The opioid problem has not only led to increased overdose deaths but also has increased the spread of diseases.
PITTSFIELD, Mass. — The decision whether to authorize the state to fund a needle exchange program in the city should come next week.
The Board of Health is the authority needed to authorize the program and is expected to take up the topic next Wednesday.
Tapestry Health is looking to open one through funding from the state Department of Health to combat the spread of infectious diseases, similar to the one opening in North Adams in the coming months.
Pittsfield has been particularly seeing an increase in Hepatitis C, led by the use of injected drugs, and the program is eyed to combat further spreading of the disease.
"We are opening one in North Adams in the next month or two as well as opening one in Greenfield in the same time period," said Liz Whynott, director of the Syringe Access Program for Tapestry Health, on Monday night while addressing the City Council's Public Health and Safety subcommittee.
According to Berkshire Opioid Abuse Prevention Collaborative Coordinator Jennifer Kimball, Berkshire County has seen 1,100 new cases of Hepatitis C since 2010, translating to a rate of 8.7 per 1,000 people, and there was 150 cases in just the first half of this year, 71 of which were in Pittsfield. If those trends continue, the end of the year shows the county has 2,000 infected with the disease, which is double the national average.
Hepatitis C and HIV are just two diseases known to be spread through the use of unclean syringes by heroin addicts. The opioid crisis has grown in recent years, with heroin showing a large uptick. That's led to needles being left throughout the city, tossed out of car windows, or discarded in public parks. And dirty needles are being shared, spreading the diseases.
In the 1990s, there was a massive awareness campaign drawing the issue of HIV to light but no such effort had been around Hepatitis C. Just a few years ago, former Gov. Deval Patrick issued a statewide public health emergency notice regarding opioid addiction.
But yet, only 11 cities and towns in Massachusetts have authorized needle exchange programs. The state now has an increased focus on the issue and is funding new programs throughout the state.
"It has always been a political issue instead of a public health issue, that stopped all of the exchanges from happening," Whynott said.
One of the most common remarks about the program from residents is that it encourages drugs use, which is something Ward 1 City Councilor Lisa Tully rejects. The purpose of the program isn't to encourage drug use but rather to help keep those using drugs a little more safe until they seek addiction treatment and become clean. She says somebody doesn't decide to do heroin just because they got a free needle.
"They are going to do drugs whether you give them a needle or not. What we are doing is preventing a disease," Tully said.
Whynott says the anonymous program isn't a simple in and out exchanging dirty needles for clean ones. At the first meeting with the client, the organization performs a risk assessment, and provides education on various recovery programs — making referrals as needed — and teaching healthier behaviors. Then, there is a round of testing for various diseases and helping connect those who are positive with the health care needed. The tests and consultations are done every six months, and even more frequently with the higher risk populations.
"We do that by sitting down with the client and having a conversation with them," Whynott said.
Additionally, the company gives out and trains users on Narcan, an overdose reversal drug, and tries to get that person ready to seek treatment. The program's use of training and distributing Narcan has also shown to keep people alive and Whynott said the number of calls to 911 for overdoses has increased. Whynott says she is working with ambulance services on how to engage with those addicts following the incidents in hopes to get them into treatment programs.
"It is really about giving the person another day to live," Whynott said.
Whynott says those who use needle exchange programs are five times more likely to enter treatment programs. The targeted population is the current drug users or those relapsing, a niche of service that is sorely lacking in the area. There is a negative stigma around opioid addiction which causes users to feel shamed and afraid to seek out clean needles from the pharmacy or health testing. That is the barrier the organization hopes to break.
"We want to work with people who are in the stages of contemplating treatment or haven't gotten to that level yet," Whynott said. "There are no services available for people using drugs."
Tapestry currently operates two programs in Western Massachusetts — one in Holyoke and one in Northampton. Whynott said both locations have brought in a significant amount of needles that otherwise may have been reused or thrown on the ground. Holyoke had some 4,500 unique clients in the last year and more than 18,000 encounters. The number of reports of Narcan being used has grown as well.
As for the area the exchange is located, "It's been one of the most thriving areas of Holyoke. .. It hasn't affected the economy in Holyoke."
Ward 2 Councilor Kevin Morandi, however, questioned the impacts a program would have on the area. He said when the methadone clinic opened on Summer Street it coincided with a large increase in the number of police calls and reports of crimes such as breaking and entering in the area. He worries that the program would draw crowds of drug uses to congregate in the area.
Whynott, however, says there is not an issue with increased crime at any of the needle exchange sites. She said sometimes there is just a negative perception with drug treatment locations even though those in the area are just waiting for treatment and not breaking any laws.
It isn't clear exactly where a site would be located in Pittsfield, or even if it will be a stand-alone location. Whynott said there are five different models of needle exchange programs — fixed sites, mobile, home delivery, peer-to-peer delivery, and clinics. Tapestry has an RV that is sometimes driven to various areas in Holyoke because often those needing the service have little or no transportation.
If authorized to pursue the program, Tapestry would then work to craft the plans for the local one, making sure it is accessible as possible for the clients.
"To me it is one more tool in our toolbox to fight everything we are dealing with," Councilor at Large Peter White said, asking how to streamline the process to open an exchange up sooner than later. "If we stop one more case of HIV, one more case of Hepatitis, we've seen success."
That sentiment was echoed in a letter from Dr. Jennifer Michaels, medical director of the Brien Center, who has become one of the leading figureheads in battling opioid abuse in the county, supporting the exchange. Michael's letter said there is an "extensive body of medical literature" showing the programs help reduce the spread of diseases.
Meanwhile, Tapestry remains active with opioid coalitions looking to reduce the use of diseases. These groups typically include law enforcement, public health officials, district attorneys, medical professionals, and the like in crafting and implementing ways to tackle the entire opioid crisis.
The needle exchange program isn't alone going to solve the entire issue, but it will reach one of the more difficult groups of people to reach, keep them healthy, and move them toward being ready to enter the treatment programs.
"We are part of the solution, not the solution. But we are at the table and part of it," Whynott said.
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