GREENFIELD — 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 before 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 program — offer a way to make an extremely risky activity a little bit safer and stem the spread of serious disease, experts say.
They’re one of 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, and the next program may be opened right here in Greenfield.
Hepatitis C on the rise
Tapestry’s Holyoke exchange, which opened in 2012, is one of six such sites in the state, and Greenfield’s Town Council will soon weigh in on whether the seventh should be allowed to open here, where rates of new hepatitis C infection have spiked 60 percent since 2011, a Recorder review of state data shows.
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.
MAP: Change in Hepatitis C rates in Massachusetts, per 10,000 residents, 2011 to 2014 (Data from MassDPH)
To the south, in Hampshire County, the increase has been a more modest 19 percent, while Hampden County, though it still has the fourth highest rate in the state, saw a 5 percent decrease since 2011. Both have at least one exchange.
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.
Tapestry’s Holyoke exchange, which opened in 2012, is one of only six such sites in the state, and Greenfield’s Town Council will soon weigh in on whether the seventh should be allowed to open here, where rates of new hepatitis C infection have spiked 60
“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,” the report read. “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, a 2012 state epidemiology 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 reports show. New infections have also skewed toward the younger population since 2007.
Green-lighted in Greenfield?
Needle exchanges like Tapestry’s have typically proven highly 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 green-lighted the idea in late June.
If it’s approved by Town Council, 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.
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, responding to a concern raised by Mayor William Martin, but she can’t remember running into any problems with other exchanges.
More than just needles?
Proponents say a needle exchange, which they’ve been calling a “comprehensive harm reduction program,” would provide a safe place for drug users to turn in dirty needles and receive clean ones.
As addicts do so, experts say the spread of disease will be stymied, but many say the exchanges also serve an even 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, H. Dawn Fukuda, the director of the state Bureau of Infectious Diseases’ HIV/AIDS office, said.
“These programs aren’t just ‘give them a syringe and say Have a nice day,’” Fukuda said. “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.”
Needle Exchanges in Massachusetts
Massachusetts legalized needle exchanges in 1993. Fukuda said the state currently funds six of the programs statewide, in Cambridge, Provincetown, Brockton, Worcester, Holyoke and Northampton. 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.
In 2006, syringes became easier to access outside of exchanges with the loosening of laws governing their possession and allowing them to be bought over the counter at pharmacies.
Do they work?
Much of the scientific research that’s been done on needle exchanges, according to a 2010 review study published in the journal “Addiction,” 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 what types of studies could be performed, but it has established a clear 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.
A 2004 World Health Organization study found evidence that needle exchanges reduce the risk of HIV transmission,
In sheer numbers, 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 unique 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.
Enabling use?
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 simply 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 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.”
Whynott said studies have shown that people who use needle exchanges are five times more likely to enter treatment at some point.
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 before 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 program — offer a way to make an extremely risky activity a little bit safer and stem the spread of serious disease, experts say.
They’re one of 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, and the next program may be opened right here in Greenfield.
Hepatitis C on the rise
Tapestry’s Holyoke exchange, which opened in 2012, is one of six such sites in the state, and Greenfield’s Town Council will soon weigh in on whether the seventh should be allowed to open here, where rates of new hepatitis C infection have spiked 60 percent since 2011, a Recorder review of state data shows.
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.
MAP: Change in Hepatitis C rates in Massachusetts, per 10,000 residents, 2011 to 2014 (Data from MassDPH)
To the south, in Hampshire County, the increase has been a more modest 19 percent, while Hampden County, though it still has the fourth highest rate in the state, saw a 5 percent decrease since 2011. Both have at least one exchange.
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.
Tapestry’s Holyoke exchange, which opened in 2012, is one of only six such sites in the state, and Greenfield’s Town Council will soon weigh in on whether the seventh should be allowed to open here, where rates of new hepatitis C infection have spiked 60
“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,” the report read. “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, a 2012 state epidemiology 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 reports show. New infections have also skewed toward the younger population since 2007.
Green-lighted in Greenfield?
Needle exchanges like Tapestry’s have typically proven highly 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 green-lighted the idea in late June.
If it’s approved by Town Council, 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.
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, responding to a concern raised by Mayor William Martin, but she can’t remember running into any problems with other exchanges.
More than just needles?
Proponents say a needle exchange, which they’ve been calling a “comprehensive harm reduction program,” would provide a safe place for drug users to turn in dirty needles and receive clean ones.
As addicts do so, experts say the spread of disease will be stymied, but many say the exchanges also serve an even 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, H. Dawn Fukuda, the director of the state Bureau of Infectious Diseases’ HIV/AIDS office, said.
“These programs aren’t just ‘give them a syringe and say Have a nice day,’” Fukuda said. “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.”
Needle Exchanges in Massachusetts
Massachusetts legalized needle exchanges in 1993. Fukuda said the state currently funds six of the programs statewide, in Cambridge, Provincetown, Brockton, Worcester, Holyoke and Northampton. 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.
In 2006, syringes became easier to access outside of exchanges with the loosening of laws governing their possession and allowing them to be bought over the counter at pharmacies.
Do they work?
Much of the scientific research that’s been done on needle exchanges, according to a 2010 review study published in the journal “Addiction,” 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 what types of studies could be performed, but it has established a clear 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.
A 2004 World Health Organization study found evidence that needle exchanges reduce the risk of HIV transmission,
In sheer numbers, 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 unique 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.
Enabling use?
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 simply 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 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.”
Whynott said studies have shown that people who use needle exchanges are five times more likely to enter treatment at some point.
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