A sharps disposal box sits beside Needlepoint Sancutary’s set up at Camp Hope, an unhoused encampment in Bangor. The syringe service program hands out provisions and clean syringes along with kits containing fentanyl testing strips and the overdose reversal drug Naloxone. (Photo by Eesha Pendharkar/Maine Morning Star)
There was a sudden flurry of activity at the otherwise quiet clearing leading up to Camp Hope, Bangor’s homeless encampment, when Willie Hurley and two other employees drove up on a Wednesday afternoon in early August and started setting up a folding table full of snacks, water bottles, and boxes of clean syringes.
A dozen or so people emerged from campers and tents to empty plastic bags and boxes of used syringes into a sharps disposal box set up a few feet from the table before lining up to get clean needles and chat with Hurley and other familiar faces.
For months, Needlepoint Sanctuary employees have been coming to the encampment near the airport on Wednesdays and Saturdays, handing out provisions and clean syringes along with kits of alcohol pads, fentanyl testing strips, cotton, and Naloxone, which is used to reverse opioid overdoses.
Some residents of Camp Hope were skeptical when Hurley and his team first started bringing the clean needles each week because they were concerned about the increase in syringe litter, they said. But over time, they’ve learned to trust and appreciate the services of one of the newest syringe exchange programs certified by the state.
Nichol Cyr lived in the encampment for two years before securing housing in Old Town, but she still takes the bus down to Bangor to visit the encampment and has started carrying clean syringes to hand out in case she sees people she knows reusing the same needles, she said. That August Wednesday, she approached Hurley to talk about setting up a few more needle disposal boxes at the encampment, and finding a space to start a similar program in Old Town.
“I think it would help people,” Cyr said. “We don’t have anywhere near as many needles on the ground since they came here. But we could put up a few more boxes like that one over there,” she said, gesturing to the red sharps box Needlepoint Sanctuary had set up in the encampment.
“No one, even the majority of our program participants, like it when they see syringes getting left out in public places,” Hurley said. “You don’t want someone or their child coming across a needle in a playground.”
Needlepoint Sanctuary and other syringe service programs (or SSPs) keep track of used syringes and offer disposal boxes every time they do outreach. But the concern over syringe litter has recently pushed some municipalities to restrict the number of syringes these programs can hand out. That means that towns are trying to assert some control over state-backed needle exchange programs, leaving the populations they serve caught in the middle.
Sanford earlier this month imposed new limits on its local program, Maine Access Points, that require a one-to-one exchange, so participants must bring in 100 used syringes to receive 100 new ones. Under current Maine law, programs are allowed to give out 100 syringes if a participant returns one used syringe.
The Maine Center for Disease Control and Prevention sent a letter to Sanford city officials ahead of a vote on the new rule, urging them to continue allowing a need-based syringe service program.
The letter emphasized what multiple experts have told the Morning Star and said in public meetings: Syringe service programs have proven effective in reducing both syringe litter and the transmission of blood-borne diseases that commonly spread due to intravenous drug use, such as Hepatitis C. But critics continue to blame these programs, which serve predominantly unhoused populations, for enabling drug use and increasing the number of used syringes discarded in streets, public parks and sidewalks.
Syringe service programs have come a long way as the state has grown to recognize the value of harm reduction, with services that include providing clean syringes, overdose prevention medication and testing for HIV and Hepatitis C.
Needlepoint Sanctuary workers, for example, have gone from illicitly handing out supplies in Bangor’s downtown transportation hub, Pickering Square, to securing thousands of dollars in state funding and working alongside the Maine CDC—but their relationship with the city remains tense.
And in light of an HIV outbreak among the unhoused community in Penobscot County, experts warn that further restrictions on needle exchanges could lead to potential spread to other counties.
Tension between cities and state-funded programs
The Lewiston-based harm reduction organization Church of Safe Injection (CoSI), was founded by the late activist Jesse Harvey, who started the program handing out clean needles and narcan from his car. Though CoSI now has a brick and mortar location, it continues to have similar issues fighting for legitimacy.
This summer, the Lewiston City Council denied the organization’s permit to host a barbecue and informational session in a public park out of concern that the event would include the distribution of drug paraphernalia.
“Times have certainly changed, I think. State funding for programs like ours has become more acceptable,” said Zoe Brokos, who now leads CoSI. “But Lewiston still does not like us, and we’ve worked really hard to rebuild those bridges.”
The focus on building a relationship with the city has shown some progress; Rosie Boyce, CoSI’s community engagement and outreach coordinator, currently serves on an ad hoc city committee about syringe disposal.
Lewiston city officials did not respond to multiple requests for comment on their relationship with SSPs.
And even though Needlepoint Sanctuary was certified by the Maine CDC to operate at three locations in Bangor, they were told by city leaders that they would not be allowed to set up in Pickering Square and Pierce Park, which adjoins Bangor’s public library.
Bangor City Manager Debbie Laurie attributes some of the tension between state-funded programs and cities to the lack of municipal involvement in the Maine CDC’s licensing process for SSPs.
“The state went through their process and granted the license with no outreach to the city,” she said of the certification for Needlepoint Sanctuary. “Our issue is that we are working to ensure that our public spaces are open and available to all of our residents. We support harm reduction, but not in those locations.”
The state went through their process and granted the license with no outreach to the city. Our issue is that we are working to ensure that our public spaces are open and available to all of our residents. We support harm reduction, but not in those locations.
– Debbie Laurie, Bangor city manager
Laurie said because the Maine CDC’s permitting system does not consult with municipalities, city leaders often have to balance harm reduction services with ensuring the interests of all residents are represented. “I understand the Maine CDC’s position that it’s an issue of public health and I don’t disagree, but to not have that conversation with the community, I think, is a huge miss.”
The Maine CDC said it may soon begin to loop municipalities into the certification process, according to an emailed statement from agency spokesperson Lindsay Hammes.
“Harm reduction work requires partnership across a community to be successful,” Hammes wrote. “And so following feedback from partners and communities, the Maine CDC is now in the process of streamlining the notification process to ensure that, alongside members of law enforcement, other municipal officials are also aware of the plans to establish an SSP when receiving certification from the Maine CDC.”
Hurley said he understands the difficult position that city leaders are in, balancing the interests of residents and small businesses owners while prioritizing harm reduction.
“If your day-to-day is having to field all these calls from local businesses that are complaining about syringe litter or homeless people, you have to respond,” Hurley said. “But syringe service programs are absolutely caught in the middle, and we have to then engage in advocacy work and stand up for our programs.”
The impacts of SSPs in Maine
During the Covid-19 pandemic, Gov. Janet Mills temporarily loosened restrictions that required one used syringe to be exchanged for each clean one. In 2022, that change became permanent, along with reforms that decriminalized syringe distribution and possession, recognizing the importance of what was once a grassroots and often illicit network of harm reduction providers.
The new rules allow people a 100 to 1 ratio, meaning participants have to bring in just one used syringe to receive a 100 clean ones. Maine Department of Health and Human Services rules also allow a participant to receive up to 100 syringes even if they don’t bring any used ones in, at the discretion of the SSP.
There are currently nine certified SSPs across the state, according to the Maine CDC. Last year, these programs collected 3,158,782 used syringes, distributed 3,676,315 new syringes to more than 8,000 participants, according to a report the state agency submitted to the Maine Legislature in May 2024.
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That means syringe services handed out 1.16 syringes for each one they collected last year. Despite some concern about the state’s 100 to 1 ratio, the effective rate of exchange is already nearly identical to the one cities like Sanford want.
SSPs also enrolled almost 2,000 new participants, and made 26,166 referrals to medical and social support services including to STD clinics, HIV and hepatitis testing, substance use disorder treatment, peer support, recovery coaches, overdose aftercare, food assistance, wound care, naloxone distribution, housing, transportation, health insurance benefits and mental health services.
“Syringe service programs ensure that people use sterile equipment more safely, and that is highly effective at preventing the transmission of this virus in this population,” said Brandon Marshall, a professor of epidemiology at Brown University.
“The other thing that syringe service programs do is connect people to resources, to health care and often treatment as well.”
Needlepoint Sanctuary was one of the most recent programs to get certified. With certification, a program is able to collaborate and receive funding from the state to help provide some of their services, Lindsay Hammes, the CDC spokesperson said in a statement.
At Camp Hope, the people that Needlepoint Sanctuary served vouched for the organization. With all of the policing and stigma unhoused people experience, several participants said it was refreshing for an organization to treat their community with empathy and understanding.
State’s first peer-led harm reduction community center opens in Lewiston
Needlepoint Sanctuary’s work at the encampment has also resulted in fewer syringes being left on the ground, one of the residents, Logan Hanson said. She drove her camper to Camp Hope because she could not find an affordable place to park it after the campgrounds closed.
“I was on both sides of the fence when it came to having syringes freely given, especially when I stepped onto the property seeing how many were just tossed on the ground with no caps,” she explained. “But because of them continuing to come out here, no judgment, I’ve noticed there’s a lot less litter and a lot less people getting infections.”
Kinna Thakarar, a physician at Maine Medical Center and an associate professor at the Tufts University School of Medicine agreed that SSPs “do a great job of providing sharps containers, drop boxes, and organizing community cleanups.”
“I think people don’t realize this but people who use drugs do care about the community as well,” Thankarar said.
According to the Maine CDC report, SSPs helped mitigate the impacts of an Hepatitis A outbreak during the second half of 2023 by facilitating events at their sites to increase vaccination rates specifically for people with risk factors.
A new push for restrictions despite warnings from the state
In addition to Sanford, leaders in other municipalities have attempted to bring back syringe ratio restrictions, arguing that increased amounts of syringe litter endangers residents.
Last month, Portland’s city council shot down a proposal from Mayor Mark Dion to revert to one-for-one exchanges. At the meeting, about two dozen residents and healthcare professionals testified in opposition to the measure, which all city council members eventually voted against on the grounds that forcing people to reuse syringes would increase public health risk, particularly for spreading blood-borne diseases like Hepatitis C and HIV.
SSPs do a great job of providing sharps containers, drop boxes, and organizing community cleanups. I think people don’t realize this but people who use drugs do care about the community as well.
– Kinna Thakarar, physician at Maine Medical Center and associate professor at the Tufts University School
But syringe litter still remains a concern for some residents, including Dion, who defended his resolution at the October meeting.
“It’s nice to talk in clinical terms, but it’s a risk for them. It changes their sense of the neighborhood,” he said of the city’s housed residents. “When people say they go outside and they crunch needles, it’s an issue. They fear for themselves, they fear for their kids and even their pets.”
However, medical professionals said they are worried about the impact of these restrictions on an already concerning spike in HIV cases. Over the past year, Penobscot County has seen 14 new cases of HIV, compared with an average of one or two cases annually in previous years. According to the Maine CDC, all 14 of the individuals who tested positive were confirmed to inject drugs, and also tested positive for Hepatitis C. Twelve of them were also unhoused.
At last month’s Portland City Council meeting, Andrea Truncali, a doctor with MaineHealth who specializes in addiction treatment, raised concern about the spike in cases seen up north.
“There is no question that a one-to-one ratio will increase health care costs and the transmission of disease, and with a recent HIV cluster in Penobscot County, we should be all the more hesitant about a backwards move like this,” Truncali said. “You don’t need to fly in the face of scientific evidence and interfere with what is effectively medical care, when you can support adequate syringe disposal options that will ultimately benefit everybody.”
The Penobscot County HIV outbreak could easily spread to other regions, said Thakarar, who specializes in infectious disease and addiction medicine, which she said makes unrestricted access to needle exchanges all the more critical.
“I think this number of cases is definitely concerning for me, and I think this could absolutely happen in other counties,” she said. “That’s something we need to prepare for. And part of preparation is like enhancing syringe service program access.”
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