Just before 2:30 p.m. on a recent Thursday, a white cargo van rolled onto 32nd Street behind Safeway, stopping near the Astoria Riverwalk.

Out climbed two Clatsop County workers: Jenna King, the Public Health Department’s harm reduction coordinator, and Nadine Campbell, a nurse with the department. They opened the rear doors, set up a folding table and a sign that read, at the top, “Harm Reduction” and, at the bottom, “Syringe Service Program.”

Soon a small woman approached the table and, with Campbell’s assistance, filled out a questionnaire. The visitor turned in some used syringes and left with fresh ones, along with supplies for filtering drugs and using them safely.

That day, the needle exchange set a record for the most syringes the county has collected in a single day: 27,980 across exchange sites in Astoria, outside the Premarq Center in Warrenton and near Providence Seaside Hospital. The number given out was slightly less.

Launched in fall 2017 with the unanimous blessing of the county Board of Commissioners, the needle exchange aims to minimize the risks, particularly the spreading of disease, associated with illegal drug use.

Needle exchange programs, which arose in communities nationwide a few decades ago in response to drug addiction and disease transmission, acknowledge an uncomfortable reality — this behavior is going to happen — and endorse the view that society should help curtail the related dangers. Parallels are often drawn to the practice of passing out condoms in high schools, rather than relying on abstinence-only sex education, to avert sexually transmitted diseases and teen pregnancies.

The federal Centers for Disease Control and Prevention states: “Nearly 30 years of research has shown that comprehensive (needle exchange programs) are safe, effective and cost-saving, do not increase illegal drug use or crime, and play an important role in reducing the transmission of viral hepatitis, HIV and other infections.”

Last December, the Clatsop County program handed out its one-millionth needle. As of mid-July, the program had given more than 1.2 million syringes in return for 1.3 million, according to county figures. Participants often exchange multiple needles for multiple people.

In addition, county staff has distributed more than 4,000 doses of naloxone — a nasal spray that counteracts opioid overdoses — saving more than 300 lives. This year alone has already seen more than 120 of these reversals. This represents “a huge number for a county of our size,” Melissa Brewster, a senior pharmacist at the Columbia Pacific Coordinated Care Organization, said in an email.

The spike in overdoses indicates the local drug supply is “much higher risk than (it) has been in the past couple of years,” Brewster said.

In spring 2020, fentanyl — a potent synthetic opioid — was noticed on the North Coast. Overdose deaths in Oregon during those months increased by about 70% over comparable 2019 statistics, according to the Oregon Health Authority. The drug is now present in the majority of illicit substances, both methamphetamine and heroin, Brewster said.

The needle exchange crew saw this peril looming and began distributing strips that test for the presence of fentanyl, to “get people prepared to start testing their drugs more often and make it kind of like a norm for them,” King said.

During the Thursday exchanges, program staff also asks participants if they want to connect with drug treatment and recovery, housing and health care, food and COVID-19 testing and vaccination.

‘This stuff is complicated’

Some of the original fears about the needle exchange were never realized — for example, the worry that public parks and other kid-friendly spaces would see a significant rise in syringes left behind by drug users.

Although the Astoria Police Department still gets calls about found needles, the police were getting these calls before the syringe swap, according to Deputy Chief Eric Halverson. Neither the police nor the city’s Parks and Recreation Department staff say they have noticed a difference in complaints.

The needle exchange wasn’t universally supported when the county rolled out a six-month pilot program almost four years ago. Leaders in local law enforcement expressed skepticism that these type of programs are the wisest way to confront drug abuse.

Sheriff Matt Phillips said in a recent interview that communities need to balance compassion and outreach with not being “so permissive that we’re enabling a behavior.”

“In some regards, it has been effective as a harm reduction tool,” he said. The sheriff pointed to fewer cases of conditions like cellulitis — a bacterial infection at injection points — showing up in emergency departments.

Phillips emphasized he does not oppose the program, and views the sheriff’s office and health department as part of “Team Clatsop County.”

“If the program is making a difference in lives, I support it,” he wrote in an email. “If that isn’t happening, or is creating additional problems … then maybe we should reevaluate or modify the program.

“This stuff is complicated and we all have to work together on it.”

Phillips said he is curious how many people, as a result of a referral from a needle exchange, enter drug treatment and recovery.

Brewster said that tying people who use the program to whether they seek treatment would “(violate) some privacy rules around protections for people with (substance use disorders).”

It would be difficult to draw conclusions about the program’s impact over the last 18 months, Brewster said, as the coronavirus pandemic led to “staggering” levels of substance use.

The county also doesn’t have a good way to measure the prevalence of syringe-borne diseases such as hepatitis C and HIV in the area, she said.

‘The hope is just to plant the seed’

Before King became the county’s harm reduction coordinator, she worked for Kerry Strickland’s nonprofit Jordan’s Hope for Recovery — named after Strickland’s son, who in 2015 died of a heroin overdose. The nonprofit dissolved in early 2020.

The needle exchange would, ideally, help people curb their drug habit, King said.

But when she’s working out of the van — serving a population composed of both the housed and the homeless, people with families and those who travel alone — King has in mind a more urgent short-term goal: giving them what they need to stay alive. And this includes using that small window of time provided by the exchange to let them know what options are available for them.

“The hope is just to plant the seed so they’re able to get to a point where they are looking for something different,” King said. “But they have to keep coming to figure that out, and navigate that themselves.”

By establishing what she calls a “stigma-free zone,” King and her colleagues hope that those who rely on the exchange will be able to find their way sooner. “And, unfortunately, many people don’t. That’s the nature of addiction,” she said.

On that record-breaking Thursday, King and Campbell had planned to show up about 15 minutes earlier but were slammed in Seaside and then in Warrenton.

Before that first visitor left, she asked through a mask if King and Campbell know how much their work is appreciated.

That the woman had masked up wasn’t unusual. In general, King said, people who use the needle exchange have respected pandemic rules — covering their face, keeping their distance.

Neither was the woman’s show of gratitude. Asked if they hear such things often, King replied, “Every single time we’re out here. Every single time.”