Q&A: Tacoma’s Dave Purchase Project

We chat with the organization's executive director, Paul LaKosky.

During the height of the HIV/AIDS epidemic in 1988, Tacoma became home to the nation’s first legal needle exchange. Dave Purchase — who is remembered as a charismatic storyteller and a public health visionary — won the support of Tacoma’s mayor and the public health department and launched the Point Defiance AIDS Project. While Purchase’s program initially caused controversy, many studies have shown syringe exchanges to be an effective strategy for preventing the spread of diseases and reducing negative outcomes for people who inject drugs.

While the organization was first founded to address the spread of HIV, it has since provided national leadership in its response to the opioid crisis.

In 2018, the Point Defiance AIDS Project became the Dave Purchase Project, named to commemorate its late founder. Under the tutelage of Dave Purchase Project, the nonprofit facilitates the Tacoma Needle Exchange, which currently hosts three sites in Tacoma and deploys outreach vans across Pierce County. At Tacoma Needle Exchange sites, clients can exchange their used injection supplies for sterile syringes, which helps prevent the spread of blood-borne pathogens like HIV.

Executive Director Paul LaKosky stresses that while syringe exchange is important, “It is the least of what we do.” Nonjudgmental provision of care, he said, helps drug users stay connected Executive Director Paul LaKosky stresses that while syringe exchange is important, “It is the least of what we do.” Nonjudgmental provision of care, he said, helps drug users stay connected to the community and access additional resources at their own pace.

Through the needle exchange, clients can attend a free wound care clinic or seek treatment for opioid use through the Meds First program. They also can pick up necessities ranging from socks to fentanyl test strips. The nonprofit also distributes and trains community members to administer the overdose-reversing drug naloxone. Last year, staff gave out nearly 7,000 doses of naloxone, which 739 individuals reported using to reverse an overdose.

A public health researcher and cultural anthropologist by training, LaKosky jokes that he is “a very deliberate anthropologist (but an) accidental public health person.” He began his public health career administering maternal and prenatal care as a Peace Corps volunteer in Cameroon. LaKosky went on to work as a community health educator in New York and Chicago and received a doctorate in Cultural Anthropology at the University of Illinois at Chicago. When LaKosky relocated to Tacoma in 2015, he reached out to the Dave Purchase Project, thinking he could do some outreach as a volunteer. Instead, he was asked to join the board, where he served for two years prior to becoming executive director in July 2017.

Today, the Tacoma Needle Exchange serves 3,700 clients throughout Pierce County, but its work touches the lives of many more.

What are the basic tenets of harm reduction, and what makes it an effective strategy?

It’s a very pragmatic approach to drug use. People are going to use drugs, and we do not condone drug use, but we don’t condemn drug use. We see it as something that people engage in in society, and we want to take an approach that addresses the harms that are associated with drug use and work to minimize those. Taking that approach — providing people with clean syringes and access to sterile injection equipment — reduces the harm that they do to themselves. Treating them in a nonjudgmental manner reduces the stigma associated with that, so when they’re ready to make a change, they can come to us for services without feeling like we’re going to shame them or judge them for being a drug user.

Can you talk about the scope of the services you administer? How many people are impacted by the organization’s work each year?

We have 3,700 registered participants, but understand that when someone comes to the exchange, the individual drug user isn’t the only person that’s impacted by the services that we provide. When we talk about harm reduction, it’s not just for individuals. It’s for the entire community.

What are the biggest barriers your clients face when seeking services or treatment?

There are so many barriers to treatment. Some of them are extremely mundane, like, if you don’t have a driver’s license, then you can’t get signed up for insurance. And if you can’t get signed up for insurance, often you can’t get into a treatment facility. There are things that are extremely basic. A lot of the folks that we deal with are homeless or unstably housed, so they may not have all the documentation or paperwork that they need to even get signed up for benefits to get into treatment, if that’s what they want. There are structural barriers, I’ll call them. Who’s going to pay for this? Does this person have access to public transportation to physically getting there? Then there are the individual barriers. Folks may not feel comfortable. Stigma. They may not feel comfortable going to the methadone treatment place, because they know that getting to the clinic five or six days a week is going to make it so that they can’t work anymore. And then there are some folks that just aren’t ready … An individual may decide they want to get treatment, but they may have no idea of how to get into treatment. And even if they have an idea of how to get into treatment, there might not be a treatment slot open. They might need inpatient residential, which (can take) a month. They may need a ride to the clinic. I think a lot of folks, they don’t even know where to begin. It’s such an overwhelming issue.

What is next for the Tacoma Needle Exchange?

I would love to see, several years down the line, having our own facility, a brick and mortar location out of which we can provide more comprehensive services. Where we have exam rooms, where we have medical staff, where we have access to medication-assisted treatment. Where people can walk up, and exchange their syringes, and see a nurse, and maybe do their laundry and get a cup of coffee. Where we have a group of folks that understand the complex needs of these individuals and are there because they want to provide those services to this population.

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