CAMBRIDGE — Here in a nameless brick building, people addicted to drugs come to get what they need. Not heroin or other narcotics, but the accessories — and more.
A smiling receptionist takes back used syringes and hands out sterile ones to those who register (no names needed; each client gets a number). A framed placard advises on needle selection. Members can also help themselves to tourniquets, cotton swabs, bandages, and other supplies.
It may look like complicity, but the AIDS Action Committee’s needle exchange in Central Square is no rogue operation. Decades of research show that needle exchanges prevent disease, do not increase drug use, and sometimes coax far-gone addicts into treatment.
Yet even amid a drug-overdose epidemic that has dominated headlines and alarmed public officials, the Cambridge needle exchange is one of only six in Massachusetts — and two are fighting hometown efforts to shut them down.
“A lot of the dialogue around the opiate issue has been focused on preventing people from getting addicted in the first place . . . and increasing treatment services,” said Carl Sciortino, a former state legislator who is executive director of AIDS Action Committee of Massachusetts. “Needle exchanges are finding people who are in the middle of that process — people who are already addicted, who are not accepting treatment, or who have gone through treatment and relapsed.”
These are the very people, Sciortino said, “who are most at risk of dying.”
Keith Waddie nearly died, right in the Cambridge needle exchange months ago. Meghan Hynes, manager of the Needle Exchange & Overdose Prevention Program, remembers that it took a long time to bring him back with the overdose-reversing drug Narcan. “He was really scary,” she said. “I was sure he was dead.”
On a recent afternoon, Waddie returned, a day out of jail, grabbing a cup of coffee in the program’s drop-in center, a room outfitted with a stained blue rug, secondhand furniture, a blaring television, and a phone, and a computer for clients to use.
This was the first place he came when released, because he has no family and no home. His parents, long deceased, had both been addicted to heroin, he said, and Waddie has been using drugs since childhood, heroin since age 18. Now 55, he said he has spent much of his life in prison, mostly for crimes to support his addiction.
“When I come here, I’m amongst a lot of people that want the best for me,” Waddie said. “I’m not accustomed to being around that. That is huge for me. It gives me the incentive to want to overcome a lot of the hardships I continue to endure.”
Still, Waddie picked up some clean needles on his way out. He is not ready to battle a lifelong affliction.
Nationwide, needle exchanges are legal in 35 states, but there are only 228 operating across the country, according to the North American Syringe Exchange Network. Last year, Indiana faced an outbreak of HIV in a rural area that had rarely seen the disease, spurring Governor Mike Pence, a Republican, to legalize exchanges on an emergency basis.
In Massachusetts, new HIV cases have continued their steady decline, but the increase in injecting-drug use has led to a spike in hepatitis C infections among people aged 15 to 29, increasing from 1,901 new cases in 2007 to 2,421 in 2013.
Governor Charlie Baker’s Opioid Working Group made no mention of needle exchanges in its 65 recommendations to combat opioid abuse. Asked about this omission, Public Health Commissioner Monica Bharel, the working group’s co-chairwoman, said the state supports needle exchanges as an important tool in the battle against drug misuse.
The Department of Public Health spends $1 million a year on needle exchanges, which were legalized in 1993, in places where local officials approve. Programs were soon established in Boston, Cambridge, Northampton, and Provincetown.
Then, the state decriminalized syringes in 2006. Anyone can own one, and anyone can buy a syringe in a drugstore without a prescription. But advocates and clients say that some drugstores don’t stock them, some simply refuse to sell them, and everywhere disapproving eyes follow the buyer.
Also, drugstores are only drugstores. Needle exchanges try to keep people as healthy as possible even while in the throes of addiction, and they stand ready to help if a client decides to seek treatment.
The Cambridge needle exchange, for example, refers two or three clients a day into treatment, Hynes said. The programs also provide such services as support groups, training in recognizing and reversing an overdose, clothing vouchers, help with managing skin infections, and referrals to primary care doctors.
In 2009, the AIDS Support Group of Cape Cod, which runs the Provincetown needle exchange, set up one in Hyannis, believing the requirement for local approval was moot now that syringes are legal.
As drug use exploded on the Cape, concern about discarded needles in parks led the Board of Health to order the program shut in September. In November, a judge backed the needle exchange, praising its contribution to public health and ordering it reopened.
In Holyoke, when a state-funded needle exchange started in 2012, the City Council challenged the Board of Health’s approval of the program, saying the council should decide. A judge declined to shut it down, and the case is scheduled for March.
City Council President Kevin A. Jourdain is leading the opposition. “We should not be using tax money to pay for needles for heroin addicts when the government has very few precious resources,” he said in an interview, noting that the state pays $200,000 a year for the Holyoke program. “By their own admission, about 500 heroin addicts daily come into the city and get needles so they can shoot up on the streets of Holyoke.”
Jourdain emphasizes that he supports services for addicts: They can get needles at the drugstore; there are methadone clinics in Holyoke and Springfield; and outreach workers are welcome to reach out, he said. But Jourdain can’t stomach tax dollars for needles. “If you’ve got the government handing out needles, what’s the message to our children?” he said.
Timothy Purington, director of harm reduction services at Tapestry Health, which runs the needle exchanges in Holyoke and Northampton, said that the exchanges carve rare inroads into the lives of people on the margins. “It’s about engaging people who are difficult to engage in care,” Purington said. “We can take steps to try to keep them connected.”
John Klasavich used drugs for 35 years, nine of them shooting heroin on the streets of Hyannis. But at the Hyannis needle exchange, he said, people accepted him as he was and understood “that not all addicts are bad people.”
He came to trust the staff over several years. Eventually, he entered a long-term treatment program in Colorado recommended by the exchange, one of nearly 60 people the Hyannis exchange referred to treatment during 2015.
“You can’t make an addict get better,” Klasavich said. “That’s impossible.” But the needle exchange, he said, will help a person who is ready.
Recent events have signaled changing attitudes. In Worcester, the Board of Health, with strong support from the City Council, voted in December to start an exchange in that city. In the state’s rural northwestern corner, health officials are contemplating needle exchanges for North Adams and Greenfield.
And Congress recently lifted a longstanding ban on funding for exchanges, allowing federal money to support the ancillary services but not the syringes themselves.
Still, needle exchanges are absent from New Bedford, Lawrence, Springfield, and other Massachusetts communities long riven by heroin use.
The state needs many more, said Dr. Camilla S. Graham, an infectious-disease specialist at Beth Israel Deaconess Medical Center, who wrote a court affidavit in support of the Hyannis exchange. She said she was “absolutely stunned” by that controversy.
“This is a 1980s conversation,” Graham said. “Twenty-five years ago we were debating the medical appropriateness of needle exchanges. This has absolutely been established across the world as the standard of care. There is no question about that.”