Advocates in the recovery community are urging Portland city officials to end restrictive policies that make it harder for intravenous drug users to get clean needles and support services during the pandemic.

The city is the only organization in the state to not ease restrictions and expand services under an executive order issued by Gov. Janet Mills in April. That order allows state-certified syringe services programs to provide clients with a larger number of clean syringes to help prevent the spread of infectious diseases during the COVID-19 pandemic.

Courtney Pladsen, a Portland-based substance use treatment provider and director of clinical and quality improvement for the National Health Care for the Homeless Council, sent a letter to city officials in November urging them to reconsider their position and follow the governor’s order. She did so after hearing concerns in the community and from her patients about having difficulty getting clean needles and observing an increase in infections. And she received no response. 

“I was appalled,” Pladsen said of the city’s restrictive policies. “We are in a global pandemic and in a year we have seen a record number of overdose deaths. As a public health expert, this is absolutely the wrong approach for the city to take and frankly it was baffling. I have a really hard time understanding why any public health response would be to make needle access more difficult right now.”

Whitney Parrish, the director of advocacy and communications for the Health Equity Alliance, said the group advocated for the changes in Mills’ order and implemented them immediately at its syringe services programs in Bangor, Ellsworth, Machias and Belfast. She said they have partnered with other groups to greatly expand outreach and delivery services throughout Greater Bangor, though the group’s annual service figures were still being finalized.

Parrish said she doesn’t understand why Portland is the only exchange not taking advantage of Mills’ order, especially since it’s supported by public health officials, including the federal government.

“From that lens alone, it’s surprising,” she said. “Not only is it surprising, it’s alarming, too.”

Kristen Dow, director of the city’s health and human services department, which oversees the Needle Exchange Program, did not respond to a reporter’s request for an interview.

Portland’s needle exchange has experienced an exodus of paid staff since the summer. The city also conducted a formal audit in the fall to ensure staff and volunteers were still abiding by a one-for-one policy, a state rule that limits the number of clean syringes a person can receive to the number of used syringes they turn in.

Mills waived that rule in April. Her order also allowed programs, whose hours and locations are restricted by state licenses, to expand their hours of operation and deliver services throughout the county, rather than being limited to fixed locations.

Maine has 10 state-sanctioned and regulated syringe service programs, which have traditionally been referred to as needle exchanges. Portland’s is the only municipally run program in the state.

Gordon Smith, the state’s opioid response director, said in an email that Portland is the only program in Maine not to waive the one-for-one exchange requirement under the governor’s executive order. Smith did not respond to requests to be interviewed and declined via email to comment on the impact of Portland’s decision on its clients.

The city has not only refused to expand services and eliminate the one-for-one requirement, but it has also doubled down on the policy, urging volunteers to sign a memorandum of understanding reaffirming it. City Hall spokeswoman Jessica Grondin said the city launched an audit of the program this fall to ensure the one-for-one policy was being followed “after we saw large quantities of needles in possession of our shelter guests and an increase in discarded needles in public spaces.”

She pointed to the prevalence of needles being found in the community and being found on people staying at the city shelter as reasons for keeping the one-for-one policy.

“We feel our one-for-one exchange policy is sound given the volume of clients we interact with and the proliferation of discarded needles in our community,” Grondin said. “These improperly discarded needles have resulted in a number of tragic incidents in our public spaces – amongst our staff and members of the public.”

Grondin did not provide any details about the “tragic incidents.”

Zoe Brokos, the former substance use prevention and harm reduction services program coordinator, said she resigned in November after being placed on administrative leave at the onset of the city’s audit. She said three other staffers resigned between July and December. Brokos declined to discuss the circumstances of her departure.

Portland’s decision to maintain its restrictive policies goes against advice from public health experts, including the federal government. And it comes at a time when overdose deaths are on pace to reach record highs in Maine and throughout the United States.

The U.S. Centers for Disease Control and Prevention issued interim guidance in May that included a recommendation for programs to “change policies to increase the number of syringes each client can receive per visit” and to provide supplies through mobile services, delivery or mail order services. It also encouraged programs to coordinate with other programs to ensure clients had access to supplies and services.

Mills’ executive order was hailed by the American Medical Association as a model for other states.

“The AMA encourages all states to consider adopting the Maine Executive Order to modify restrictive laws and regulations concerning the sale and possession of needles and syringes to maximize the availability of sterile syringes and needles,” said Dr. Patrice A. Harris, the AMA’s president. “Sterile needle and syringe exchange is a proven harm reduction strategy. We commend Governor Mills for her action.”

There was “no debate” at MaineGeneral Health about waiving the one-for-one exchange requirement and expanding services under the governor’s executive order at each of its syringe services programs in Augusta and Waterville, spokesperson Joy McKenna said.

Before the order, McKenna said their programs were part-time, with the Augusta program being open two days a week and Waterville open one day a week. Now, each of those locations is open five days a week, she said. As a result, they’re serving more clients and have nearly doubled the number of clean syringes distributed on average each month.

“The impact of the executive order on MaineGeneral clients has been positive,” McKenna said. “As a result of the change in policy, we are no longer forced to turn clients away who are in need. We have seen improved the trust between clients and the program.”

Statewide syringe exchange data for 2020 is not yet available. But in 2019, nearly 5,600 people were enrolled in syringe programs throughout the state. Organizations received 948,904 dirty needles and distributed 879,853 clean needles.

These programs are also access points for other health care and treatment services. Last year, syringe programs in Maine made 17,376 referrals for primary care, testing, substance use treatment, family planning, mental health and other services and conducted 80 HIV tests.

Portland operates the oldest and largest exchange in the state. In 2019, Portland’s Needle Exchange Program, which is based on India Street, had 3,550 people enrolled, which is 63 percent of the state’s total. The program collected 257,187 dirty needles and distributed 221,303 clean needles, and made over 17,000 referrals.

According to preliminary figures for 2020 provided by the city, the exchange distributed 370,740 clean syringes last year – a figure that’s nearly 150,000 greater than the number of syringes collected. The exchange also distributed nearly 150,000 more syringes than it did in 2019, even though it served 162 fewer clients in 2020.

Brokos, the former program coordinator, declined to comment on the data.

Volunteers at the Portland exchange say the city’s policies are increasing risks for clients, who say they are trying to clean and reuse needles; sharing needles more often; buying used needles from other people, or breaking into sharps containers around the city to get used needles, so they can trade them in for clean ones.

“We’re seeing needles become a commodity on the street in a way they weren’t before,” said Alex Vining, a 31-year-old South Portland resident and volunteer with the needle exchange’s mobile outreach program.

Kari Morissette, executive director of the Church of Safe Injection, said her group of volunteers resumed operations in Portland when the city temporarily closed its exchange after a worker there tested positive for COVID-19. They continued to operate in the city, she said, because people were having trouble accessing city services.

The Church of Safe Injection is a nonprofit formed in 2018 by recovery advocate Jesse Harvey, who died in September. The nonprofit provides clean syringes and other supplies, including the overdose antidote naloxone, through mobile outreach. The group is not certified by the state and operates on legally questionable ground.

The city told the group in December they could not longer exchange the used syringes they collected for new ones at India Street.

Morrissette said her group turned in 9,000 syringes during its last exchange and only received 5,000 clean ones in return. And they don’t expect the city will provide the additional 4,000 syringes they are owed, she said.

“It is very hard for us to understand that they have a problem with us helping the community when their hours of operation and access to their services are so limited,” Morissette said.

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