Holyoke's approval of needle exchange could prompt a court fight led by the City Council president.
A box of syringes at Tapestry Health's needle exchange site on Main Street in Holyoke. The program won approval from the city's board of health this summer.HOLYOKE – When the Board of Health gave its approval last month, Holyoke became only the fifth city in the state to permit operation of a needle exchange program since a 1993 law began allowing such facilities.
Reaching that step in the Paper City followed years of political fights that still may spill into court if the City Council decides to challenge the health board’s Aug. 14 vote.
The rhetorical elbows flying around needle exchange highlight the controversial nature of an issue that has led communities to shun it even though doctors, nurses and other specialists say it saves lives and limits the spread of disease.
Northampton became the first city in Western Massachusetts to permit needle exchange in 1996.
“I think it speaks to the challenges of a law that requires local approval. It has been some heavy lifting for some communities to even begin considering needle exchange,” said Kevin Cranston, director of the infectious disease bureau of the state Department of Public Health.
Boston became the first to adopt needle exchange in 1994. Cambridge followed the same year, with programs getting approved in Northampton in 1996 and Provincetown in 1997.
The 1993 needle exchange law allows up to 10 program sites in the state. The idea is such programs would open in dense urban areas where intravenous drug users tend to gather, Cranston said.
But the state’s second- and third-largest cities, Worcester and Springfield, don’t have needle exchange, and neither do other cities that have grappled with heroin problems like Pittsfield, Brockton and New Bedford.
Springfield last considered needle exchange in 2005, when the City Council rejected it 5-4.
In the supply room at Tapestry Health's Holyoke needle exchange site, program supervisor Liz Whynott shows the locker where the needles are kept.Below, audio excerpts from an interview with Whynott.
Liz Whynott, Tapestry Health
The Holyoke Board of Health’s 3-0 vote had the support of Mayor Alex B. Morse and Police Chief James M. Neiswanger, with both saying the program can improve public safety.
The Board of Health is Chairwoman Katherine M. Liptak and Patricia A. Mertes, who are registered nurses, and physician Robert S. Mausel.
But President Kevin M. Jourdain and other councilors objected not only to the city having such a program, which Jourdain said essentially displays a welcome sign for heroin users, but they said the approval process ignored the public and City Council authority.
Voters in 2001 rejected needle exchange in a nonbinding referendum.
Councilors and Morse also disagree on the meaning of “local approval” of needle exchange. Morse said that was achieved with the Board of Health vote and his signature. Jourdain and other councilors say such a program requires approval of the City Council, which twice has voted it down.
Jourdain has vowed a court challenge. But Morse said the only entity that can represent a city department is the city solicitor and the solicitor agrees with the mayor. Jourdain has filed an order to amend an ordinance to let the council hire its own lawyer in certain cases.
At Tapestry Health's Northampton needle exchange site, assistant director of prevention services Kari Downs, center, talks with harm reduction counselor Stephen Roussel (at right), and Tom, a client of the program (at left).Below, excerpts from an interview with Tom, who said he first came to the program after over a year of thinking about getting tested for HIV.
Tom, Northampton needle exchange client
Needle exchange is just what it says: People visit an office, such as the one at 15-A Main St. here run by Tapestry Health, hand over used drug needles and get clean ones in return.
Doctors and specialists like Cranston, as well as the Centers for Disease Control and Prevention and World Health Organization, said isolating the used needles is vital because the sharing of infected needles is largely to blame for spreading diseases for which there are no cures like HIV-AIDS and hepatitis C.
Needle exchange programs are credited with a statewide 75 percent reduction in HIV infections attributed to injection drug use, dropping from 193 cases in 2001 to 49 in 2009, said Anne Roach, spokeswoman for the Department of Public Health.
“The large indicator of success of these programs is the documented 75 percent reduction in HIV transmissions associated with injection drug use,” Cranston said.
Measuring the success of needle exchange in relation to hepatitis C is more complicated, Roach said. The number of confirmed cases of hepatitis C statewide was 6,405 in 2002 and dropped to 4,706 in 2010, a decrease of 1,699 cases, or nearly 27 percent. Unlike HIV case report data, much of the hepatitis C data are based on laboratory reports of infection, usually antibody test results that indicate past as well as current infection, and contain no risk information on the patient, she said.
“Therefore, these cases cannot be exclusively attributed to injection drug use,” Roach said.
Further, she said, since many, and likely most, Massachusetts residents have not been screened for hepatitis C, officials estimate the actual rates of infection far exceed what is indicated by our surveillance data.
“So we cannot make definitive statements about whether rates among (intravenous drug users) are going up, down, or staying stable,” Roach said.
Stephen Roussel, a harm reduction counselor at Tapestry Health's Northampton needle exchange site, shows a "cooker" in the program's exchange room. In addition to clean needles, the program offers other supplies used by injection drug users in an attempt to reduce other risks associated with use. Cookers, Roussel explained, can transmit hepatitis C if shared among users.Below, audio excerpts from an interview with Roussel.
Stephen Roussel, Tapestry Health
Any reduction in HIV and hepatitis C cases among injected-drug users is helpful, Cranston said at the Aug. 14 health board meeting, because people with such diseases need treatment.
“These will be not insignificant,” Cranston said.
Cranston said 301 people with HIV-AIDS were living in Holyoke in 2011. And 39 percent of them said they were injected-drug users. Needle exchange can help reduce that, he said.
“This is well-established science,” Cranston said.
Another sign that needle exchange has been effective, officials said, is that between 1994 and 2008, 19,916 clients enrolled in state-approved programs. Those programs took in and safely disposed of 3,677,450 used and possibly infected needles.
In that same period, the programs issued 4,653,255 clean needles, officials said.
The reason nearly one million more needles were issued than submitted from 1994 to 2008 was because needle exchange programs do not operate on a strict one-for-one exchange basis. A user might bring in three days’ worth of needles but need a week’s worth back because of being unable to return to the exchange office for a while, Roach said.
Also, cities and towns have syringe-disposal options, such as the kiosk to be set up here in the Council on Aging office at 310 Appleton St., that are collecting some of the used needles. Those needles wouldn’t get counted at a needle-exchange office, she said.
The Holyoke program operates on a strict "one-for-one, plus one" policy, said program supervisor Liz Whynott. Clients are eligible to receive exactly the same number of syringes they return, plus one additional syringe -- so, for example, a client returning 5 syringes is eligible to receive 6.
Another benefit of the program is it gets into the door drug addicts who use needles and exposes them to counseling, details about treatment to get off drugs and other “harm reduction” steps they otherwise might never see, officials said.
Exposure to treatment and counseling is a big reason why Northampton Police Chief Russell P. Sienkiewicz supports that city’s needle exchange program. It’s run by Tapestry Health at 16 Center St.
“If they hear the message enough, hopefully, someday they’ll make a change,” Sienkiewicz said.
He welcomed needle exchange when it began and supports it now, he said.
“I’ve always said it’s not such much a law enforcement issue, it’s not soft on drugs, it’s a public health issue. You know, we’re in the business of saving lives, and the needle exchange program, which I prefer to call harm reduction programs,” does that, Sienkiewicz said.
Other Northampton officials say the program hasn’t promoted illegal drug use, hasn’t caused more discarded needles and hasn’t stigmatized the city as a drug haven – all common concerns of exchange program foes.
“I always use the analogy that a bartender giving you a clean glass doesn’t make you an alcoholic,” Northampton City Council President William H. Dwight said.
“I’m not speaking for the whole city, but I’m pretty damn proud of the program,” he said.
“I haven’t heard of any problems,” Councilor Jesse M. Adams said. “I’ve known of needle exchange since it came here.”
Two people who work near the needle exchange office in Northampton, Kat Kruse, who works at Northampton Chiropractic & Wellness Center, 24 Center St., and Samantha Somtois, patient coordinator at Hampshire Family Dental, 12 Center St., said they hardly notice the needle exchange is there.
One thing Sienkiewicz disagrees with was the 2006 law that decriminalized over-the-counter sales of needles and syringes at pharmacies.
Letting injected-drug users buy needles removes their motivation to get infected needles off the streets and learn about treatment, he said.
Since over-the-counter syringe purchases became legal in Massachusetts in 2006, use of needle exchange programs has shown a drop, “which is understandable,” Cranston said.
Tracy Cheatle, a harm reduction counselor at Tapestry Health's Holyoke needle exchange site, looks for used syringes at a wooded location in South Holyoke where heroin users congregate.Cheatle said that during her initial 'outreach' efforts, in July, she might find up to 90 needles in a single location. The number of used needles she finds at these sites has dropped since the launch of the Holyoke program, she said.Below, audio excerpts from an interview with Cheatle.
Tracy Cheatle, Tapestry Health
In 2006, for example, 511,267 needles were submitted. That dropped in 2007 to 431,337 and in 2008 to 314,030.
The 2006 act legalizing sales of needles at pharmacies is a good step, but insufficient by itself, according to advocacy groups like the Massachusetts Statewide Harm Reduction Coalition. Many injected-drug users can’t afford to buy needles and others fear the stigma of others knowing of their drug use, they said.
The state agrees to contracts based on providers having filed notices of interest to run needle exchanges. The only one to file such a notice for a Holyoke program was Tapestry Health. That state contract is being finalized, Cranston said.
The state pays a range of costs for such programs, from up to $65,000 a year in Provincetown to $350,000 in Boston. Holyoke’s would cost about $150,000 a year, he said.
A program’s effectiveness is based on a provider meeting conditions in its contract with the state, he said.
Such conditions deal with number of clients seen and number of education programs, public health screenings and substance abuse treatment referrals conducted, he said.
At Tapestry Health’s needle exchange office here, a sign reads, “All services are free and anonymous/confidential.” Hours are Monday to Friday, 8 a.m. to 4 p.m. Brochures about HIV, hepatitis C and many other things are available in English and Spanish.
Across the street, two business owners said they weren’t thrilled a needle exchange has opened, but it was acceptable as long as it doesn’t prompt people to hang around outside.
Janet Kaciak, who runs the Zumba gym on the third floor of 48 Main St., translated for Francisco Ortiz, owner of Ortiz Used Tires at that address.
“I don’t want to sound negative,” Kaciak said. “If they come and go, that’s fine. I want people to be safe. I just don’t like it if they’re hanging around.”
