For many years, AIDS Action Committee has been on the forefront of advocating for sound policies to protect those struggling with addiction. A decade ago we worked for passage of syringe decriminalization, pharmacy access to syringes without a prescription, and the Good Samaritan Law to empower those dealing with overdoses to seek help from law enforcement. A decade before that we pushed for the creation of needle exchanges to stop the spread of HIV among IV drug users.
This month, AIDS Action succeeded in removing a major obstacle to fighting the opioid epidemic. Gov. Charlie Baker has approved a measure proposed by AIDS Action and passed by state lawmakers updating the Commonwealth’s existing law governing needle exchange programs. The changes will make it much easier to open more needle exchange programs around the state, and will be an important tool to fighting this growing crisis.
The need for more effective tools to fight the opioid epidemic is clear. Opioid overdoses in Massachusetts have risen 273 percent since 2000; in 2014, 1008 Massachusetts residents died from unintentional opioid overdoses (representing a 33 percent increase over 2013). As rates of opioid addiction have risen, so have new infections of Hepatitis C, as the virus is easily spread not just with the sharing of needles, but also by sharing other drug injection equipment such as cookers, tourniquets, and filters. And the increased use of needles that has come with the opioid epidemic has put the state’s historic success in reducing HIV infections in jeopardy.
The updated law makes it clear that local boards of health have the final say in whether a needle exchange program can open in a city or town. The original requirement to seek local approval for needle exchanges, which dates to passage of the first 1994 law governing needle exchange programs, was vague. It didn’t define what local approval was, nor did it define which authority at the local level (for example, a board of selectmen versus a board of health) could approve the opening of a needle exchange. This ambiguity led to lawsuits as communities, service providers, and the state Department of Public Health grappled with competing interpretations of an antiquated statute.
The updated law also removes the 10-program limit on the number of needle exchanges that can operate in the state. Since 1994, DPH has approved needle exchanges in Boston, Cambridge, Northampton, Provincetown, Holyoke, Worcester, North Adams, and Brockton. Four more localities are in active conversation about starting their own programs. Under the old law, only two of the new programs under consideration would have been permitted to open. Given that the opioid epidemic has reached across the state into every community, and effective programs are far too geographically limited to reach all of those in need, this removal of the 10-program limit is critical.
Among the many interventions employed to fight opioid addiction and the spread of Hepatitis C and HIV, needle exchange programs have been shown to be one of the most effective. These programs, such as the one operated by AIDS Action in Cambridge, reach active users in the midst of their addiction and serve as an entry point into health services such as HIV and Hepatitis testing, wound care, and substance abuse detox and treatment. Studies also show that injection drug users who participate in a needle exchange program are five times more likely to enter drug treatment programs than other injection drug users.
AIDS Action Committee operates the Cambridge Needle Exchange and Overdose Prevention Program. Established in 1994, the Cambridge site is among the first established in the state and its primary goals are to reduce the incidence of overdose due to opioid use; reduce the transmission of HIV and Hepatitis C by increasing the availability of sterile syringes; connect clients with health care, social services, and drug treatment programs; and reduce the level of harm experienced by active drug users and their families. Since the establishment of needle exchange programs in Massachusetts, the prevalence of HIV among residents who inject drugs has dropped by 92 percent.
Opening more needle exchange programs won’t just save lives, it will also save substantial amounts of money. The lifetime treatment cost of each HIV infection is estimated at $379,668 and one treatment regimen for Hepatitis C costs around $30,000. Most needle exchange programs, which prevent significant numbers of new infections of both HIV and Hepatitis C, operate at an annual costs of approximately $120,000.
Needle exchange programs save lives, help prevent the spread of infections, save the state unnecessary health care spending, and most importantly, provide those struggling with addiction a place to not only receive critical services but also the dignity and support they need to overcome their disease. While the effects of the opioid crisis will likely continue for many years, we now have easier access to this critical tool, and AIDS Action applauds our elected leaders for their wisdom in making it more readily available.
Carl Sciortino is the executive director of AIDS Action Committee of Massachusetts.