BELFAST — A needle exchange program made its Belfast debut April 18, when it officially opened to the public.

The program, which is overseen by the Maine Department of Health and Human Services, is run by the nonprofit Health and Equity Alliance. Until the Belfast office opened, the closest place for those struggling with addiction to exchange their needles was in Bangor. HEAL also has offices in Ellsworth and Machias.

Needle exchange programs are designed to promote public safety by providing clean needles to addicts free of charge, allowing them to use a new needle and syringe for every injection.

Sharing needles is a common way to spread infections and disease, including HIV, viral hepatitis, and other blood-borne infections, according to the Center for Disease Control. Skin infections and abscesses are risks of sharing needles, or simply reusing the same needle over and over again. 

Exchange programs offer users a safe way to both dispose of used needles and to acquire new, sterile needles to take their place, advocates maintain.

As of 2018, 39 states, in addition to Washington D.C. and Puerto Rico, have needle exchange programs, with more than 320 programs nationwide, according to the Kaiser Family Foundation.  

According to the National Institute on Drug Abuse, Maine is among the top ten states with the highest rates of opioid-related overdose deaths, with 301 deaths attributed to opiate overdose in 2016 alone. 

In 2012 a nationwide county-level vulnerability assessment identified 220 counties as particularly vulnerable to “rapid dissemination of HIV or HCV infections” among intravenous drug users, according to amfAR, the Foundation for AIDS research. Four Maine counties were among those deemed especially vulnerable, including Waldo, Somerset, Washington, and Kennebec counties. 

HEAL’s Belfast office

Currently, HEAL’s Belfast office is open on Tuesday from 11 a.m. - 4 p.m., and Friday from 2 - 7 p.m., although Dwyer said the busiest time is typically Friday from 5-7 p.m. when people are getting out of work.

The office, which is in the Wentworth building on Waldo Ave., is run by HEAL’s Harm Reduction Community Organizer Duncan Dwyer.

Dwyer said the goal of the Belfast office is to serve both Waldo and Knox counties, with the potential for a mobile needle unit being discussed for the future. The mobile unit would require CDC certification, according to Dwyer, who said that HEAL is still discussing the possibility.

HEAL’s Director of Harm Reduction and LGBTQ Services, Maddy Magnusson, said the group is excited for the new Belfast office.

“We’re excited because a lot of people know there is not a lot of services in Waldo County, whether its exchange or looking at homeless shelters, things like that, so the resources I think are just not quite there yet, but there’s still definitely a need, so we’re excited to help fill that need in Waldo County,” Magnusson said.

Despite officially opening its doors April 18, Dwyer said the office has been seeing people for a few weeks already, with 600 used needles taken in at the exchange the week before they opened. Dwyer said the high amount taken in is likely due to people saving their used needles instead of throwing them away in an unsafe manner, such as in regular trash.

In order to become a part of the needle exchange program, participants must first register with HEAL, which maintains a database of its clients. Each used needle can be exchanged for a new one, though there is a 30 needle limit per visit. Any extra credits are logged and available for future need, Dwyer said.

The registration system also allows HEAL to collect data for the CDC.

One of the limitations of the Belfast office is its small size, with but a single room to both see people and allow others to wait their turn. Dwyer said they are also required to only see one patient at a time, leading them to create a separate section of the small space, where participants can privately turn in their needles and/or register with the program if needed.

Dwyer has also talked about HEAL’s Belfast office to residents at the Reentry Center and those attending various area support groups.

“It went well, they certainly appreciated it. They had a lot of questions, they were very engaged,” Dwyer said of his meeting with Reentry Center residents.

Non-needle services

While exchanging needles is a large part of the service offered by HEAL’s Belfast office, it is far from the only one. There are also fentanyl testing strips available free of charge, which allows those struggling with addiction to ensure their drug of choice has not been tainted with the synthetic opioid, which is roughly 100 times as potent as heroin and has led to many overdoses.

Additionally, the office has naloxone on site to hand out to anyone who struggles with addiction or knows someone who does. A 15-minute training video is the only requirement people must fulfill before they are able to be given naloxone kits.

The kits come with two doses of naloxone, a syringe, ways to tell someone is suffering an opioid overdose, and usage instructions.

Signs that someone may be suffering an overdose can include slow, shallow breathing, loss of consciousness, choking or gurgling sounds, a limp body, or pale or bluish skin, among others.

The first action someone should take if they think they are witnessing an overdose is to move the afflicted to the ground and put them in the recovery position, according to Dwyer.  The shot is delivered to the arm, where one vial (which is one dose) of naloxone should be administered.

“A lot of folks will say, ‘well that’s a really long needle, I’m worried about hitting the bone,’” Dwyer said, “I guarantee that if somebody has the option of dying of an overdose or getting a bruised bone, they’re going to appreciate what you’ve done.”

Naloxone works by blocking a person’s opioid receptors, which means it will work for all types of opioid overdoses. Dwyer said there have been rumors about naloxone-resistant fentanyl, but that those rumors are simply untrue.

“It doesn’t matter whether they’ve overdosed on heroin, or if they’ve taken too much Vicodin, or if they’re shooting fentanyl - none of that matters. If it’s an opiate, then Narcan will work,” Dwyer said.

The reason that two doses of naloxone are given is that naloxone lasts for 30-90 minutes, and if the overdose was a severe enough one, the user can go back into an overdose once the drug has worn off, according to Dwyer.

While medical treatment should be sought for any overdose, Dwyer said that often times those who are around at the time of an overdose are reluctant to seek medical attention due to fear of either getting themselves in trouble or getting the person who suffered the overdose in trouble.

“Also, in rural areas, it might take longer than you expect for emergency services to get there. So we have two doses that we hand out and we let them know once you start seeing overdose reoccur, if emergency services aren’t there yet then you administer another shot,” Dwyer said.

While anyone has access to naloxone with a prescription, the requirements for obtaining the prescription include having a primary care physician, meaning that patients must ask their doctor, something not everyone is willing to.

Dwyer said HEAL has been “remarkably thrilled” about the fact that the State of Maine is allowing for “so many more doses” of naloxone to go out, but that due to prescription limitations much of it ends up just sitting on shelves and not being distributed.

“Offices like ours, that have a standing order for high-risk populations, are able to get it into the hands of people,” he said.

According to Dwyer, he primarily suggests naloxone to someone if they are actively shooting up opiates, but said that generally, even if a drug user is not using intravenously, they know someone who is.

“So I tell them, ‘here’s your chance to be a superhero, take the naloxone with you and have it in your glove box, have it in your house and if one of your friends is in overdose it's your chance to save their life,’” Dwyer said.

Though an injection is the typical way naloxone is administered, there is also a nasal spray available, though it is not handed out at HEAL’s offices the same way the injectable version is. This is largely due to the cost difference between the two varieties, while naloxone is the generic form of the drug, Narcan, a widely known brand, is the only maker of the nasal spray. Dwyer said the nasal spray is mostly used in places where possession of needles is banned, such as the Reentry Center.

In addition to providing new needles, naloxone, and fentanyl test strips, HEAL also looks to get those impacted by addiction help by getting them connected with other available services. People can be referred for therapy, which is handled by a therapist working out of HEAL’s Bangor office.

Referrals are also made to SequelCare for recovery coaching and other drug-related issues, who Dwyer said has “been fantastic.”

“The great thing about SequelCare is that they both take Mainecare and will work with anybody we send them. We don’t have to wonder whether or not somebody we send them is going to get the services they need,” he said of the organization.

Dwyer said he recently attended a harm reduction retreat where people from a variety of social agencies gathered as an informal way for those working in the field to get together and talk.

No wrong door

According to Dwyer, one of the initiatives he really liked and would like to see agencies work together towards is a ‘no wrong door’ policy which he said means “that if somebody comes into any related office looking for services then they shouldn’t feel like they’ve come to the wrong door,” he said.

Waldo County currently has the Waldo County Recovery Committee, which was formed in the summer of 2018 to combat opiate addiction in the area.

The Recovery Committee includes a number of community agencies, including the Waldo County Sheriff’s Office, Volunteers of America, Seaport Family Health Center, the Restorative Justice Project of the Mid-coast, Greater Bay Ministerium, and Maine Adult Community Corrections.

Dwyer said HEAL’s Belfast office already has made an effort towards a ‘no wrong door’ policy by including a small food shelf and coats in the office for those in need. While HEAL’s Bangor office offers a food pantry, Belfast’s doesn’t.

Despite this, Dwyer said he wanted to ensure he could help someone in need of food should they present themselves. Once spring comes, he said he plans to go to the farmer’s market to see if he can get local farmers to share their goods with those in need.

Dwyer, whose wife is the nurse practitioner at Belfast’s Family Planning Office, said one important aspect of their new Belfast office is a desire to work with the already established programs in the area.

“That’s why we spent the first couple months after I came here just getting to know people and seeing what people are doing in the area. So what we don’t want to do is duplicate any services,” he said. “We want to help with whatever we can.”

Erica Thoms can be reached at news@penbaypilot.com