Portland's India Street Public Health Center is the home of the city's needle exchange program. (Portland Phoenix/Colin Ellis)
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Two Portland city councilors want to see the city shift away from its current needle exchange program and embrace a less restrictive approach.

City Councilors Belinda Ray and Mark Dion said they would rather the city employ a needs-based approach to needle exchange, instead of the current and controversial one-for-one exchange.

Portland City Councilor Belinda Ray.

The councilors announced their support for the change during a March 4 Health and Human Services and Public Safety Committee meeting where Gordon Smith, director of the state’s opioid response, outlined the state’s approach to the epidemic.

Smith said the U.S. Centers for Disease Control recommends a needs-based exchange, which is why Gov. Janet Mills issued an executive order that allows state-certified programs to provide clients with more clean syringes during the pandemic.

Smith, however, said he couldn’t give city officials a clear picture of what will happen when that order expires.

“There is so little bandwidth to do anything other than COVID that we have not been able to have a good discussion about amending the rule,” Smith said.

He added, however, that he believes the state will eventually make it a permanent rule.

Portland, which has the only municipally run program in the state, remains an outlier by remaining with the one-for-one exchange. City Manager Jon Jennings has said cleaner and safer parks and public areas are a result of the program because there are fewer syringes being left in the parks.

Last summer, the city temporarily halted cleanup in Deering Oaks Park and stopped sending in crews because of the large number of discarded syringes that were found at the height of a homeless encampment in the park.

Jennings has also said the program is still giving out large numbers of syringes. In January, the city’s Needle Exchange Program on India Street gave out more than 30,000 needles. That’s an increase of around 3,000 from January 2020. Kristen Dow, the city health and human services director, said the January distribution was the largest ever.

Portland City Councilor Mark Dion.

While the city may be using what it believes to be best practices, Ray said evidence from the federal CDC and a World Health Organization recommendation of a needs-based approach should be considered. Given the number of overdose deaths annually, she said, she wants the city to take an expedited approach in researching other options.

“I don’t doubt we’ve been using a lot of best practices, but it doesn’t mean we shouldn’t look at these,” she said.

Ray also said the research has shown one in five people visiting the city’s needle exchange are sharing needles, which she said is proof the city’s model needs additional work.

Dion said he believes members of the public have misunderstood the nature of Mills’ emergency order, mistakenly believing it had waived the one-to-one approach entirely.

Whitney Parrish, director of advocacy and communications for the Maine Health Equity Alliance in Bangor, said the emergency order has allowed her organization to better serve clients than the one-for-one program would have allowed.

She said having a one-for-one method is problematic because people using needles often know they can only possess a certain number or else they can be charged with a crime. Often they either drop them, she said, or if they are homeless, leave discarded needles behind.

“Evidence shows when restrictive policies are in place you will find more syringes on the ground,” Parrish said.

She said the federal CDC guidelines for a needs-based approach have proved to be better for reducing the spread of diseases such as HIV.