Needle exchanges are an evidence-supported public health approach that help prevent the spread of infectious disease and reduce unsafe injection practices. Maine law has for decades allowed for licensed needle exchanges, and there are currently seven exchange sites listed on the Maine CDC website. Four of those exchanges, including one here in Bangor, are run by the Down East AIDS Network and the Health Equity Alliance (HEAL).
These state-certified sites not only provide clean syringes to reduce the transmission of infection, they also provide access to the life-saving opioid overdose-reversing drug naloxone (commonly referred to under the brand name Narcan) and other harm reduction services that seek to reduce the harm associated with drug use, while connecting people to additional health and recovery services.
Allowing and funding these operations are two very different things. In the midst of the ongoing efforts to tackle Maine’s daunting opioid epidemic, the state has not done enough to financially support the existing echanges and expand these important services across Maine.
Encouragingly, change may be on the horizon. Gordon Smith, Maine’s Director of Opioid Response, says the Mills administration has identified approximately $1.5 million it intends to use to expand the number of certified exchange sites to as many as 12, with a focus on currently underserved or unserved areas including Andorscoggin, Aroostook, Oxford, Somerset and York counties.
“People die when these services aren’t available.” Smith said. He said expanding needle exchange sites is “a high priority of ours” and hopes to have a request for proposals (RFP) ready from the CDC before the end of 2019.
With the high stakes in mind, and the slow pace at which legislative and administrative action often comes, it’s understandable that members of the harm reduction community aren’t willing to wait for more licensed services to become available. But laws and regulations governing these vital services — and public trust in them — still matter.
Bangor is currently seeing the tension between existing law and good intentions playing out in Pickering Square, where a group of volunteers has been operating an unauthorized needle exchange, handing out free needles and naloxone. Police temporarily shut down that exchange, which is led by a volunteer group called Needlepoint Sanctuary, in August. The group resumed its efforts — at least in handing out naloxone and providing training on how to use it — last Friday.
Bangor Police Department spokesman Sgt. Wade Betters told the BDN that the department has tried to work with the Pickering Square exchange organizers. He said there have been some complaints about the exchange operating in the square, and emphasized that police “have no issue” with the naloxone distribution and generally “understand and empathize with the need” for these services.
“We fully support needle exchange. It’s a public health initiative,” Bangor Public Health Director Patty Hamilton said in an interview. “But we support the licensed, evidence-based approach” offered by HEAL. She has concern about an exchange operating in a public square where kids and elderly residents are present.
City officials, and this editorial board, have been wondering why, in an area that already has a state-certified needle exchange, an unauthorized operation is both necessary and not instead employed in area completely lacking these services. So, we asked the organizers of the unlicensed Pickering Square exchange, and the organization running Bangor’s existing, certified exchange.
What we heard from both is that barriers to accessing these services still exist in Bangor, despite HEAL’s important efforts.
Richard Strange, who identified himself as a Needlepoint Sanctuary board member, said that some people don’t feel comfortable sharing their personal information at certified exchanges, where individuals must sign up to access services.
HEAL executive director Kenney Miller acknowledged that reluctance, explaining that “people are slow to trust” in a community that has been “deeply stigmatized, deeply criminalized.” He sees value in both what his organization does and what Needlepoint Sanctuary is doing, and said the other group is able to reach people in part by “meeting them where they are” in the center of town as opposed to HEAL’s location on Hancock Street.
“That’s why we’re here — we’re here to provide that safety net,” said Strange, who also said that the volunteer organization is working to become certified.
Miller said his organization is willing to have conversations with Needlepoint Sanctuary and the police to try to facilitate a combination of harm reduction efforts under HEAL’s state license. Those, from our perspective, are the magic words as we look for a productive path forward.
We see the definitive public health value of both allowing — and providing guidelines for — needle exchanges. We recognize and commend the passion and commitment to helping a vulnerable community displayed the volunteers who have been running the Pickering Square exchange. But ultimately, we don’t fault local law enforcement for, well, enforcing the law.
All parties involved should focus on a shared interest: protecting public health and supporting vulnerable members of our community. We believe that is best facilitated under a state-certified organization, and hope there will be conversations between HEAL, Needlepoint Sanctuary and the city about finding a way to harness the combined passion and energy to provide these services in a legal way.