For nearly half his life, 64-year-old Navy veteran Duane has used meth. He first tried it when partying with friends but said it quickly became a way to numb pain from troubled relationships and challenges transitioning out of the military in the 1970s.
“Trying to block out what I was feeling and trying not to think about it,” said Duane, who asked that we not use his last name due to his illegal drug use.
Duane is a patient at the Orlando VA Medical Center and in 2020 became the first veteran to enter the hospital's syringe services program.
The program provides vets with clean needles, sterile water, test strips for Fentanyl and other supplies. It's meant to reduce some of the risks that come with injecting illegal drugs. Patients typically receive a two-week supply. Whether a vet needs ten needles or 50, staff members said they'll provide them without passing judgment.
“We're meeting patients where they are,” said Jacqueline Byrd, a clinical pharmacist practitioner and one of the program leaders.
“We're not endorsing drug use, we're not condoning drug use. But we do know that not everyone who utilizes the program is ready to stop right now,” she said.
Preventing infection
Needle exchange programs have existed for decades, but they are relatively new to the Department of Veterans Affairs. The first launched in Danville, Illinois in 2017, followed by the one in Orlando. The VA said there now are eight around the country, and more are developing.
In addition to the supply kits, veterans can get mental health treatment and instructions about preventing overdoses, among other harm reduction services.
“You have the gear, you have the tools to work with and be safe about it,” Duane said. “And there were times I didn't have it and I was fretting trying to think that needle could go up in that vein, and it's gone. So I had to learn those things, like don't keep putting the same one in and out.”
Duane has HIV and could spread it to others if he shares supplies. According to the VA, syringe services programs are a “key component” of a federal initiative launched in 2019 to end the HIV epidemic.
Infectious disease physician Minh Ho said people who inject drugs also could get hepatitis C or B, as well as skin abscesses, vein damage and inflammation of the heart known as endocarditis.
He added that people with drug addiction are more likely to engage in high-risk sexual behavior, which can contribute to the spread of infection.
"Those are the harms, and of course the harms affect not just the veteran," Ho said.
Helping some vets get off drugs
In addition to the cost savings, research shows people who participate in syringe programs are five times more likely to enter drug treatment and about three times as likely to stop using drugs, according to the Centers for Disease Control and Prevention.
It's worked for Navy veteran Jose, whose last name we’re not sharing.
“It's a program that saved my life,” he said.
Jose, 39, served in the Iraq War and said he struggled with mental health challenges when he got back. He used drugs and alcohol as a way to cope, and he connected with VA care after he attempted suicide.
He learned about the syringe services program when he told his doctors he injected drugs and was “terrified” of getting HIV or hepatitis. Like other veterans in the program, Jose was able to connect with substance use treatment and received PrEP, a medication to prevent HIV.
Jose said he is sober now, but has a syringe kit in case he relapses.
“As anyone who is an alcoholic or a drug addict knows, it's a day-to-day, one day at a time kind of thing," he said. "I'm trying to fight for my life, and they have tools. It’s empowering for a veteran to know that they have these options out there."
Barriers to expansion
The VA is expanding its syringe services programs, but there are barriers. In about a dozen states, needle exchanges are illegal. Hospitals have also had to navigate federal restrictions on using government funds to buy items that could be considered drug paraphernalia.
The team in Orlando is helping other VAs work through those challenges, according to Byrd. She wants more programs to open because she said they help reach vets who might otherwise avoid the VA.
“They need somewhere safe to know that I still can get healthcare and can still be treated even though I'm going through what is a very stigmatized disease state,” Byrd said.
Ho said Orlando has served only 18 veterans, even though it is one of the VA's largest programs.
“There’s hesitancy for veterans to admit they use drugs, and also I think there’s some hesitancy among providers to feel comfortable to ask about it,” he said.
Ho said program staff tell veterans that disclosing their drug use won’t cost them VA benefits. They’re also educating health workers to be more compassionate when talking with patients about substance use and sexual behaviors. Their next priority is to get out into the community to find veterans not currently in the VA system or who face barriers to care like lack of housing and transportation.
Of the 18 patients in the program so far, Jose is one of two vets who have quit using drugs.
Duane said he’s not there yet. He eventually wants to get off drugs, and the staff at the VA syringe services program said they will stick with him until he's ready.
“I want to be myself again, but I don't even know who I am anymore because I’ve been through this cycle up and down, over and over," Duane said. "It's hard, it's a struggle.”
This story was produced by the American Homefront Project, a public media collaboration that reports on American military life and veterans. Funding comes from the Corporation for Public Broadcasting.