The White House has declared opioid abuse a national public health emergency. But it’s also fueling another epidemic: a rise in hepatitis C.
The U.S. Centers for Disease Control say that the number of new hepatitis C infections has tripled since 2010. About 3.5 million people in the U.S. have the disease, which is most often spread through intravenous drug use.
Needle exchanges are being promoted as an effective tool to prevent further spread of the infection, but public health advocates in Maine say the state doesn’t have nearly enough of them.
This is the first in a three-part series.
It’s easy to pass by the needle exchange in Bangor without noticing it — and that’s kind of the idea. The people who come here don’t want to draw unwanted attention. They use intravenous drugs, and they come to this unmarked brick building just a few blocks from the heart of downtown to exchange dirty needles for clean ones.
It’s summer, and staff member Gretchen Ziemer is helping a woman we’ll call Sara with new syringes and other supplies. Sara and her husband have been using the needle exchange off and on during periods of relapse for about a year.
“We come here because it’s safe,” she says. “I’m sure it’s saved our life on many occasions.”
Using intravenous drugs and sharing or reusing needles put Sara and her husband at risk for contracting viruses that are spread through blood, such as HIV or hepatitis C.
“I have children that I want to be there for, even though not every choice that I make is a good choice,” she says.
Hepatitis C is a liver infection. When people first contract it, they don’t usually have any symptoms. That’s why most infections become chronic, which leads to liver disease and cancer.
Baby boomers account for a high percentage of hepatitis C cases, but the rise in intravenous drug use from the opioid epidemic has caused a sharp increase in new infections in younger people. The number of acute cases has tripled in recent years.
“Hep C is generally considered, or has been called a silent epidemic as far as the U.S. CDC is concerned, because it’s gone unnoticed for so long.” says Kenney Miller, executive director of the Health Equity Alliance, which operates the needle exchange in Bangor.
Miller opens the door to the exchange office, a room that’s about the size of a large closet.
“The first time they come in, we do client intake, which involves a lot questions around what they’re using, when they started using, other things they might be facing in terms of homelessness, law enforcement involvement,” he says.
After the intake interview, clients drop their used needles into a bin on the wall and get clean supplies in exchange. Some return every day — others in a week or month.
At first, many clients aren’t interested in talking much, and the staffers don’t push it. Miller says that’s because the goal of the exchange isn’t just to prevent infections.
“Beyond that, it’s about the relationship with this incredibly hard-to-reach population that engages with so few other points of care in the world at large,” he says.
Over time, Miller says, as clients learn to trust staff, they tend to open up more. When they signal that they’re ready for help with their addiction, they can be linked with resources.
Heath Delait says had he not walked through the exchange’s doors about a decade ago he wouldn’t be here.
“I’d probably be dead. Like, legit. No joke,” he says.
Delait, who is now 29, says at first he came purely for the needles, and even that was difficult.
“Oh, it was scary,” he says. “I figured I’d be judged. And think I was trash because I was using needles.”
But Delait says the staff was kind. Eventually, they became like an extended family.
“They all have your back pretty much. When you come here, you can talk to them, you can confide in them, you can vent with them. Anything,” he says.
It took several years for Delait to decide that he wanted to stop using. He was connected to treatment, and has been off heroin for about six years. He now volunteers at the exchange, loading and unloading deliveries for the food pantry, taking care of the trash, whatever is needed.
“I’m very happy that there’s a place like this in existence. Because if there weren’t, I don’t know what I’d be doing right now. Because it’s giving me, like, a sense of purpose,” he says.
Delait also managed to avoid contracting hep C. His story supports findings that intravenous drug users are five times more likely to enter treatment when they use a needle exchange.
Maine has six exchanges in the state. Aside from Bangor, the Health Equity Alliance operates two others in Ellsworth and Machias. There are also exchanges in Portland, Augusta and Lewiston. All together, they serve about 2,700 people a year.
Ross Hicks, the harm reduction coordinator for the Health Equity Alliance, says that’s not enough. Some clients in northern Maine, he says, drive two hours to the Bangor exchange to drop off used needles.
“We have somebody who comes down I think every month, but he comes down with two 5-gallon buckets, because again, there isn’t a syringe exchange north of Bangor, so he collects for his community,” he says.
Some advocates have made a case that Maine should have at least one needle exchange in every county. The Health Equity Alliance has tried to get state funding to establish new needle exchanges and support existing ones.
The Legislature has considered two bills that would have each allocated $75,000, but both had their funding stripped and one was vetoed.
Miller says the lack of public support for these kinds of centers is fueled by a common misconception.
“We still have to combat this idea that it’s enabling and we’re helping people to use drugs, instead of helping them to stay healthy,” he says.
Miller says they also save the state money by preventing hep C infections, which cost Maine’s Medicaid program about $17 million to treat last year. A new emergency request to the Legislature would provide $75,000 to support needle exchanges.