Mayor Linda Tyer led off the meeting by saying this is one of many sessions planned to take the concept to the public.
PITTSFIELD, Mass. — It wasn't long ago when a young man came to the Brien Center looking for help after he had overdosed on heroin.
Dr. Jennifer Michaels, the center's medical director, got him into sober housing, meetings, and family support. He "did all the things he needed to do."
And then the health screening came back and showed during his drug-use days, he contracted Hepatitis C from sharing needles.
That was yet another hurdle for the man to overcome and the medical treatment bills piled up, bills paid by the taxpayers of Massachusetts, to the tune of $100,000.
Now the man is clean, working, and dating. It is a success story but Michaels used it to show that even if someone doesn't believe in the compassion arguments for a needle exchange program, the efforts to curb diseases like Hepatitis C makes sense financially.
"It cost us, society, almost $100,000. Whether you are people person or a balance sheet person, needle exchange programs make sense," Michaels said.
Michaels said the majority of the people who enter treatment programs are successful and go on to live "wonderful lives." But more and more are facing an even taller mountain to climb when it comes to treating diseases. A needle exchange program is being promoted as a way to help curb those numbers, while also boosting the number of people who enter treatment programs.
The Board of Health would need to authorize the state Department of Health to open one in Pittsfield. The board was close to voting on one in December but ultimately pushed it back to engage the public more. On Tuesday, the first community engagement session was held at the Berkshire Athenaeum.
However, there wasn't much engagement from the community as only a half-dozen residents attended as the meeting took place while an ice storm pelted the roads outside.
Health Director Gina Armstrong said the arguments for a needle-exchange program are twofold: preventing the spread of infectious diseases and connect people to addiction treatment programs.
"The goal of this is to help people be safe and be healthy until they are ready to seek treatment," Armstrong said.
The spread of infectious diseases is particularly focused on Hepatitis C. There is no vaccination for it and can lead to liver failure and death. Nationally, the cases have grown since 2010 to 2014 by 250 percent, according to Jennifer Kimball, a health planner with Berkshire Regional Planning Commission. Massachusetts has three times the national estimate and each year since 2011 there have been 2,300 more cases. In the Berkshires since 2010, 1,100 new cases of Hepatitis C were diagnosed. From 2007 to 2011, there was a 37 percent increase in Berkshire County.
Further, the detection of those cases is difficult. Often symptoms are not seen for years and the screenings require two tests, tests which are seldom available in Berkshire County. It is estimated that only between 25 and 50 percent of people who have it, know they have it
"More people in Berkshire County are dying of this disease and one of the reasons is a lack of access to screening and services," Kimball said.
The virus is spread fairly easily — it can survive in a syringe barrel for 63 days, 21 days in water in a plastic container, and five days on surfaces. Bleach doesn't kill it. It is spread by blood and can be shared through open wounds coming in contact with those, or sharing personal care items that could be bled on, or having sex, according to Kimball.
But what spreads it the most is intravenous drug use. That's why health officials are also noticing a trend in demographics. It used to be known as a "baby boomer" disease because of the numbers from that generation. But now it is growing in the younger generation. Armstrong said according to federal data from 2015, one in three drug users have reported sharing needles in the past year.
"These are young people, they don't know they are infected, and they could be spreading this infection," Kimball said.
By now most people know that heroin use has skyrocketed. Putting all the pieces together, health officials are saying the signs of a massive Hepatitis C outbreak are all there.
"We are already behind the eight ball on epidemics. We need to start now," Kimball said.
Liz Whynott oversees the operations of three programs — in Northampton, Holyoke, and North Adams. The program works with current users, moving them toward getting them into treatment programs, and swaps out dirty needles for clean ones.
"I really believe this is the missing link that isn't happening with the conversation about how to reduce overdoses and the spread of infectious diseases," Whynott said.
The director of HIV health and prevention for Tapestry said when addressing the opioid crisis there are many groups focusing on prevention of drug use from the state and then others focused on treatment for those seeking help. Tapestry fills the middle by reaching out to current drug users and those who have relapsed, keeping them healthy, and trying to get them into treatment programs. Michaels said needle exchange programs bring current users in for the needles but they leave with help in taking the next step.
The anonymous program starts with the users coming to the location, which can be a fixed site, delivery, or mobile, and going through an initial screening. Tapestry does health screenings for diseases, educates the client about prevention, provides overdose information and the overdose reversal drug Narcan, makes referrals to treatment programs, enrolls clients in health insurance, coordinates with organizations providing care, and makes referrals to service organization as well as the needle exchange.
But maybe more importantly, they build a relationship with the clients. That relationship is what brings the user from being isolated into seeking health and addiction treatment. For many, they aren't ready to enter a program but through the program, the day they are they have someone they can trust to help them get there. In the meantime, they're preventing themselves from being infected or spreading infections.
"It is really the relationship with that extremely hard to reach population," Whynott said.
The program, however, can be controversial. For one of the dozen in the audience Tuesday, he felt such a program may address the disease issue but furthers the drug use issue. He said giving the tools — and not just needles but everything else needed to shoot heroin — to users is enabling them to continue to use. He added that Narcan contributes to the same end as well, giving users and excuse to push the envelop more because they know the antidote is available.
Health officials, however, say there is no evidence to suggest that is the case and needle exchanges have been operating for decades.
Nonetheless, the majority of those in the audience were supportive of the program. The Board of Health is expected to vote on the authorization letter, which is sent to the state to start the process, in March. From there, the state will look for an operator and a specific location would be determined.
The first public engagement session about a needle exchange program is scheduled for Tuesday. The city is considering authorizing a needle exchange program to operate in the city and the Board of Health was close to voting to give that authorization last month. But, the board decided to hold off and in conjunction with the mayor's office launch a series of public sessions to gain additional feedback and inform citizens about the program.
At the request of the mayor and City Council, the Board of Health has put the brakes on the opening of a needle exchange program. Just one month ago the board was ready and planning to vote in favor of giving the authorization to allow Tapestry Health to pursue opening one somewhere in the city in tandem with the state Department of Public Health.
The nonprofit health agency was given approval on Monday night by the Redevelopment Authority to operate out of 6 West Main St., a building owned by the city and formerly used by the School Department. It received approval from the Board of Health in June.
It is very unlikely the City Council will change the mind of the Board of Health when it comes to opening a needle exchange. But, the Board of Health does want to wait until the council has a chance to weigh in before making the decision.
The decision whether or not 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.
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