Another political casualty: Needle exchange programs rely on local support after the feds bail on funding

By Amanda Waldroupe, Staff Writer

For the second time in two years, Congress is reversing its policy on federal funding for syringe exchange programs, leaving many in health care business wondering how far local money can continue to carry the harm reduction programs.

While Portland and Multnomah County’s needle exchange clinics don’t expect a direct hit from the federal funding ban, shrinking state and local dollars are another issue altogether.

Kathy Oliver, the executive director of Outside In, a Portland-area homeless youth agency operating a needle exchange that is frequently used by young injection drug users, worries in particular about $63,000 in one-time money from the City of Portland that may be cut this year.

The total budget for Outside In’s needle exchange clinic is $190,000, meaning the money from the city represents a pretty hefty chunk of change (much of the rest of the clinic’s budget comes from Multnomah County). The elimination of it would mean more than cutting administrative waste or other ways of not harming the clinic’s efficacy.

“We would have to cut staff, cut hours,” Oliver says.

Oliver says she is “cautiously optimistic” that the city funding will be preserved. When the Portland Housing Bureau eliminated funding for the clinic in its 2011 budget proposal, despite the fact that the clinic had received city dollars since Vera Katz was mayor, Mayor Sam Adams put the $63,000 back into the city’s budget. “He is an advocate for the program,” Oliver says.

Kim Toevs, director of Multnomah County’s HIV/STD/Hep C program, is less fearful that funding for the county’s four clinics will be cut. Much of the budget for the county’s clinics — close to $260,000 — comes from state and county general fund dollars. “Oregon has been proactive and forward thinking for many years about needle exchange,” she says.

Syringe or needle exchange clinics are walk-in facilities that provide clean needles to people, mostly injection drug users. According to the North American Syringe Exchange Network, there are at least 221 needle exchange programs in 33 states and Washington D.C. Needle exchange clinics have relied on private donations or money from local governments to fund their operation. For 21 years, Congress has banned federal agencies from funding needle exchange clinics.

In December 2009, President Barack Obama signed a law lifting the ban on federal funding. The Obama administration’s position is that needle exchange clinics are an evidence-based practice that lowers the transmission of HIV and other infections among injection drug users.

The decision was supported by multiple comprehensive studies, including eight federally funded research reports that concluded that syringe exchange programs, as part of a comprehensive HIV prevention strategy, “are an effective public health intervention that reduces HIV transmission without increasing the use of illicit drugs. Research has also shown that syringe exchange programs are important in preventing the transmission of hepatitis B and C.” That’s according to the information Congress reviewed when it overturned the ban in 2009.

The Community AIDS and Hepatitis Prevention Act, which overturned the ban, also cited data from 81 cities across Europe, Asia, and North America that found that, “on average, HIV prevalence among injection drug users increased by 5.9 percent per year in the 52 cities without syringe exchange programs and decreased by 5.8 percent per year in the 29 cities with syringe exchange programs.”

“I think there’s still a lot of stigma around people who inject drugs,” says Julie Lager-Mesulam, director of the Partnerships Project which promotes HIV advocacy and services. Lager-Mesulam said the ban ignores the harm reduction benefits of the exchange and instead adopts a posture of punishing the user.

“It is a step back in the harm reduction model. In Oregon we’ve been really fortunate that we have great organizations and counties and a state that supports it,” Lager-Mesulam said.

Toevs says the county never applied for federal funding. She says lifting the ban was particularly helpful to communities where there is demand for needle exchange clinics, but a lack in local funding and political will to implement such a program.

Congress put the ban back in place in its budget bill in December. Putting the ban back in place is widely seen as a partisan issue, with Republicans in support of the ban. “It’s bad policy,” Oliver says. “The data is in, in terms of the effect [of clinics].”

Outside In will lose around $6,250 in federal funding because of the ban. Oliver says the inability for local clinics to apply for federal support puts more pressure on local governments to fund the clinics.  “Local money is more critical than ever,” Oliver says.

The city is early in the 2012-13 budget cycle, with each department asked to present budget cut packages of between 4 and 8 percent. Outside In’s funding is a special appropriation, which are due until the end of January. The mayor, who included the funding last year as a special appropriation, will not be presenting his budget until later in April.

The threat to funding is coming at a time when Multnomah County’s four clinics and Outside In’s exchange program are experiencing record levels in both the number of individuals coming to the clinics and the number of syringes exchanged.

Toevs  says the number of needles exchanged at the five clinics has increased, on average, by 15 percent each year since 2008. In 2011, a little over 1.5 million needles were exchanged at the clinic’s four sites and Outside In.

Toevs attributes the rise in numbers to the increasingly popularity of heroin among young people. She also says that the recession may drive people who usually buy syringes at a pharmacy to needle exchanges, where they can get clean needles for free.

Public health officials tout the programs as an effective and proven method of reducing the spread of infectious diseases among injection drug users, particularly HIV, by getting drug users to use clean needles and not share needles with other people. According to the Centers for Disease Control and Prevention, 36 percent of HIV infections are the result of injection drug use.

“It’s ridiculous,” said Michael Kaplan, executive director of Cascade AIDS Project. “At a time when we just got the ban removed, when we know that access to clean needles makes a difference in HIV prevention, when we know that it does not increase substance abuse, and despite what surgeon generals and people throughout government have argued for many years, the House has gone — counter to good public health — and said, ‘We’re not going to fund access to clean needles.’”

Toevs says needle exchange clinics can also be the gateway to drug treatment and other services that drug users would not normally be willing to think of accessing.

“We’re pretty neutral in terms of meeting people where they’re at,” Toevs says. “If they are interested in reducing their use or exploring or engaging in treatment, we are like a first step to getting them into the system.”

The clinics Multnomah County operates also provides information and teaches individuals about how to identify an overdose and what to do, as well as how to prevent overdoses, abscesses, and other health-related risks.

Oliver says Outside In’s clinic frequently sees individuals who do not use any other type of social services, but clinic staffers are typically successful at convincing individuals to go to Outside In’s medical clinic if they have abscesses or other basic, preventable, and treatable health needs. “It helps keep them safe,” she says.

Photo by Kristina Wright

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