Last Wednesday was a busy day for Tim Purington. That afternoon, his agency, Florence-based Tapestry Health, officially announced that it was starting a needle exchange program in Holyoke. In addition to getting the program, which had been approved by city officials just a few days earlier, off the ground, Purington also found himself fielding calls from the local media.
A little before six o'clock, a reporter from Channel 22 who'd come to interview him left, and Purington found himself alone in Tapestry's office at 15A Main St., where the program will operate. "It was such an emotional time," he said the next day, his voice still sounding emotional. "I was reflecting on what a long battle it's been."
A long battle, indeed. It's been 19 years since the Massachusetts Legislature passed a law allowing the creation of up to 10 needle exchange programs in the state. The programs allow users of injection drugs to trade in used syringes for clean ones, with the goal of stemming the transmission of HIV and other blood-borne diseases that occurs when users share dirty needles. Participants can also be tested for HIV, hepatitis C and sexually transmitted diseases, and receive counseling and referrals to addiction treatment and other health services.
In the first couple of years after the law passed, a handful of municipalities—Northampton, Boston, Cambridge and Provincetown—established needle exchange programs. In a number of other cities, including Holyoke and Springfield, efforts to set up exchange programs met with fierce resistance, including votes in opposition from their respective City Councils. In 2001, the majority of Holyoke voters signaled their opposition to needle exchange via a nonbinding ballot question.
Meanwhile, HIV has continued to be a problem in the city. According to state Health and Human Services statistics, Holyoke had an HIV diagnosis rate of 18.7 cases per 100,000 residents between 2007 and 2009; the statewide rate, by comparison, was 9.4 per 100,000. In about one-third of those Holyoke cases, the means of transmission was believed to be IV drug use.
"The state has done a good job over the years of reducing HIV," said Purington, Tapestry's director of prevention services. But those efforts have been less successful in communities that have drug problems, like Holyoke, he added. And it's not just drug users who are at risk; as the nonprofit Western Mass. Center for Healthy Communities notes: "HIV in our region is typically spread by sharing dirty needles, and heterosexual sex between two people, one of whom is an injection drug user."
That's where programs like the ones Purington runs can prove invaluable. "Needle exchange is such a proven intervention," he said, pointing, as just one example, to studies of the effectiveness of programs in New York. A 2005 study there found that after the city expanded its clean needle programs, the HIV rate among IV drug users entering treatment fell from 54 percent to 13 percent, while the hepatitis C rate fell from 90 to 63 percent.
Holyoke's new needle exchange program was established quietly, in sharp contrast to the public controversy that surrounded earlier efforts.
The city's Board of Health unanimously approved the measure at its July 9 meeting, with Mayor Alex Morse—who appointed all three members of the board after taking office in January—promptly signing off. While the meeting was public, and the needle exchange vote included on that week's agenda, the whole process apparently flew under the radar of local media until Tapestry issued a press release about it two days after the board's vote.
That, presumably, was no accident; supporters of needle exchange were no doubt eager to avoid the rancor that marked previous campaigns and to take advantage of the new mayor's support of the program, in contrast to previous administrations.
Under the state law that authorizes needle exchange programs, interested municipalities can only proceed with "local approval." Municipalities have interpreted that in different ways, however. Cities including Springfield and, in the past, Holyoke have interpreted "local approval" to mean a vote from the City Council. But in those communities that have established exchange programs, approval came through the executive branch; in Northampton, for instance, then-mayor Mary Ford approved the program.
This April, Holyoke city solicitor Elizabeth Rodriguez-Ross, also a Morse appointee, sent the mayor a memo with her department's opinion on what "local approval" means. According to the memo, written by staff attorney Sara Carroll, the state law "does not clearly specify whether local approval means approval of the mayor, approval of the City Council, both, or simply approval by the Board of Health"; in addition, previous case law does not clarify the issue. But, the memo continued, based on her interpretation of the state law and the mayoral powers granted in Holyoke's charter, Carroll determined that approval from the mayor alone would suffice, and that the matter was outside the City Council's jurisdiction.
The Law Department's opinion will, no doubt, not sit well with Holyoke residents and city councilors who are opposed to needle exchange. Last week, Purington said he was bracing himself for the inevitable backlash.
Purington himself is a former city councilor, having served as Ward 4's representative from 2008 to 2011, when he opted not to run for re-election. He defended the decision to bypass the City Council and leave the matter of needle exchange in the hands of the Board of Health, arguing that public health matters shouldn't be decided in a political context.
"It became clear, I think, especially after living through the 2001 referendum question in Holyoke, that this is just not a way to do this work," he said. "The issues are complicated. ... Especially in communities that are affected by drug use, the way Holyoke neighborhoods are, people are afraid of drug use and don't understand the issues and just want the problem to go away."
Meanwhile, he said, supporters such as Tapestry simply don't have the resources to do the kind of in-depth public education campaigns necessary to demonstrate to people the benefits of needle exchange programs.
For Holyoke residents anxious about what the program might mean for their city, Purington points to some statistics from Northampton's program: last year, he said, more than 900 people participated, exchanging about 83,000 needles in the program's office in the heart of downtown, just upstairs from the Iron Horse, without any adverse affect on the area. "People still love the restaurants in Northampton," he noted. Meanwhile, exchange participants received more than just clean needles. "We've done hundreds of HIV tests, hepatitis C and STD [tests], gotten countless people into substance abuse treatment," Purington said.
"I think it's safe to say most of the controversy around needle exchange programs happens before they open," he continued. "People don't understand how they work. The truth of the matter is, the drug users we serve value the program and wouldn't do anything to jeopardize the program."
As one of the strongest counterarguments to Holyoke residents' worry that the program will lead to crime, Purington pointed out that it has the support of police chief James Neiswanger (as Northampton's program has long enjoyed the backing of its chief, Russ Sienkiewicz). "I think that's one of the big things that allowed it to happen in Holyoke," he said. "We had a mayor that listened to the Board of Health, and we had a chief that saw this as a public health issue and saw this wasn't going to undermine his ability to end drug use."