Zoe Odlin-Platz and Lizzy Garnatz, who run the needle exchange program at Portland’s India Street Public Health Center, say their clients don’t fit into a clearly defined category.

There are the clients you might expect, such as the transients hooked on heroin. But there also are college students dabbling in injection drugs, and soccer moms or fishermen graduating from prescription opiates to harder stuff.

The one thing they share is a sense of humility.

“By the time we see people, they are often at the point of ‘I can’t believe I’m in here doing this,’ ” Odlin-Platz said. “So we like to be the one person who smiles at them and makes them feel like a human being.”

They have been handing out a lot of smiles.

In the past five years, the number of enrollees in Maine’s needle exchange programs has increased by about 225 percent – from 1,238 in 2010 to 4,050 last year, according to a recent report to the Legislature by the Department of Health and Human Services. The Portland exchange serves slightly more than half of those clients.

The statewide number actually dipped by about 7 percent from 2013 to 2014, but officials believe that’s an aberration, given the rising number of new clients and the all-time high in the number of needles distributed.

From 2010 to 2014, the number of needles increased by 238 percent, from 166,746 to 564,847. About one-third of those were in Portland.

The growing demand for needle exchange programs is a mixed blessing: Although it’s an indication of more injection drug use, it’s also a sign that outreach efforts are reaching more people.

RISE IN MAINE HEROIN ABUSE

Experts say the increased prevalence of heroin is a big factor in the rising number of needle exchanges.

Maine has seen a spike in the number of heroin overdose deaths, from seven in 2011 to 28 in 2012 and 34 in 2013, according to state officials.

Nationwide, the number of heroin deaths increased by 39 percent from 2012 to 2013, the most recent data available from the federal Centers for Disease Control and Prevention.

More Mainers are seeking treatment for heroin addiction as well.

From 2010 through 2014, the number seeking treatment more than tripled from 1,115 to 3,463, according to the Maine Office of Substance Abuse’s treatment data system.

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

The state DHHS oversees needle exchanges to ensure they are following regulations, said spokesman John Martins.

Although the number of needles distributed reached an all-time high in 2014, the number of Mainers enrolled in a needle exchange program decreased slightly last year, to 4,050 from 4,333 in 2013.

Martins said the state could not definitively say why there was a decline, but “we expect that the number will align more with the previous trend in 2015.”

PROTECTING PUBLIC HEALTH

Needle exchange programs were created in the late 1980s as a public health response to the growing HIV/AIDS epidemic.

The concept is simple: For every used needle a client brings in, he or she gets a clean one.

Supporters say the programs keep dirty needles off the streets and dramatically reduce incidents of HIV and other infectious diseases, such as hepatitis C. Those diseases are often transmitted through sharing needles; using a clean needle for every injection eliminates that risk.

Critics of needle exchange programs say giving addicts clean needles only enables them to keep abusing drugs, but supporters say the program is intended to improve public health, not pass judgment or eliminate drug abuse.

“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,” said Dr. Caroline Teschke, the administrator at India Street. “If we prevent just one case of HIV, that is a huge savings.”

For proof, she points to Austin, Indiana, which saw an outbreak of 90 new HIV cases in just a few months among a population of only 4,272. The outbreak prompted Indiana Gov. Mike Pence, an opponent of needle exchanges, to allow temporary exchanges in Austin.

“As prevention of chronic or infectious diseases, exchanges serve a very important role,” said Ziller.

However, 24 states don’t allow needle exchanges, said Temple University law professor Scott Burris, who tracks access.

The states that do offer exchanges tend to set them up in urban areas with critical masses of people, putting rural populations at a disadvantage.

Sharon Paul, a health promotion specialist for Eastern Maine AIDS Network in Bangor, has been running the needle exchange there for nine years. She said she’s seen more clients in recent years who are injecting drugs rather than ingesting them.

Paul said some of her clients travel from as far away as Houlton.

“The stigma is still very much alive,” she said. “We always get people who say, ‘Why not just give them the drugs, too?’ I explain that we’re not supporting IV drug use, we’re just trying to keep people safe when they use. And they’re going to use.”

SMALL PROGRAMS, LITTLE FUNDING

State law has allowed needle exchanges in Maine since 1997, but the program only became active in 2002. There are four state-certified needle exchange programs, operating at six sites: Portland, Lewiston, Augusta, Bangor, Ellsworth and Machias.

All of Maine’s programs operate without federal or state funding. Federal funding for needle exchange has been banned since 1988 (except for a period from 2009 to 2012) and states often don’t provide funding either, so the programs run mainly on private grants or donations.

That is indicative, Ziller said, of the broader problem of public health funding.

“The amount we spend on prevention versus cures is out of whack,” she said.

The Portland needle exchange, run by the city through its India Street clinic, serves 53 percent of all Maine enrollees and handed out 172,091 needles last year – one of every three statewide – but received only a $5,000 grant and some small donations.

The cost of supplies alone at the Portland clinic is about $15,000 to $18,000, said Teschke, the clinic administrator.

The alternative to needle exchanges, she said, is paying for HIV treatment, which can cost about $20,000 per patient annually.

Drugs to treat hepatitis C are among the costliest on the market – as much as $1,000 per day over a 12-week treatment cycle.

In addition to providing clean needles, exchange programs often encourage clients to get tested for infectious diseases common to injection drug users, such as HIV and hepatitis C, and provide referrals for substance abuse treatment.

In 2014, Maine’s programs made 3,307 referrals to clients, including 466 HIV tests and 1,240 hepatitis C tests. They also helped 466 clients enroll in a substance abuse program. Garnatz, one of the two women who run the Portland exchange, said it’s about building relationships with clients.

“We keep them as safe as we can today, and maybe tomorrow we can get them to think about treatment,” she said.