In 2003, Susan MacNeil, then the executive director of AIDS Services for the Monadnock Region, had a plan to start a needle exchange program in the area.
The organization already ran a van that drove to different locations, offering HIV testing and preventative counseling. But after the Legislature made it legal for people without prescriptions to buy clean syringes in 2001, she wanted to expand the organization’s offerings: to operate a needle exchange out of the van, where drug users could swap their dirty needles for clean ones. Starting needle exchange programs was a priority of many AIDS services organizations in the state at the time, she said.
Exchanges serve as a way for communities to combat the spread of diseases, such as HIV and hepatitis C, which can be contracted when intravenous drug users use contaminated needles.
But AIDS Services for the Monadnock Region’s needle exchange never saw the light of day.
That’s because the organization soon realized there was no legislation on the books that made needle exchanges legal.
Possessing dirty needles with residue or trace amounts of drugs like heroin is a crime in New Hampshire. And at the time, there was no law that made exceptions for needle exchange programs.
Fourteen years later, there are still no legal needle exchanges in the Granite State.
But that’s due to change.
A bipartisan bill that passed in both chambers of New Hampshire’s Legislature this year would pave the way for needle exchanges by making it legal for members of such programs to possess dirty needles. Gov. Chris Sununu, a Republican, has pledged to sign the bill sometime in the coming weeks, according to his press secretary, Ben Vihstadt.
“This will save lives,” said Sen. David Watters D-Dover, a co-sponsor of the bill, Senate Bill 234. “We need to be proactive when it comes to public health.”
While the legalization of needle exchanges is around the corner, it’s unclear if any organizations in the Monadnock Region would be poised to quickly start up such a program.
Officials at Southwestern Community Services and Cheshire Medical Center/Dartmouth-Hitchcock Keene did not respond to requests for comment about the prospect.
And Keene’s local AIDS services organization, the Southern New Hampshire HIV/AIDS Task Force, doesn’t plan on opening an exchange, according to its vice president, Wendy LeBlanc. The organization is based in Nashua, but has a satellite location in Keene where it serves about 30 clients.
The case for exchanges
Passage of the bill that will allow for needle exchanges comes as the state grapples with an opioid crisis. Seventy-eight fatal overdoses, from opioids and other drugs, have been confirmed so far this year, and the cause of another 86 suspected drug deaths is pending toxicology testing, according to the latest update from the N.H. Office of the Chief Medical Examiner. Sixty-eight of the state’s confirmed drug deaths of 2017 were caused by opioids.
Four people in Keene have died from opioids this year, according to Keene Fire Chief Mark Howard.
Last year, New Hampshire saw a record number of deadly overdoses for the third year in a row; there were 477 recorded drug deaths, of which 420 were caused by opioids. Toxicology results are still pending for three deaths from last year.
With increased drug use, many doctors worry about the potential of an HIV or hepatitis C outbreak. In April, The Concord Monitor reported that, statewide, doctors are seeing an increase of patients with hepatitis C.
Catholic Medical Center in Manchester, the only hospital that provided The Monitor with a complete data set of its hepatitis C cases from the past three years, saw the number of its patients who are both drug users and positive for the disease rise from 157 to 289 between 2014 and 2016.
According to the article, doctors in New Hampshire haven’t reported a spike in HIV cases, but still fear there could be an outbreak in the state. Hepatitis C tends to travel more quickly through the blood stream and is easier to contract. In a report last year, the Centers for Disease Control and Prevention urged states to start needle exchange programs to help prevent HIV outbreaks.
In 2016, N.H. Rep. Joe Hannon, R-Lee, proposed legislation that was the precursor to this year’s bill and would have effectively legalized needle exchange programs. It passed the House but was blocked in the Senate.
In an interview last October, Hannon said the bill didn’t pass the Senate in large part due to concerns within the law enforcement community. His bill would have decriminalized possession of dirty syringes for all drug users, not only those who are part of needle exchange programs. Law enforcement authorities feared this would limit their ability to make drug arrests on the street, Hannon said.
So lawmakers limited the bill’s scope, to legalize needles with trace amounts of drugs only for needle exchange members, Watters said.
Keene Police Chief Steven Russo said he wouldn’t be worried if a needle exchange opened in the city.
“This is going to have negligible or no effect on us,” he said. “Any time that you can decrease any infectious disease ... it has to be good for the community.”
But even with the new law in place, Russo said, police officers wouldn’t necessarily stop arresting those found in possession of dirty needles, even if they said they were part of a needle exchange program.
Watters and the bill’s lead sponsor, Sen. James Gray, R-Rochester, said the bill does not require needle exchange clients to carry documentation that proves they’re members, or enter their names into a database that law enforcement can access.
So on the street, officers would have no way of finding out whether drug users belong to needle exchange programs or not.
However, Watters and Gray said, those who are arrested for possessing dirty needles would be able to use their membership as an affirmative defense if their case went to court: They could not be convicted.
Who could start an exchange?
Senate Bill 234 would give community health centers, public health networks, AIDS service organizations, community-based organizations and substance treatment organizations the authority to operate needle exchanges.
LeBlanc said that for the Southern New Hampshire HIV/AIDS Task Force, opening a needle exchange isn’t off the table indefinitely, but for now the organization wouldn’t have the funding or staffing to do so. She’d also want to make sure community stakeholders were on board with a local needle exchange before opening one.
But, according to LeBlanc, there’s certainly a need for such a program in southern New Hampshire.
“Everywhere in the country there’s a need for it,” she said.
If an organization does consider starting an exchange locally, funding could be a challenge; the bill doesn’t allocate any state dollars to be used explicitly for these programs.
However, Watters said organizations could fund needle exchanges by applying for money the state has provided to the N.H. Department of Health and Human Services to fight the opioid crisis. Organizations could also apply for money through the state’s alcohol fund, which takes money from the N.H. Liquor Commission and puts it toward substance abuse treatment and prevention. This fund has been fully funded only once since it was authorized in 2000.
Gray said that by preventing the spread of diseases like HIV and hepatitis C, running needle exchanges could be affordable for AIDS services organizations. Because of needle exchanges, there will be fewer patients, he said.
“... the vision is that they will save money and it will pay for itself because (AIDS services organizations) won’t be providing those other services,” he said.
LeBlanc said this logic doesn’t work because her organization will still have to cover the expenses of its current patients, who will have HIV for the rest of their lives.
“HIV is a chronic, lifelong illness, and those people aren’t going to just go away,” she said.
Still, she’s hopeful needle exchange programs open in New Hampshire and that people find a way to fund them.
“I think that if we had tried to attach funding to the bill it probably wouldn’t have gone through,” she said.
A successful exchange
In September, the AIDS Project of Southern Vermont opened up a needle exchange program on Grove Street in Brattleboro. The exchange is open on the first and third Tuesday of every month and currently serves 73 members, according Sue Conley, who runs it.
But she said that her exchange offers much more than clean needles.
Seeing the same members on a regular basis, Conley said she has the opportunity to help refer them to addiction treatment, HIV and hepatitis C testing and other medical services.
“When you have a program where people can come in and talk to someone, they’re more likely to get into treatment and get their health taken care of,” she said.
Needle exchanges have been legal in Vermont since 1999. Brattleboro’s new exchange is one of five in the state, according to Conley; others are in Rutland, St. Johnsbury, Burlington and White River Junction. Another is scheduled to open soon in Springfield.
Karen Peterson, executive director of the AIDS Project of Southern Vermont, estimates that in its first year, the exchange will cost $20,000 to $25,000 to operate.
But not all of that is paid for out of pocket: Vermont’s Department of Health provides about $100,000 each year in funding for all of the state’s syringe exchanges.
“I’m very grateful that the state of Vermont legalized needle exchanges years ago,” she said.
MacNeil can’t help but imagine what impact needle exchanges could have had in New Hampshire if its Legislature had done the same.
“... the tragedy is that it takes this horrible crisis point to bring us to our senses,” she said, referencing the spike in drug use in New Hampshire in recent years.
“How many more people have died? How many people have become addicted? How many people have unknowingly contracted disease?”