We are clinicians who specialize in addiction medicine, and who live and work in Greater Portland. We are writing in our personal capacities on behalf of ourselves and colleagues who were disturbed by Mayor Mark Dion’s column chalking up evidence-based public health practices to uninformed “groupthink” (“Needle waste is a public safety hazard of Portland’s own making,” Sept. 12 ). We feel compelled to respond as clinicians who have spent collective decades treating patients, reading studies and applying evidence to practice.

A healthy community is safe, supportive, and provides health care that responds to people’s medical needs. We do not deny that discarded sharps can be harmful, as Mayor Dion noted. But his call to cut harm reduction services would be far more costly and dangerous. It also contradicts evidence that syringe exchanges reduce the number of improperly disposed syringes.

When a person enters a syringe service program, they are offered more than clean syringes. They are also offered vaccinations, wound care, the overdose reversal medication naloxone and opportunities to engage in treatment. First-time participants in Seattle’s Syringe Services Program were up to five times more likely than non-participants to enter treatment for substance use disorder, and regular participants were up to three times more likely to reduce or quit drug use. These types of programs have referred thousands of people to housing, health care services and substance use treatment. All of these services are crucial to reducing overdoses and creating opportunities for people to engage in treatment.

Reducing access to evidence-based harm reduction services would impose substantial health risks, including increased HIV and viral hepatitis transmission. Maine led the nation in the rate of acute hepatitis C and had the second-highest rate of acute hepatitis B in 2020. Maine’s acute hepatitis B rate nearly tripled, and the acute hepatitis C rate increased sevenfold from 2015 to 2020. These trends have been particularly drastic in Penobscot County, where the rate of HIV infections is rising exponentially – and where harm reduction services are limited. Amid this crisis, Portland’s mayor has recommended blunting one of our most effective tools: syringe services programs.

Mayor Dion’s proposal would move Portland further away from public health best practices by requiring a 1-to-1 syringe exchange. This means a person may only receive as many syringes as they return to the syringe service provider. The mayor used highly stigmatizing language (e.g., “addict interests”) and contradicted CDC guidance saying that while 1:1 exchanges “may seem desirable, [they] are associated with increased syringe sharing and increased risk of infections.” Further, studies show 1-to-1 needle exchanges contributed to the 1990 HIV epidemics in Vancouver and Montreal. 1-to-1 needle exchange ratios are also associated with more skin infections and other injection-related injuries. Additionally, the median cost in Maine for treating patients with complications of unsafe injection practices is $175,000 per patient, and 1-to-1 exchanges lead to worse outcomes for people with substance use disorder and higher burdens on our health care system.

Improperly discarded syringes pose public health challenges, but syringe service programs may be the least likely source of stray syringes. People who use syringe service programs receive education about best practices for disposal, unlike people who obtain syringes in other ways. To address the problem of improperly disposed syringes, Portland should invest in more disposal options, including increasing the number of publicly accessible sharps boxes, and better public education, which city staff have already proposed.

Mayor Dion’s proposal may be rooted in concern for some Portland residents, but it is not rooted in science. A 1-to-1 needle exchange would increase rates of communicable disease, infections and hospitalizations, and it is unlikely to meaningfully decrease the number of used syringes on city streets. We acknowledge that our streets, sidewalks and parks need to be safer for all residents to enjoy, but there are ways to achieve this without further harming some of our city’s most vulnerable people.

Policymakers can follow science or they can follow anecdotes and fear. As members of the Greater Portland community, we too want to live and work in a safe and healthy environment. But policies restricting access to health care will harm many of Portland’s people and burden its budget. We urge Portland’s policymakers to choose science over stigma.