In a small waiting room just inside a stone building on Holyoke’s Main Street, surrounded by informational posters about safe sex, drug use, addiction and communicable diseases, a couple sat munching on pieces of donated ham-and-pineapple pizza.
Finishing the last bits of crust from his own piece, the man stood up, reached into the side pocket of his gray cargo pants, and produced a fistful of used syringes.
“You ready?” asked a receptionist behind the intake window, and the man nodded. He was led to a separate room, where he’d drop the dirty needles into a secure disposal bin before leaving with a pack of fresh, sterile ones and other supplies designed to help limit the spread of blood-borne pathogens the next time he injects drugs.
He may have been offered an on-site blood test to determine if he’d contracted hepatitis C or HIV, possibly from sharing dirty needles. If receptive, he could even leave with a referral to a local addiction treatment service, or a pack of Narcan, the life-saving drug used to reverse the symptoms of a heroin overdose.
For that man and other intravenous drug users like him across the Pioneer Valley, facilities like this one — Tapestry Health’s Needle Exchange and Harm Reduction Services — offer a way to make a risky activity a little safer and stem the spread of serious disease, experts say.
They’re on the front lines in the fight against a prescription opioid and heroin abuse epidemic that’s rocked the nation and claimed the lives of an estimated 1,500 Massachusetts residents in 2015 alone.
Tapestry’s Holyoke exchange, which opened in 2012, is one of six such sites in the state. Since Massachusetts legalized needle exchanges in 1993, programs have opened in Northampton, Cambridge, Provincetown, Brockton and Worcester, said H. Dawn Fukuda, the director of the state Bureau of Infectious Diseases’ HIV/AIDS office. A seventh site is under consideration for Greenfield and the Town Council is expected to decide soon whether to give it the green light. A review of state data by the Recorder in Greenfield has shown that rates of new hepatitis C infection have spiked 60 percent in that community since 2011. That’s the most drastic increase of any county in the state during that time frame. Berkshire County saw the second biggest increase at 28 percent. Neither county has a needle exchange.
In counties where exchanges are available, the data is more encouraging. In Hampshire County, the increase has been 19 percent, while Hampden County, though it still has the fourth highest rate in the state, saw a 5 percent decrease since 2011.
Statewide, about 8,760 people contracted confirmed or probable cases of hepatitis C in 2014 and about 20,000 are currently living with HIV, the virus that causes AIDS, according to the state’s most recent sexually transmitted disease surveillance reports.
Signs of chronic hepatitis C infection are the result of liver damage caused by the virus.
“The annual number of newly diagnosed hepatitis C cases reported in Massachusetts since 2004 remains high, with 7,000 to 10,000 probable and confirmed cases reported each year,” according to a 2012 state epidemiology report. “There were 5,802 confirmed hepatitis C cases reported to DPH in 2014. Hepatitis C virus remains one of the highest volume infectious diseases reported in Massachusetts.”
While big gains have been made in reducing HIV infection in Massachusetts, the report notes, those gains may have been offset by the increase in hepatitis C, which the report said is nearly 10 times as infectious.
And those infections appear closely linked to intravenous drug use: between 2007 and 2014, 60.4 percent of people who had confirmed hepatitis C infections reported using injection drugs, the report shows. New infections have also skewed toward the younger population since 2007.
Needle exchanges like Tapestry’s have typically proven controversial in many of the communities where they’ve been proposed, but that hasn’t been the case in Greenfield. The idea has drawn favorable recommendations from the town’s police and fire chiefs, top officials from Baystate Franklin Medical Center, members of the recovery community, and others. A survey by the regional Opioid Task Force found widespread support for the idea, and the Board of Health approved the idea in late June.
If the Town Council agrees, said Liz Whynott, the director of the Northampton needle exchange, the state DPH would put the contract for a Greenfield program out to bid. The state provides all the funding to operate exchanges.
In response to a concern raised by Mayor William Martin, Whynott said the town, the exchange’s operator, and the state would each need to rely on their own legal teams regarding possible liabilities surrounding an exchange. However, she said, she can’t remember running into any problems of that sort at other sites.
Proponents say a needle exchange, which they’ve been calling a “comprehensive harm reduction program,” not only provides a safe place for drug users to turn in dirty needles and receive clean ones, they serve a broader purpose; just walking through the program’s doors provides users with another place to connect with health workers who can get them on the road to recovery, Fukuda said.
“These programs aren’t just ‘give them a syringe and say Have a nice day,’ They provide a space where the most vulnerable, acute users can say ‘I need help,’ and get what they need, whether that’s a referral (to treatment), a syringe, mental health services, domestic violence services,” Fukuda said.
The programs serve about 7,200 people statewide, and collect and distribute hundreds of thousands of syringes each year, Fukuda said.
The smallest programs carry an annual cost of about $90,000 while the largest cost about $400,000 per year. Services are typically free, she said, which removes insurance barriers to treatment.
A 2004 World Health Organization study found evidence that needle exchanges reduce the risk of HIV transmission. However, according to a 2010 review study published in the journal “Addiction,” much of the scientific research that’s been done has had a hard time measuring the direct effect of a needle exchange on local hepatitis C and HIV infection rates due to limitations on the types of studies that could be performed. Still, the research has established a connection between the programs and reductions in injection-related behavior that puts users at risk for the disease, such as sharing needles and disposing of them unsafely.
The Northampton and Holyoke exchanges have taken in a combined total of 559,268 syringes and distributed 546,319 since 2012. Since 2008, a reported 568 doses of Narcan given out by the programs have been used, according to data provided by Tapestry.
Over the past year alone, Whynott said, the Holyoke and Northampton needle exchanges have seen over 3,600 clients. Though the Holyoke needle exchange costs about $200,000 annually, it costs about $379,668 over a person’s lifetime to treat an HIV infection, and one hepatitis C treatment regimen costs around $30,000.
Since needle exchange programs essentially provide users with the mechanical means to inject drugs, many are concerned that they’ll actually promote more drug use by making it easier to accomplish.
But most experts say that’s not the case. Fukuda said evidence has shown that areas with exchanges do not see increases in drug use. That’s because the people who turn up at the programs are typically the ones who’ve become concerned about their habit and want to stop, she said.
Whynott related concerns about needle exchanges encouraging use to early thinking around increasing the availability of contraceptives like condoms.
“It used to be a popular belief that if people, if kids, have access to condoms they’ll have sex more. It’s a lot of the same thought that if there’s access, people will use more, but that’s just not the case,” she said. “People don’t think of a syringe and then decide to start using drugs.”
The good news is, said Whynott, studies have shown that people who use needle exchanges are five times more likely to enter treatment at some point. “
The reality is people are already using needles and there needs to be more access and nonjudgmental counseling for the people who are not ready to stop using.”
Tom Relihan can be reached at trelihan@recorder.com.