The City of Portland’s commitment to providing essential public health services through its Needle Exchange Program remains strong as evidenced by the number of clients it serves and the services it offers seven days a week, in two locations with more than 40 hours of operation. The City is sharing the following information regarding its current operation and policies of the Exchange so the community has a better understanding of the ways in which it provides syringe exchange and harm reduction services.
In November of 2020, the City conducted an audit of the Needle Exchange Program after learning that some guests checking into City shelters were in possession of large quantities of needles, some in excess of 100 each. During the course of the audit, HHS management learned that the 1:1 exchange limit (contained in the City’s needle exchange policies and in the State’s usual rules) had not been consistently enforced. Not just during the pandemic when relaxation of that rule was permitted under the Governor’s Executive Order, but since as early as 2016. The audit also revealed other areas of concern, including that significant numbers of needles had been requested by and provided to individuals who sought them not for personal use but to facilitate the operation of unsanctioned needle exchange programs, something that is not permitted under the State’s program rules.
Following the audit, the Public Health Division clarified its policies for staff, volunteers, and clients of the Exchange and made clear that the City’s Needle Exchange Program continues to follow a 1:1 limit on exchanges (with limited exceptions noted below). City staff also notified the State and discussed the results of the program audit with Maine CDC staff.
The City made its decision to remain a 1:1 exchange following the Governor’s order because, when it made that decision in March, it did not believe that a relaxation of that limit was needed in order for the Needle Exchange Program to continue operating safely during the pandemic. The City’s decision was based on the mistaken understanding that the 1:1 limit had historically been enforced and that it had not had any negative impact on the quality or scope of the services provided.
Since the City reiterated its 1:1 exchange limit last month, the Exchange has not seen a dramatic shift in the number of clients served nor does it appear to have negatively impacted new enrollments. In fact, the Needle Exchange Program continues to enroll new clients on a weekly basis.
Nevertheless, in an effort to further evaluate the community's needs and the Needle Exchange Program's efficacy in meeting those needs, clients of the Exchange will be asked to provide feedback on their needle sharing and/or reuse practices, as well as their utilization of community sharps boxes if they are comfortable disclosing this information. At a time when overdoses are on the rise and individuals are experiencing increased isolation and loneliness, our Public Health Division emphasizes the importance of maintaining connection. We encourage clients of our Needle Exchange Program to visit us often, in part, to ensure that they are equipped with the life-saving overdose reversal drug Narcan.
“The findings of the investigation were deeply disappointing,” said Kristen Dow, the City’s Health & Human Services Director. “As we move forward, the City is committed to more thoroughly reviewing its needle exchange program data to ensure that our essential harm reduction services continue to meet the needs of our clients as our staff work to provide life-saving resources for those living with substance use disorders.”
Under State regulations, certified needle exchanges are generally required to adhere to a 1:1 exchange limit. In March 2020, Governor Mills signed an Executive Order temporarily suspending that limit in recognition of the fact that relaxing that requirement might allow needle exchange programs to better engage with clients during the COVID-19 pandemic.
The City’s Public Health Division currently has several exceptions to its 1:1 policy, which include:
- New enrollees who present with no supplies will receive a “Starter Kit” which includes the following: Safe injection supplies including one package of 10 needles.
- Clients who are unsheltered or utilize shelter services and present with no syringes to exchange are eligible to receive safe injection supplies including one package of 10 needles
- Clients who report having had their supplies confiscated by law enforcement or who have recently been released from jail, prison, or a hospital or treatment setting are eligible to receive safe injection supplies including one package of 10 needles.
- Clients who present with no supplies (including those who report disposing of them in one of several community sharps boxes) and do not meet the above criteria will also be eligible to receive safe use supplies including one package of 10 needles. Clients who report disposing of large amounts of needles in community sharps boxes should be encouraged to increase their utilization of the Needle Exchange Program at 103 India Street and/or the outreach location, when possible. The Exchange currently offers more than 40 hours a week of services.
Back in March, following a review of CDC guidelines, the City decided not to further suspend the 1:1 policy primarily because doing so did not appear as though it would meaningfully improve the quality or reach of the services being provided by the program. Specifically, Public Health staff were confident that the pandemic would not limit their ability to continue to safely provide needle exchange services, due in part to the added capacity and flexibility afforded by the program’s mobile location (which was in existence prior to COVID) as well as ongoing services provided at the India Street Health Clinic location. When it made this decision in March, the City also weighed several other factors, including the fact that there was no long-term change in access for clients and that data collected by the City since 2015 showed a consistent increase in the number of needles being distributed as well as a concerning increase in the number of needles found in public spaces throughout the community (from 598 in 2015 to 6,240 in 2020).
“The State’s temporary suspension of the 1:1 exchange limit has most likely proven to be beneficial to those operating in rural communities with limited access to syringe exchange programs,” said HHS Director Dow. “The City’s Needle Exchange has continued to provide seven day a week coverage that includes both our brick and mortar location at India Street as well as our mobile outreach location. COVID 19 protocols were established with the assistance of our medical director early on in the pandemic. Public Health staff did not identify any immediate needs to lift the 1:1 policy in order to continue providing access and serving our clients during the pandemic. And the fact that we were not changing our 1:1 policy was known to both the State and our local partners.”
Dow continued, “The U.S. CDC says that during a pandemic it is critical for syringe service programs to have the capacity to ensure the safety of staff, volunteers, and clients and lists approximately 20 recommendations that programs should follow. Of these recommendations, the only one the City is not currently following is the suspension of the 1:1 exchange. Syringe exchange programs are so much more than providing clean needles; they are a bridge to life saving resources for the clients we serve.”