There’s little in life that Amos Howard resents more than used needles in the street.

He’s 60, and the street is where he sleeps in San Francisco. So he spends a good portion of each day picking up dirty syringes with thick gloves so he doesn’t get pricked when he sits or lies down.

He says he’s seen more needles lately. So do a lot of people. The number of complaints to the city about discarded needles has skyrocketed in the past couple of years — and although San Francisco has the largest program in the nation for handing out free, clean needles to drug addicts, a quiet policy change has evolved over the past decade that may be contributing to that rise in complaints.

San Francisco no longer requires that addicts turn in a dirty needle for every clean needle they receive at city programs. In fact, since 2008, the practice has been termed “syringe access” rather than “needle exchange” — the same change that has occurred at handout programs across the country.

Now, said San Francisco’s Public Health Department spokeswoman, Rachael Kagan, “you don’t need a needle to get a needle.”

More addicts

If they can get a clean needle without having to make a one-for-one trade, addicts are far less likely to share syringes, thereby reducing the transmission of HIV, hepatitis C and deadly staph infections, program managers say. Encouraging clean-needle use has become especially urgent in San Francisco, where health department figures show the number of intravenous drug addicts has ballooned 46 percent since 2007, to 22,000. Officials attribute at least part of the increase to a growing use here and nationwide of methamphetamine and heroin.

A side-effect of the policy shift, however, is that addicts have less reason to bundle up their dirty needles to tote them in for exchange. San Francisco has tried to compensate by making needle-disposal “sharps” boxes more readily available in pharmacies and restrooms and on street-cleaning trucks, and by conducting aggressive cleanup sweeps.

But by some people’s accounts, it’s not working. According to the city’s 311 portal, which records citizen complaints, reports of used needles littering the streets and parks soared from 440 in all of 2012 to 2,565 this year through Nov. 19.

City workers say much of this can be explained by gentrification pushing street addicts into neighborhoods that didn’t see them as much before — particularly in the Mission District. But not all of it.

More on the street

Mario Montoya, a longtime Public Works Department supervisor, picked up 100 or so discarded needles the other day at United Nations Plaza — what he called a normal haul.

“Just in the last few years, I’d say it’s gone up 30 percent,” Montoya said. Homeless displacement and touchy newcomers doubtless account for part of the rise, he added, “but I’d have to say, that could be from a lot more folks out here doing drugs. Because I also see that.”

Assessing the causes of needle litter is difficult because statistical examination of the subject is thin.

The San Francisco AIDS Foundation is paid $1.7 million by the city to distribute about 2.4 million clean needles each year, and there is no tally of how many are turned back in to the city or the sharps boxes. Although the city health department is working on a way to count dirty syringes, for now it’s guesswork.

Meanwhile, even homeless people like Howard are concerned enough about the proliferation of dirty needles to pitch in.

“I despise anyone who throws their needles in the street, and I let them know it,” Howard said one recent afternoon, glaring at a pair of methamphetamine addicts lying on the sidewalk at South Van Ness Avenue and 16th Street. “I do not want to sleep on them, I don’t want a child stepping on them. And fortunately, the DPW (Department of Public Works) guys are very good about working with us.”

Back to Gallery Complaints skyrocket over syringes on streets in S.F. 5 1 of 5 Photo: Gabrielle Lurie, Special to The Chronicle 2 of 5 Photo: Gabrielle Lurie, Special to The Chronicle 3 of 5 Photo: Gabrielle Lurie, Special to The Chronicle 4 of 5 Photo: Gabrielle Lurie, Special to The Chronicle 5 of 5 Photo: Gabrielle Lurie, Special to The Chronicle









Addicts’ arrangement

As he spoke, city street cleaner Juan Venegas was scouring the gutter for syringes. Like most of his colleagues in needle-heavy areas such as the Mission, he has agreements with addicts in the street camps that they will leave used syringes at certain spots for him — in his case, at the base of a tree and at the foot of a wall.

“Junkies are regular human beings,” Venegas said, poking the dirt with a pair of pickup tongs. “They don’t want to be around used needles, but some get neglectful. So we pick them up. I tell them where to leave them, and they do. Most of them, anyway.”

One of the meth addicts Howard glared at, Orelia Slinky, 43, said leaving dirty needles lying around was “not cool. It would be nice if they took all the dirty ones back when we got clean ones.”

She and her boyfriend said they try to bundle their used syringes into water bottles or sacks and leave them for street cleaners or take them to drop boxes.

Such diligence is not universal. Take, for example, a young man who identified himself only as “Junkie Jim.”

Jim sat on a box at on Folsom Street south of 17th Street the other afternoon, shot a load of methamphetamine into his well-tracked arm and tossed the syringe into the gutter. Another half-dozen needles lay scattered nearby.

“Hey man, I didn’t sleep last night, and I’ve been sick,” he said when asked why he didn’t stow the needle. “I usually try to turn ’em in, but today ...” He shrugged.

Changing the rules

San Francisco has funded a needle-exchange program to prevent the spread of disease among drug users since 1993. But gradually, with little or no public debate — none was required — the organizations that run the syringe dispensaries ended the exchange requirement.

Some officials acted after a landmark study by the National Institutes of Health in 2007 found that most addicts properly disposed of syringes even if they weren’t required to trade one-for-one. But many agencies, from New Jersey to Los Angeles, were evolving toward the change anyway based on experience.

Locally, Alameda County still aims for a one-for-one trade, but doesn’t require it. Contra Costa County still demands a one-for-one exchange, but that’s because it is not as densely populated with intravenous drug abusers, officials said.

“San Francisco’s technique is good for that city, and the fact is that every location examines and adapts their practices for what works for them,” said Obiel Leyva, a needle exchange and education manager for Contra Costa County. “Not requiring one-for-one exchange is probably more prevalent in the heavily impacted urban areas.”

Making it easy

San Francisco makes it as easy as possible for users to get a clean needle without turning in a used one.

For instance, a handout flyer at a city syringe access center at Sixth and Mission streets directs people to a nearby facility on Market Street if the office is closed. “Just say hello to the folks at the desk and let them know what size — longs, shorts, micros, 29’s or bee stingers & they will bring syringes & all the supplies to you in a discreet plain brown bag,” the flyer reads.

At the Market Street facility, users can obtain a “starter kit” — 20 needles, alcohol swabs, cotton balls and other items. A staffer also hands out a small biohazard bin for safe needle disposal. No swap of dirty needles is required.

In fact, the Market Street outlet won’t even accept used needles. “We don’t take returns at this location — please visit an exchange for safe disposal,” the flyer says.

“Not requiring used syringes in exchange for clean ones is completely more effective in preventing disease — people are less likely to share, because they have more clean needles available,” said Eileen Loughran, a community liaison for San Francisco’s syringe programs. “But to be clear — if someone approaches one of our syringe sites, you get more clean ones if you turn old ones in. If you have no used needles to trade, all you can get is a starter pack of 20.”

Lower HIV rates

Advocates have long credited San Francisco’s syringe programs for the city’s significantly lower rates of HIV infection among drug injectors. A 1997 study in the medical journal the Lancet found that San Francisco and other cities with needle-exchange programs had an 11 percent lower HIV rate than cities without exchanges. And a 1994 study sponsored by the National Institute on Drug Abuse, also of San Francisco and other cities, found “no support for the hypothesis that syringe and needle exchange contributes to drug abuse.”

Loughran recalled that some San Francisco dispensaries began to go from “needle exchange” to “syringe access” as far back as 15 years ago. The Public Health Department, needing no state or city approval, made the official change in 2008.

“At least half of the programs (in the nation) now operate with a more flexible distribution model. Probably over half,” said Daniel Raymond, policy director for the national Harm Reduction Coalition in New York, one of the leading needle outfits in the U.S.

Raymond said that even without the swap requirement, many users still bring in used needles. In most cities with syringe access programs, the return rate is 80 to 90 percent, he said. Raymond said syringe access rather than needle exchange has become recognized as “a best practice.”

Drop-off boxes

However, although used needles have dotted the city for decades, there is clearly an impression that more are littering San Francisco’s streets and parks today. City Hall, said Loughran, is aware of the spike in complaints and is having “multiple conversations” about what to do, including establishing “rapid response teams.”

The city has placed syringe disposal boxes in seven hot spots, and Walgreens has added dirty-needle boxes in its stores throughout the city. “We do a lot of emphasis on disposal,” Loughran said.

The Public Works agency also plays a major role in the cleanup. According to spokeswoman Rachel Gordon, street crews have stepped up their efforts in recent years and carry 421 syringe disposal boxes on the job. The department’s nine public Pit Stop toilets have syringe disposal boxes.

Gordon said an average of two Public Works employees are pricked each year, but that there have been no reported disease transmissions.

Public Works employees aren’t the only ones — police officers also suffer needle sticks from time to time, said Lt. Mike Nevin.

“There needs to be a reasonable approach to this,” Nevin said. “There needs to be responsibility on the user’s end.”

For some, it’s tough

Some drug users say being responsible — tracking, storing and swapping needles — is a tall order amid the chaotic environment of the street.

“I’m trying to quit meth, but it’s a job just to get your next fix, your food, keep from getting raped,” said Ariel Young, 30, as she sat in her tent at Folsom and 17th streets. “I put my needles in plastic bottles and take them to the Capp Street needle center, and they don’t ask for them there, but I leave them anyway.

“It’s nasty having them around. Most of us out here try to do something instead of just throw them in the street. But yeah, sometimes you slip up.”

Another homeless woman standing next to Young’s tent, who merely snarled when asked her name, spat on the ground.

“I hate slammers,” she said, using the street term for meth injectors. “Slammers are slobs. Leave their needles everywhere, and I have to walk on them. Slobs.”

Young grimaced and stared at her sleeping bag, silently.

Chronicle staff writer Joaquin Palomino contributed to this report.

Debra J. Saunders and Kevin Fagan are San Francisco Chronicle staff writers. E-mail: dsaunders@sfchronicle.com, kfagan@sfchronicle.com Twitter: @DebraJSaunders, @KevinChron