The Justice Resource Institute, a nonprofit based in Boston, received approval this summer from state and local officials to establish a syringe service program.
FRAMINGHAM — Hoping to reduce the transmission of HIV and other diseases among drug users, a social services organization that serves Framingham and surrounding communities is set to launch the first needle exchange program in MetroWest.
The Justice Resource Institute (JRI), a nonprofit based in Needham, received approval this summer from state and local officials to establish a so-called syringe service program.
Funded through the state Department of Public Health (DPH), the initiative will allow injection drug users to obtain clean hypodermic needles and other safe injection supplies through JRI’s program near downtown Framingham.
Known as RISE, the program offers a variety of services to people living with, or affected by, HIV, including preventative care, counseling, testing, case management and group support.
In response to questions from the Daily News, John Gatto, senior vice president of community health at JRI, said needle exchanges have been proven to reduce transmission of HIV, which has become increasingly prevalent among drug users in Massachusetts.
In a prepared statement, Gatto said participants will meet individually with staff to be assessed and discuss their drug use patterns. JRI will provide them with supplies and relevant information regarding health risks, strategies for changing their substance use behaviors and treatment resources, Gatto said.
According to the Centers for Disease Control and Prevention, needle exchanges are recognized as an effective strategy for HIV prevention, and have been shown to reduce the risk for infection with hepatitis C, a blood-borne virus that can cause serious health problems, including liver damage and cancer.
Rates of hepatitis C infection have been climbing in Massachusetts, a phenomenon believed to be linked to needle sharing and the use of opioid drugs, such as heroin.
The number of confirmed, or probable, hepatitis C infections diagnosed in Massachusetts each year dropped below 7,900 in 2010, but rose to more than 9,000 in 2015, the most recent year for which data was available.
Framingham has been one of the state’s hot spots for new hepatitis C cases, according to Director of Public Health Sam Wong, who said the city Board of Health supported JRI’s request in part to help address the spread of disease.
"That seems to be a missing gap in the service,” Wong said, explaining that the closest needle exchanges are in Worcester and Boston.
“Through the literature, we know that people who access these services, they don’t tend to travel far,” Wong said, "so that means in MetroWest, Framingham, our residents who need the service, they don't have access to that, and that's one of the reasons that we're seeing a spike in hepatitis C infections in the Framingham area.”
More programs coming
Currently, there are about 20 needle exchanges operating in Massachusetts, where the the state Department of Public Health has provided funding for syringe service programs for more than two decades.
With the state's fiscal 2019 budget now approved, DPH is contracting with local agencies, such as JRI, to establish additional programs. Under state law, cities and towns must grant local approval before DPH can establish a syringe service program in a municipality.
Omar Cabrera, a DPH spokesman, wrote in an email that syringe service programs are effective at preventing the spread of disease among active drug users, giving them access to sterile equipment and other services, such as testing for HIV, hepatitis C and sexually transmitted infections. Drug users also learn harm-reduction strategies, and get referrals to primary care and substance use treatment.
“We are pleased to see the expansion of the number of these programs since state law allowed local boards of health to provide this approval, which 30 Massachusetts communities have now done in response to the opioid use epidemic,” he wrote.
Despite the potential benefits, needle exchanges have sometimes proven controversial in some communities.
In Barnstable, town officials temporarily shuttered a program in 2015 run by the AIDS Support Group of Cape Cod, saying it created a nuisance in the area. The group sued the town, eventually winning a Massachusetts Supreme Judicial Court case in which the court found private organizations are free to distribute clean needles without local approval, though cities and towns can still reject programs funded by the DPH.
Research has also cast doubt on the notion that needle exchanges place burdens on their host communities. A 2000 study by researchers at the Johns Hopkins School of Hygiene and Public Health found no significant difference in arrest trends emerging after a needle exchange program was introduced in Baltimore.
Reaching drug users
Wong pointed to one potential benefit. Because it provides a method for drug users to safely dispose of paraphernalia, a needle exchange could help reduce the number of needles discarded in public areas. The city is seeing more needles left in spots such as parks, trails and playgrounds, he said. Staff from the Health Department now train DPW workers on how to safely collect needles and dispose of them. Some DPW staff also carry sharps containers, or have them available in their vehicles.
The DPW has discarded at least 13 needles since July 2017, according to a department log, removing them from locations on Howard Street, Hollis Street, Irving Street and Union Avenue.
While the needles are a conspicuous sign of injection drug use, users are often not highly visible to the medical community. Dr. Amesh Adalja, an expert in infectious diseases and senior scholar at the Johns Hopkins University Center for Health Security, said needle exchanges give health care workers time to interact with drug users they might otherwise only see in the emergency room.
The exchanges then become a focal point to address a range of health issues. In Pittsburgh, for example, exchanges provide HIV testing and flu shots. Many also distribute the overdose-reducing drug naloxone and provide training on how to recognize an overdose and administer the naloxone.
Asked about the negative stereotypes attached to needle exchange programs, Adalja said it’s important to remember that injection drug use is widespread, and likely to continue whether the community hosts an exchange program or not.
“Injection drug use is a fact in this country right now,” he said, “and all needle exchange does is make it safer, and stop some of the negative cascading effects.”
Jim Haddadin can be reached at 617-863-7144 or firstname.lastname@example.org. Follow him on Twitter: @JimHaddadin