Lawmakers are considering a bill that would end a restriction on how many clean syringes intravenous drug users can get at needle exchanges across the state.

That change would bring Maine in line with best practices endorsed by the U.S. Centers for Disease Control and Prevention and experts in infectious diseases and addiction treatment.

The Legislature decriminalized the possession of hypodermic needles last year, but syringe service providers and recovery advocates said the existing limits are still putting people at risk of deadly infections and overdoses.

A record 636 people died last year from drug overdoses, up 23 percent from the year before.

“The way the rules are currently written, people are not able to access the supplies they need,” wrote Kari Morrissette, executive director of the Church of Safe Injection, which recently opened a syringe service location in Lewiston. “It’s really that simple. We need to update the rules for syringe service programs in Maine. We are not successfully engaging with people the way we should and it shows. … We should be doing every single thing that has been proven effective in reducing this number drastically.”

Right now, the state requires syringe service providers to follow a one-for-one exchange policy. That means a person can only get as many clean syringes as used ones they turn in. Gordon Smith, the governor’s director of opioid response, said that rule has been on the books since the first needle exchange opened in Maine in 1998.


In 2020, Gov. Janet Mills waived that requirement for more than a year in response to the COVID-19 pandemic. But when her executive order expired in August, the providers had to go back to the one-for-one rule.

Democratic Rep. Genevieve McDonald of Stonington sponsored L.D. 1909 to permanently get rid of that policy.

A majority of the Legislature’s Health and Human Services Committee endorsed an amended version of her bill Tuesday that would still allow the Maine Center for Disease Control and Prevention to set a cap on the number of needles provided. Smith told the committee last week that the governor supported that amendment. If the bill passes, he said, the state will set the limit at 100 needles or the number of needles returned, whichever is greater. In 2021, the average number of needles exchanged by individual clients per visit was 99.

“That hinges on our desire to encourage program participants to visit the program sites in order to receive harm reduction services like fentanyl test strips – and to establish a trusted relationship with the staff there,” Smith said during the public hearing. “Studies show that the participants in a syringe exchange program are five times more likely to seek recovery at some point than people who do inject drugs and do not participate in a syringe exchange program.”

Harm reduction programs try to reduce the risks for people who are actively using drugs by providing them with information and safe supplies, like naloxone in case of overdose and clean needles to prevent the spread of disease. Their goal is to meet people where they are, reduce overdose deaths and build relationships.

The bill received overwhelming support during a public hearing last week from recovery advocates, medical experts, syringe service providers, the American Civil Liberties Union of Maine and others. Dr. Kinna Thakarar testified on behalf of the Northern New England Society of Addiction Medicine and the Maine Medical Association. She said one person could easily go through 10 needles in a day, and she often sees patients who have to stay in the hospital for weeks because of serious infections or other complications.


“Our research during the pandemic has shown that expansion of harm reduction services through mobile delivery, mail delivery, and temporary elimination of the 1:1 needle exchange were effective ways to improve access to harm reduction services,” said Thakarar. “In the past year, I’ve seen countless patients admitted to the hospital with serious, sometimes life-threatening infections related to injection drug use. Especially with our Maine hospitals being overwhelmed with COVID patients, it’s so important to try and prevent serious infections and hospitalizations when we can.”

Brian Townsend is the executive director of Amistad, which supports people struggling with substance use disorder in Cumberland, Sagadahoc and Lincoln counties. He told the committee that the organization applied to become a syringe service provider in Portland during the pandemic because staff were seeing a spike in overdose deaths, as well as transmission of HIV and Hepatitis C. Amistad’s program launched having never experienced the one-to-one exchange ratio. He encouraged lawmakers to support the bill.

“We started to build a system of support that actually worked for our underserved and most vulnerable community members, and we saw reductions in non-fatal and fatal overdoses and infection reductions among the target population,” Townsend said in his testimony. “We also saw first-hand how effective harm-reduction programming supports recovery, as we were able to leverage our connection to support many individuals with accessing treatment, entering recovery residences, and connecting to recovery resources. The resumption of ‘business as usual’ following the expiration of the Governor’s orders stopped this progress in its tracks.”

One of the bill’s few opponents at the hearing was the Maine Sheriff’s Association. In his testimony, York County Sheriff Bill King said discarded syringes are a hazard in public places across Maine. The CDC has pointed to peer-reviewed studies to show that getting rid of the restrictions on needle exchanges does not increase syringe litter, but King said he wants to see an incentive for returns.

“Unfortunately, eliminating the requirement to return used syringes creates another public health issue that we cannot ignore,” King said.

Eight members of the Health and Human Services Committee voted in support of the bill Tuesday, while three opposed it. The measure will still need to go to the full Legislature for consideration.

“The problem is, I see this as we’re helping people with drug issues do drugs, more than we’re doing anything else,” said Rep. Michael Lemelin, a Chelsea Republican who opposed the bill.

In 2021, syringe service providers operated 17 sites across the state. An annual report shows they collected 2 million syringes and distributed 2.7 million. During the previous year, they collected 1.3 million syringes and distributed 1.6 million. More than 5,200 people used their services – including 1,800 who signed up for the first time last year. They distributed naloxone to nearly 1,500 people and made more than 5,400 referrals to other services such as substance use treatment, primary medical care, STD clinics and mental health services.

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