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What Maine Can Teach The Rest Of The Country About Needle Exchanges

A man holds up a syringe, hand towel and citric acid sachet at a needle exchange facility CREDIT: AP PHOTO/PETROS GIANNAKOURIS
A man holds up a syringe, hand towel and citric acid sachet at a needle exchange facility CREDIT: AP PHOTO/PETROS GIANNAKOURIS

Enrollment in Maine’s needle exchange program has more than doubled in the last five years, according to a recent report compiled by the state’s Department of Health and Human Services, pointing to the need for this public health service in the wake of a heroin epidemic that has gripped the East Coast.

According to the report, which state health officials presented to the lawmakers, the number of people who joined Maine’s needle exchange program increased by 225 percent in the last four years, rising from more than 1,200 in 2010 to 4,050 last year. The number of needles distributed also grew by more than 200 percent, with more than 560,000 going throughout the state, particularly Portland.

While these findings tell part of the story of Maine’s heroin epidemic, health officials contend that the numbers also show the success of its outreach efforts in preventing the spread of infectious disease. The number of heroin addicts seeking treatment has more than tripled since 2010, with numbers reaching more than 3,000 according to the Maine Office of Substance Abuse’s treatment data system. In 2013, more than 30 people overdosed on the substance.

“People who have substance abuse problems are not always in a place where they are ready to accept that,” Erika Ziller, a senior research associate at the University of Southern Maine’s Muskie School of Public Service, told the Portland Press Herald. “But interacting with workers at programs often gets them on that path to changing behavior.”

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Needle exchange programs, in existence since the late 1980s, have served as a public health response to the HIV epidemic. Intravenous drug users can visit a health clinic and exchange their needles for new, clean ones. Since Maine began allowing needle exchanges in 1997, four state-certified exchange programs have opened up in the state. Practitioners in each program dole out clean needles to clients, encourage them to get tested for common diseases associated with drug use, and refer them to substance abuse treatment. In 2014, more than 3,330 clients received referrals to HIV and Hepatitis C tests, and drug abuse services.

The success of Maine’s needle exchange program could have implications of what similar initiatives could do for the rest of the country amid a resurgence heroin abuse in the last five years. More than 4 million Americans older than the age of 12 reported using heroin at least once, according to the Centers for Disease Control and Prevention. The same report said that heroin among that group has increased in the last three years, especially in the Midwest, West, and Northeast regions of the United States.

“We’re not going to change people who have moral concerns, but if people don’t like what we do, they should at least love our economics,” Dr. Caroline Teschke, the administrator at India Street health clinic in Maine, told the Portland Press Herald. “If we prevent just one case of HIV, that is a huge savings.”

Even so, 24 states have banned needle exchanges. In 2012, Congressional Republicans reinstated a federal ban on funding for needle exchange programs, reversing a law that President Barack Obama signed three years earlier lifting the original ban that had been in place in the late 1980s. Programs across the country, including those in Maine, operate solely on private grants and donations, even as the cost of supplies and treatment costs up toward $20,000.

“On a gut level it’s easy to understand why policymakers might feel squeamish about needle exchanges,” The Washington Post’s Christopher Ingraham wrote in his piece last month lambasting lawmakers who opposed needle exchange programs. “Giving needles to a drug addict may feel like putting a gun in the hands of a person determined to harm himself. Caution in the face of a controversial topic is a reasonable response. But there is no controversy when it comes to syringe exchanges. None. Zero.”

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A host of public health experts and groups endorse needle exchange programs as an effective means of the containing infectious disease, including the Centers for Disease Control and Prevention, the World Health Organization, AIDS United, The National Institutes for Health, and the Foundation for AIDS Research

Those who oppose needle exchange programs say that they encourage drug use. But proponents point to the programs’ proven record of keeping dirty needles off the street and curbing the spread of HIV and other infectious diseases that are spread by sharing needles.

When faced with public health crises, even lawmakers who have historically opposed needle exchanges are often forced to reconsider. Such was the case earlier this month when Indiana Gov. Mike Pence, a staunch opponent of needle exchange programs, allowed its temporary implementation in the wake of an HIV outbreak that has infected more 90 people in one rural town. Shortly after, lawmakers in the Indiana House approved a measure that would allow counties with high rates of hepatitis C to create needle exchange programs.

Overall, Maine lawmakers have had a mixed record when it comes to tackling the state’s heroin addiction problems. In his State of the State address in February, Maine Gov. Paul LePage unveiled his strategy to combat drug abuse that centered on a crackdown on drug dealers, rather than on treatment and prevention strategies. His new proposal calls for the hiring of more a dozen new drug enforcement agents and four drug prosecutors and four judges for special drug courts: additions that cost nearly $3 million. However, critics have accused the plan of relying on the same strategies that haven’t worked in the past.