
30%
40%
50%
60%
70%
98368 Other within
Jefferson County
Outside Jefferson
County
2012
2013
2014
2015
2016
2017
22%22%
46%
10%
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
2012
2013
2014
2015
2016
2017
2017 Annual SEP Report 5
Figure 4: SEP Participant Reported Drug of Choice
Most participants reporting “other” for drug of choice report they are using prescription medications,
usually opioids.
Figure 5: SEP Reported Syringe Use, 2015 – 2017
Figure 6: SEP Reported Syringe Use, 2011 – 2014
56%
19%18%
7%
0%
47%
19%19%
13%
2%
34%
23%
40%
2%1%
0%
10%
20%
30%
40%
50%
60%
Meth Only Heroin Only Meth and
Heroin
Other,
including other
opoiods
Meth Heroin
and Other
Pe
r
c
e
n
t
o
f
V
i
s
i
t
s
w
i
t
h
D
r
u
g
C
h
o
i
c
e
2015
2016
2017
72%
17%
11%
3%
76%
20%
4%0%
69%
15%
8%8%
0%
20%
40%
60%
80%
Each syringe used once Each syringe used twice Each syringe used 3+
times
Unknown
2015
2016
2017
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
2017 Annual SEP Report 6
Most participants reporting “other” for drug of choice report they are using prescription
medications, usually opioids.
Table 5: Naloxone Distribution and Training Provided
First Naloxone Kit Naloxone Refill1 Refills with known
OD treatment
reported
Total Kits
distributed
2017 59 76 41 135
March-December 2016 44 17 6 61
Note: 1 Many refill clients reported the first kit was given away to someone who needed it.
Table 4: Materials, Education, and Referrals Provided
Syringes
Exchanged
IDU
Prevention
Materials1
Condoms/
Latex
Barriers2
Educational
Materials3
Provided
Referral
Information4
Outreach
Education5
2017 91,290 39,347 305 17 179 237
2016 47,790 17,293 464 14 71 132
2015 35,328 15,414 692 19 86 109
2014 42,809 18,373 625 52 139 177
2013 24,596 15,984 377 18 129 105
2012 17,405 11,535 406 28 128 90
2011 17,726 16,512 319 10 142 86
2010 9,156 11,024 102 7 67 29
2009 14,044 7,098 271 26 51 33
2008 21,330 7,941 140 32 35 32
2007 24,585 9,988 20 18 23 N/R6
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 testing, tuberculosis testing, 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, overdose prevention, vein care, and other as needed.
6 N/R: Not reported
3/22/2018
Lisa McKenzie
lmckenzie@co.jefferson.wa.us