Hot Topic (8/4): Needle exchange programs
Drug needle exchanges threatened
Federal budget bill would limit locations available to facilities
ELLSWORTH, Maine — Three or four times a week, “Kevin” — not his real name — drops by the inconspicuous, side-street offices of the Down East AIDS Network.
He deposits a handful of used syringes — the tiny, sharp-needled variety favored by intravenous drug users — into a red plastic container labeled for safe disposal. He helps himself to a supply of new syringes, along with some single-dose vials of sterile water he later will mix with crushed prescription painkillers, heat and inject into his bloodstream.
These supplies, and others aimed at reducing the dangers of IV drug abuse, are given away freely, anonymously and without question at DEAN, which has run a low-profile needle exchange program here since 2007. The “harm reduction” goal of the program, and of the three other needle exchange programs that have operated in Maine since 1998, is to reduce the transmission of HIV, viral hepatitis and other diseases related to IV drug use, while also collecting used needles and syringes for safe disposal.
Needle exchange programs like this are imperiled at the federal level. A double-edged Health and Human Services appropriations bill recently approved by the House would free up much-needed federal funding, which has been prohibited in recent years. But advocates say a misguided amendment to the bill would ban federally funded programs from operating in the places they’re most needed. The amendment imposes a 1,000-foot perimeter around any school, college, park, library, public pool, youth center or other place where juveniles typically congregate, and prohibits needle exchange programs from operating inside that zone.
When the Senate passes its version of the Health and Human Services budget bill later this year, the two measures will be merged into a single piece of legislation for final approval by both bodies.
“If the House amendment makes it through [into the final appropriations bill] it will affect virtually all programs located in urban areas,” said Andrew Bossie of the Maine AIDS Alliance. “The HIV community here in Maine is very concerned about this.”
“This restriction would make it virtually impossible to operate a needle exchange program in Ellsworth,” said Steve Richard, executive director of DEAN.
Between schools, day care programs, parks and other sites, he said, there is essentially no place within the small coastal city where the program could be located and still be accessible to the people who need it.
In addition to Ellsworth, other needle exchange programs in Maine are headquartered in Augusta, Bangor and Portland. Some offer occasional mobile services that reach into more rural areas of the state. A fifth site in Lewiston has closed but may reopen in the future. Funding is a shoestring of state dollars, foundation grants and private donations.
Patsy Murphy, director of the Eastern Maine AIDS Network in Bangor, runs the city’s needle exchange program out of her Harlow Street offices. She said the specifics of the proposed restriction are unclear, but it’s unlikely the EMAN program would qualify for federal funds if the House amendment were to be included in the final budget bill.
In the past year, EMAN has collected almost 12,000 dirty needles and given away approximately the same number of clean ones, Murphy said. In addition, out of the approximately 200 drug users enrolled, about 150 have been referred for substance abuse treatment, medical care, mental health counseling and other services.
“There is a lot of relationship-building that goes into this program,” Murphy said. “We all have the utmost respect, compassion and commitment to our clients’ health and well-being.”
The needle exchange program at EMAN has a budget of about $30,000, cobbled together from small private grants and personal donations. It’s enough to keep the program running at its current level, Murphy said, but federal funding would enable a much-needed expansion of services.
“People think we are promoting drug use, but that is simply not the case,” she said. “We are committed to stopping the spread of disease.”
Since 1998, when the first program opened in Portland, tens of thousands of clean needles have been distributed in Maine. According to a recent report to the Maine Legislature, the four programs in 2008 collected a total of more than 29,000 used syringes and gave away close to 31,000 new ones. Nearly 900 individuals partici-pated, including about 260 new enrollees.
The programs also collect and compile anonymous public health data, such as the age and ethnicity of enrollees, their drug of choice, whether they’ve been tested for HIV and hepatitis and what the results of that testing are.
“Science has told us that for IV drug users … these programs are access points to education, testing, substance abuse treatment and other referrals,” said James Markiewicz, director of the HIV, STD and Viral Hepatitis Program in the Maine Center for Disease Control and Prevention. “The programs are good, sound public health.”
Reps. Mike Michaud and Chellie Pingree both voted for the Health and Human Services budget bill that contains the amendment. Michaud said in a recent interview that he was unaware of the amendment and would have concerns about its implementation. A spokesman from Pingree’s office said Pingree has co-sponsored leg-islation that would negate the ban in future budgets.
A spokesman from Sen. Olympia Snowe’s office said the location of drug treatment programs, including needle exchange programs, is a “multidimensional challenge” often best left to local decision-makers.
Kevin Kelley of Sen. Susan Collins’ office said Collins supports programs that combat the spread of HIV-AIDS. But, he said, the senator feels taxpayer funds should be spent on “bringing help to the population suffering from heroin addiction, not on giving them more effective means to continue their addiction.”
Bossie of the Maine AIDS Alliance said people who don’t understand the principle of harm reduction are fearful that the programs will attract drug users to their neighborhoods and even worsen the problem of drug abuse.
“But statistics show that having a syringe exchange does not encourage drug use,” Bossie said. “It does mean that people with this unhealthy habit do it more safely, while getting dirty needles off the streets.” At DEAN, needle-exchanger Kevin agreed. The 30-year-old clam digger said intravenous drug use is “rampant” in Hancock and Washington counties. “Everybody and his uncle is using,” he said.
“Especially between Steuben and Lubec, it’s amazing how many people are on the needle.” He often picks up extra supplies for his drug-using friends Down East. Paying for illicit drugs is easier for day laborers like him, who can use a portion of each day’s pay to support their habit, Kevin said.
“A lot of us are pretty here-and-now types,” he said. If needle exchange programs are discontinued, he said, it won’t drive addicts into treatment or make them stop using drugs.
“People are going to do what they do,” he said, bagging his clean supplies in a discreet brown paper sack and heading for the door. “A program like this just makes it cleaner and safer.”
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What do you think about needle exchange programs? Do you think they ought to be federally funded?
Do you believe these programs enable addicts in their addictions?
Or do you think they are essential in preventing the spread of HIV-AIDS and other diseases?