First, I want to thank the Portland City Council for keeping the city-run syringe exchange program open – even if its meetings about the program are not.

In February, I know Portland often fills with bright red hearts. These hearts, no doubt, are intended as a feel-good community gesture, but I’d like city councilors to think about what they’re doing to people’s actual hearts. Think about the restrictions that put people at increased risk for getting endocarditis – a preventable disease that literally ruins people’s hearts.

I recently read a sentence that breaks my heart: “The average age at death was 36.”

The sentence appeared in a recent issue of the New England Journal of Medicine, and those data were cited by a doctor who describes what it is like to treat infective endocarditis. Via video link, he meets a patient he calls “Ms. A.” She’s gaunt, covered with a blanket despite the summer heat, and her nursing home hasn’t set up oxygen tanks, so she’s struggling to breathe. Ms. A had started taking medication in the hospital, but no one at her facility possessed the proper paperwork (the so-called X waiver), so she’s gone without medication. Ms. A tells him she’s feeling chilled, like she might throw up.

Although her chart indicates “a tricuspid valve left in tatters by infection,” surgeons have told Ms. A she needs medication before they fix her heart. But again, no one at her facility possesses the waiver and can’t prescribe her medication, so she doesn’t get what she needs.

Ms. A isn’t alone. The average age of death among patients with endocarditis has plummeted. It used to be older Americans, but now young adults in their 20s and 30s are succumbing to a deadly bacterial infection that literally ruins your heart. The driving factor: The opioid crisis and punitive policies that punish people and hinder safe injection drug use.


“The average age at death was 36.”

Again, I’m a science reporter living in Portland, and I’m not writing on behalf of anyone or any organization. I’m not sharing my own opinion; rather, I’d like to share what I’ve learned in speaking with experts in addiction medicine.

Endocarditis is preventable. One way to reduce the harm and save money, according to the U.S. Centers for Disease Control and Prevention, is to offer people unrestricted access to sterile needles. In practice, the city had been doing the right thing –until last month, when Mayor Kate Snyder reportedly met behind closed doors and decided to enforce a strict one-for-one policy.

Unrestricted access was the right thing to do, according to the leading authorities in academic medicine, practicing clinicians and people who use. Indeed, when I spoke with the epidemiologist who authored the paper I sent city councilors last week (the study showing that more generous syringe dispensing is associated with less syringe reuse), he responded as if the council had voted to make the Earth flat again: “It is crazy to me that in 2021, this is still a very live wire.”

Unrestricted access has been so obviously the right thing to do for decades, and less restrictive access demonstrably lowers the risks associated with sharing and reusing needles. The city’s more restrictive policy discourages safe injection, discourages harm reduction and hinders efforts to stop the spread of viruses and bacterial infections caused by unsafe injection drug use, including infective endocarditis.

When those red hearts go up this year, on behalf of all the constituents who cannot speak up because they are afraid of being arrested and shamed, I ask councilors to think about who they are punishing. What scientific evidence and data guide their beliefs and their decision to deny people services that are proven to reduce harm? Think about how more restrictive policies drive people like Ms. A to unsafe options and think about how that literally ruins their hearts.

Stop breaking the hearts of Portlanders who have decades more of life ahead of them. Start doing everything that can be done to support unrestricted access to clean needles. Don’t listen to me, though. Read what the doctor said: “The average age at death was 36.”

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