It's an instrument that's supposed to deliver so much pleasure but ends up inflicting so much pain.

"I observed (her) lying flat on her back next to the bed with pale blue ashen skin," Duluth police wrote about an overdose call in January. "I saw in plain view several dozens of uncapped needles littered throughout the entire apartment."

Where there's heroin, there are usually needles, and Duluth has seen a sharp increase in both in the past several years.

Used needles are a public health risk for the diseases they can carry - and a hazard increasingly spilling onto the streets.

Police are seeing more instances of needles being hoarded and face a growing risk of getting stuck by one in the line of duty.

Despite a busy and relatively accessible syringe exchange, public sharps disposal containers are even being broken into by those desperate for a needle.

Others end up flushed down the drain.

"It's always been an issue," said Karen Anderson, community relations director for Western Lake Superior Sanitary District. "But anecdotally we hear about it: These things are coming closer and closer to people."

Why needles?

Typically, it starts with pills. OxyContin, Vicodin, Percocet and other opioids, whether prescribed or not, get a user hooked. When the prescription runs out or the street price is too high, heroin has to suffice.

Heroin does not come in a pill.

An assortment of used needles and heroin preparation and injection supplies from a bust. Courtesy Duluth Police Department
An assortment of used needles and heroin preparation and injection supplies from a bust. Courtesy Duluth Police Department
While it can be smoked or snorted, one online resource for drug users claims "the only way to get anywhere near one's money's worth is to shoot it."

Any method of getting the drug into one's body can cause an overdose, but at least locally, injection is by far the most common, according to a review of Duluth Police Department reports from the past several years.

In some cases, first-responders find overdose victims with needles still stuck in the arm or, in one case from last May, one man was "slumped over in the bathroom and had a needle in his left hand."

Given the stigma surrounding intravenous drug use, the power of opioid addiction is apparent when considering the move from pills to needles. A study in the International Journal of Drug Policy reports that for those who move from pills to heroin, "there was a sense of physical compulsion and even desperation in their choice. Many of them seemed shocked to have found themselves injecting heroin."

Then suddenly it's the new normal, and those orange-capped cylinders become a daily necessity.

Officer risk

Patting down an overdose victim, a Duluth police officer yelled out.

"I felt a sharp poke in my right palm," the officer recounted in his report. "I immediately took my glove off and noticed a puncture wound and a small drop of blood."

A bent, uncapped hypodermic needle was sticking out of the victim's left pocket. It was dirty.

"He used that needle approximately a couple weeks prior and suggested he was going to use the needle that night," according to the police report.

Law enforcement officers, like medical workers and sanitation workers, carry a high risk of accidental needle injuries. The state Department of Health says as many as one in three officers are stuck with a needle during their careers.

A study in the Journal of Urban Health found that in addition to an increased risk of exposure to hepatitis and HIV, needlesticks can be a source of trauma and could pass on trace amounts of powerful drugs like fentanyl that are increasingly being cut into the heroin supply.

"Training, equipment, and other measures to improve occupational safety are critical to attracting and safeguarding police," the authors wrote.

Kazel, with the Duluth Police Department and drug task force, said he knows of no officers who have contracted diseases after needlestick injuries.

The danger remains, as officers encounter stashes of used and unused needles and this refrain becomes more familiar: "On the bed in plain view, I saw several hypodermic needles, some capped and some uncapped," officers wrote about an overdose response in 2017 - a similar scene recounted earlier this year.

The exchange

Inside a blink-and-you'll-miss-it storefront in downtown Duluth, containers full of contaminated syringes are loaded into large boxes to be trucked away and destroyed. In the back, boxes full of new needles await deployment.

It's an hour before opening on a Wednesday morning, and another busy day is expected at the Duluth syringe exchange at 18 W. First St.

Needle exchanges exist to get used syringes out of circulation and clean ones in the hands of anyone who asks - diabetics, those who inject hormones, drug users and others. The Duluth syringe exchange last year gave out more than 245,000 needles in exchange for about 203,000 used syringes.

"Harm reduction is intended to meet people where they're at to reduce the amount of risk in the community," said Mary McCarthy, executive director of the Rural AIDS Action Network, which runs this and several other exchanges in Minnesota. "It has been amazing to have so much space and great partnerships with the community."

The exchange has been providing safe injection kits for more than four years in its current location. It is no blind handoff - the people working there develop relationships with folks who come in and are able to provide testing, Narcan, connections to housing and medical services and referrals to treatment.

"Those are positive outcomes of people going to a place where some people say they're being enabled, but they're going to use no matter what," said Jeff Kazel, commander of the Lake Superior Drug and Violent Crime Task Force. "So if we're able to get a shot at maybe getting that person to change... I think it's worth a shot, plus you're preventing other diseases."

Among people who inject drugs ages 18-30, a third of them carry hepatitis C, according to federal data. Older users have a much higher rate, and sharing needles is a primary cause of the disease's spread.

The state Department of Health, which helps pay for the Duluth exchange and five programs in the Twin Cities, says evidence shows the needle exchanges prevent disease and curb drug use.

"When people participate in a (syringe service program), they are five times more likely to enter treatment for substance use disorder and more likely to reduce or stop injecting," according to the department. "Research shows that SSPs do not cause any increase in drug use."

The hotline

On a freckled map of Duluth, two years of public needle pickups paint a clear picture.

"We've got some major areas of concentration," said Amber Haglund Pagel, the city's safety and training officer, "but there is not a part of Duluth that hasn't been affected."

When residents first started to spot abandoned needles in greater numbers a few years ago, they'd call the police or bring what they'd found to their neighborhood fire stations. Neither the officers nor the stations were necessarily equipped for the task, Haglund Pagel said, but they made do.

"There's getting to be more and more," she said. "It became so burdensome for our police department, we created a hotline."

Duluth's sharps hotline (218-730-4001) has received hundreds of calls over errant needles in public places since it came online in June 2016, after the problem really started to spike.

The sharps hotline is staffed by the folks who handle calls for Comfort Systems, the city's water and natural gas provider. Parks and street maintenance crews along with the Duluth Downtown Waterfront District's Clean and Safe Team were called to join in the retrieval effort.

Haglund Pagel has trained numerous city employees in the proper way to pick up and discard used needles - to wear gloves and place the needle into a rigid container before finding a proper sharps disposal unit.

To reduce the strain on resources, one solution would be more city-issued sharps disposal containers, Haglund Pagel said. But then it becomes a question of who maintains the containers, picks up the contents and follows through with proper disposal.

Duluth's reactionary response these past few years seems to have reached its capacity.

"It's a growing problem," said Haglund Pagel, who suggested a better solution might be for the city to adopt a formalized program with a designated coordinator.

"It's not in my job description, but it's also not in anybody else's either," she said. "Employees look to me for safety solutions. They're the ones picking up the needles. We're all involved in this big thing - and it's not even a (formal) project."

How to Dispose of Needles

If you come across a syringe/hypodermic needle and do not feel safe or prepared to dispose of it, call the Duluth Sharps Hotline at 218-730-4001. Calls are answered 24/7.

Those comfortable with disposing the needle themselves should wear gloves or take every measure to prevent skin coming into contact with the needle. Using tongs or picking up the syringe from the plunger end, the needle should be placed in a hard plastic container with a screw-top lid, such as a laundry detergent jug or pop bottle. Secure the lid tightly and wash hands immediately.

Needles cannot be thrown in the garbage. They can be taken to:

Rural AIDS Action Network, 18 W. First St., 10 a.m. to 4 p.m. Monday-Friday

WLSSD Household Hazardous Waste, 2626 Courtland St., Gate 9, 9 a.m. to 4 p.m. Thursday-Saturday

Duluth library added security to deal with drug use, needles

Few public places intersect with drug use and needles like the Duluth Public Library, where almost a year ago a security company was hired to staff the downtown library in the afternoons.

As part of the job, a security officer patrols the bathrooms, where sharps containers have been broken into by people desperately in search of needles - even contaminated ones.

The main branch of the Duluth Public Library in downtown Duluth as seen Friday. Clint Austin / News Tribune
The main branch of the Duluth Public Library in downtown Duluth as seen Friday. Clint Austin / News Tribune
"We have stickers right on sharps container about the needle exchange," library manager Carla Powers said. "We're trying to let people know there are resources for them that are safer, but we still have had sharps containers broken into."

Powers is not comfortable addressing the damage to sharps containers and the fact that drug use occurs on the premises. She worries about creating the false impression that the downtown library isn't safe.

"Honestly, I don't even like talking about it," she said.

Powers called the library "the great equalizer," where everyone is free to pursue their interests and people from all walks of life encounter each other.

"We're trying to be here for everybody," she said.

But inviting people from all walks of life means courting life's troubles, too. Regarding drug use, Powers said, "We've had concerns."

First responders have been called several times for welfare checks in recent years, Powers said, though she can't say for sure when calls are drug-related.

Library employees are trained in the use of naloxone, the emergency overdose remedy also known as Narcan, and the drug is kept on all three floors of the main library. They have not yet had to use it, Powers said.

But from time to time needles show up to confirm the library's reason for its diligence.

"Mostly, they end up in the sharps containers, but our custodians will find a needle in some random place unfortunately," Powers said.

Staff, downsized through the years, has been aided in its coverage of the vast main library building by the added security presence.

"It's made a difference," Powers said.