Portland councilors are expected to begin a public discussion about whether the city should maintain its restrictive policy for providing clean syringes to intravenous drug users during the coronavirus pandemic.
Mayor Kate Snyder said in an email Tuesday morning that she has requested a “management update” on the city-run Needle Exchange from staff for the March 1 City Council meeting. And the council’s Health and Human Services Committee is expected to hold a workshop in the coming weeks on the exchange’s policy allowing clients to receive only the same number of clean needles as the used needles they turn in, unless they qualify for an exemption.
Snyder’s request comes after a dozen residents spoke during a council meeting Monday to urge councilors to hold a workshop and public conversation about the Needle Exchange program.
The Press Herald reported last month that Portland was the only syringe services program in the state not taking advantage of an executive order from Gov. Janet Mills that relaxed regulations amid the pandemic.
The order, issued last March, allowed but did not require the state-regulated programs to provide as many clean syringes as people needed during the pandemic, regardless of the number of used needles they returned. It also allowed programs to increase hours and expand mobile outreach, which was previously limited to certain locations.
The goal was to ensure that people had life-saving supplies, while also limiting personal interactions to prevent the spread of the coronavirus.
Portland is the only municipality in the state running a syringe services program, which is a proven harm-reduction strategy to prevent the spread of other diseases and infections, such as HIV and Hepatitis C. The other programs are run by nonprofits. State officials have said Portland is the only program maintaining the 1:1 exchange rule.
Since the Jan. 18 story, city officials have defended their decision to keep their 1:1 policy and have met in private with the city attorney to discuss the city’s legal rights and duties associated with the program. The city said it has reaffirmed its 1:1 exchange policy with staff and volunteers after an audit showed workers have not been following the policy for years. The city said it distributed nearly 150,000 more syringes than it collected last year.
City Hall Communications Director Jessica Grondin said Tuesday that the city’s audit showed that the program had not been complying with its 1:1 exchange rule since 2016 and was providing supplies to noncertified exchange programs. She said the city has worked with the state to file corrected reports for those years. Other controls have been put in place, she said, including separating the operating and reporting duties to create an internal system of checks and balances and conducting a weekly audit of inventory.
Grondin said Portland’s program operates 40 hours a week, seven days a week, at two locations, which the staff believes is enough to meet clients’ needs. She said the city has expanded its mobile syringe-service program to homeless encampments throughout the city.
The city also has been surveying clients about needle use. Of 182 clients surveyed, 80 percent report not reusing or sharing needles since their last visit, 17 percent report reusing and 3 percent report sharing, according to Grondin, who noted staff is also researching current best practices for harm reduction.
“Public Health staff are undergoing literature review of syringe services best practices, including 1:1 policies and (the) relationship to overdose rates, infection rates, and community needle waste,” Grondin said, stressing that Mills’ order was not a mandate and is only in effect during the coronavirus public health emergency.
Meanwhile, the council itself has yet to have a public discussion about policy. Mayor Snyder has said that the issue is an operational one for city staff, rather than a policy decision of the council.
Twelve people urged the council during an open public comment period at Monday’s meeting to reconsider its position and to hold a public session about the 1:1 policy, which several described as antiquated. Some noted that waiving the requirement during the pandemic was recommended by the U.S. Centers for Disease Control and Prevention and supported by harm-reduction advocates.
Mills’ order allowing programs to waive the restriction also was applauded by the American Medical Association, which urged other states to follow.
Dr. Kevin Sullivan, a primary care physician and addiction treatment provider, urged councilors to hold a public discussion about the policy, saying that he’s seen an increase in abscesses among his patients – one of several conditions caused by reusing and sharing needles. Sullivan said a needs-based exchange policy could reduce infections and emergency room visits at a time when hospitals are stretched thin because of the coronavirus.
“I see my patients suffering and all I can do is advocate for them,” Sullivan said.
Other Portland residents wanted councilors to go on the record with their opinions.
“So far, the City Council has only heard the views of city staff, to the best of my knowledge, and I would like to know the views of the City Council,” Mollie Kravitz said.
Cait Vaughan also urged the council to break its silence.
“We are the only exchange program in the whole state that’s chosen to hang on this policy,” Vaughan said. “And I haven’t heard a good rationalization for why. I think we deserve to know why.”
At least two city councilors are ready to discuss whether the city should move to a needs-based exchange, as opposed to the 1:1 policy.
“There’s a pretty vigorous debate on both sides of those terms about what’s a more effective public health strategy,” City Councilor Mark Dion said during the HHS committee’s Feb. 9 meeting. “There seems to be some merit in terms of the efficacy of a needs-based plan of care, and that’s where I will be coming from. … We need to fully explore that.”
Councilor Belinda Ray also said on Feb. 9 that she’s interested in “having a bigger conversation around this,” since she has been pressed by friends and constituents.
The councilors’ comments came after a brief presentation by Kristen Dow, the city’s health and human services director. A discussion of the needle exchange program was not on the Feb. 9 agenda, but it was briefly discussed as part of a general update of HHS programs.
Dow said that in January the city had made 819 exchanges, giving out 821 more syringes than it collected (30,006 versus 29,185). Although the city reaffirmed it’s 1:1 requirement following the audit, Dow noted that the city will provide a kit of 10 needles to certain individuals who show up without turning in any dirty needles.
Dow said in an email Tuesday that, prior to the executive order, only new clients could receive a starter pack of needles. But the city expanded that in response to the governor’s order to include homeless individuals either staying in the shelter or in an encampment, people recently released from an institution or who had their supplies confiscated, and others who present without needles to exchange.
Dow also emphasized an increase in the number of discarded needles found in public during the committee’s Feb. 9 meeting. In 2020, public works staff reported collecting 6,240 used syringes in public, up from only 598 in 2015, she said. Only 1,732 syringes, or roughly 29 percent, were retrieved from community sharps disposal bins throughout the city.
Dow said Tuesday that the city collected 4,008 syringes from public places in 2019, but did not say what percentage was found in sharps containers.
The city is currently surveying clients about their needle use and staff is reevaluating where it places the sharps disposal bins, she said.
It’s unclear when the HHS committee will hold its workshop.
Committee Chairman Tae Chong said in an interview Tuesday that details about the committee workshop, including the panelists and the date, are still being finalized. But he expects to invite someone from the Maine Center for Disease Control and Prevention to discuss the rationale behind the governor’s order and have city staff explain why it’s choosing not to lift its 1:1 policy.
Chong noted that Portland is only 5 percent of the state’s population, yet it distributes about half of the clean syringes in the state. If access to clean syringes is a problem, he said other communities should stand up exchange programs, rather than relying on Portland. And he would like to see Mills encourage hospitals to operate exchange services, not only to increase access, but also to provide additional health care to clients and to destigmatize the service.
“I hope people realize this is a state issue and we as a community and state leaders need to address it, rather than people thinking that if Portland changes this one policy it’s going to change all of those numbers, because it’s not,” Chong said.
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