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Thursday, Sept 12, 2024

The only public health risk from needles is that we might not give out enough of them.

As a City Councilor and former healthcare educator, I have a duty to speak out against Mayor Dion’s dangerous and irresponsible opinion piece in the Press Herald today that spreads misinformation and puts members of the intravenous drug-using community at increased risk. 

Portland has a syringe distribution program because it is good public health practice, not “group think.” Worldwide, over one million people die every year from deadly infections caused by the reuse of needles, costing the public billions of dollars in treatment and end-of-life care. Many also suffer from limb-threatening skin infections and sepsis.

Having good needle distribution coverage is a key component of an effective disease prevention program. HIV and hepatitis B and C treatment is so costly (on the order of millions of dollars per patient) that even one additional infection can negate the cost savings of having a program at all. It’s a fragile equation: a syringe services program with an annual budget of $500,000 needs to prevent 3 new HIV infections per year to be cost-saving. To do that, we need to make sure everyone who needs a syringe can get one. No questions asked.

No one likes seeing needles on the ground. They are a reminder that people are hurting, and that there is a raging opioid epidemic happening all around us. But having a well-run needle distribution program like we have here actually improves needle disposal, because it comes along with public support for education, disposal, and needle boxes. If we are seeing increased needle waste, there are more effective interventions we can take to address this. Reducing the number of needles we give out is not one of them. Expert consensus on best practices for needle distribution programs is to have no limits on the number of needles given out, so that people can take extra needles back to members of their community who may not be able to access the program themselves. 

The fact that we freely distribute a lot of needles in Portland, during an opioid crisis, is a very good thing, not a problem. Trying to arbitrarily shrink this program down to a 1:1 clean-for-dirty “needle exchange” does nothing to solve opioid addiction, will result in a secondary public health crisis, and is not an evidence-based approach to reducing needle waste. 

It is really important to educate people who are concerned for their safety that the risk of communicable disease from needles found on the ground is extremely, extremely low. In a worldwide non-healthcare workplace study, spanning more than 20 years since the start of the AIDS epidemic to 2008, less than 3 confirmed cases of HIV, hepatitis B/C transmission from needle sticks were identified. Extrapolate that out beyond the workplace, to the public at large, and the threat posed by discarded needles is certainly not “a daunting hazard to Portlanders” or equal in any way to an HIV/HCV/HBV outbreak among drug users.   

The fear of needles is deeply rooted in our society, and so is the fear of IV drug users and homeless people. Changing public policy to align with fears that have absolutely no basis in fact would be a grave mistake. A better solution to Portland’s needle waste concerns is to implement a program founded in public health research, such as a needle buy-back program, which is incentivizing, not punitive, and has been effective in Boston and New York at reducing needle waste. That is the solution I support.

We are in an opioid epidemic because greedy pharmaceutical companies pushed these addictive drugs on the public. We have a needle waste problem because the commodification of housing has resulted in a housing affordability crisis that leaves many people who use IV drugs unsheltered, with nowhere to dispose of their syringes. Instead of fighting needle distribution, let’s apply our efforts towards social programs that build housing and create addiction recovery beds. 

ksykes@portlandmaine.gov 207-558-5764

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