Looking for a Clean Fix

CORRECTION: Tracy Cheatle of Tapestry Health in Holyoke was quoted as saying that bleach kills the Hepatitus virus. In actuality, experts believe that bleaching syringes only reduces the chance of spreading the virus.

Only hours after the sun has risen, Liz Whynott and Tracy Cheatle are on the move.

Both work for Tapestry Health in Holyoke; Whynott as the needle exchange program director and Cheatle as a harm reduction councilor. Three days each week they walk the streets to connect with addicts, targeting areas of the city known for high drug activity.

The needle exchange program began operating this past summer, with approval from Mayor Alex B. Morse and a unanimous vote by the city’s Board of Health. But city councilors, some of whom are opposed to spending public money on addicts, took umbrage at having been excluded from the decision, and threatened the program with legal action this fall.

When making their rounds, Whynott and Cheatle both carry large backpacks holding  “sharps” containers, for safe disposal of hypodermic needles, and two types of kits to distribute to drug users. One kit includes bleach, a condom, alcohol wipes, antibiotic ointment, a tube of sterile water, and a round tin cooker that resembles a bottle cap used to prepare the drugs for injection.

The second contains Narcan, the brand name of drug naloxone, which is used to counter the effects of opiate overdoses, and can be administered nasally without an injection.

Flicking off the lights and locking the door of the Tapestry location on Main Street, the two blondes walked to a parking garage near City Hall. The space was cluttered with empty fast food containers, articles of dirty clothing, condom wrappers, used needles and used needle-bleaching kits

For times when clean needles are not available, Cheatle hopes drug users sterilize their needles.

“The bleach will kill the Hepatitis virus,” she explained, displaying the kit.

In the parking garage, Cheatle pulled tongs from her backpack and picked up used needles, which she placeed into a biohazard container.  “You never touch the needles with your hands,” Whynott says.

Where needles and trash cluttered the ground, the two cleaned the space and left fresh kits.

Needle exchange programs have existed in the United States since the 1980s, and there are currently 138 in operation around the country. The first Massachusetts exchange opened in Boston, in 1994. Holyoke became the fifth city in the state to start a program.

Within a month of the Board of Health’s vote, the cloud of an impending lawsuit loomed over the Holyoke exchange. City Solicitor Elizabeth Rodriguez-Ross said the Board of Health’s decision violated open meeting laws, and the matter needed to be voted on again. So the board did just that and voted once more, 3-0, in favor of the program.

In August, the city council voted 13-2 to contest the program, and authorized City Council President Kevin A. Jourdain to seek legal counsel about whether council approval was needed for the needle exchange to continue operation.

“The needle exchange promotes crime. I have no objection to methadone clinics, I’m all for that,” Jourdain said. “I’m not for the government using our precious tax dollars to purchase needles to lure drug addicts from all over to shoot up drugs in our alleyways.”

In opposing the program, Jourdain said he is upholding the will of his constituents. “We have already voted the needle exchange down twice. This has been the law of the city for 16 years,” he said, referring to nonbinding referendums in 1996 and 2001. “65% of voters were against the needle exchange, 35% were for it.”

Attorney John J. O’Neill, a former city councilor, took the council’s case pro bono. In October O’Neill filed an injunction against the needle exchange on the behalf of Jourdain and six other city councilors. The Board of Health, Tapestry Health and Mayor Alex B. Morse were named as defendants in the suit. William C. Newman, director of the Western Massachusetts office of the American Civil Liberties Union, represented Tapestry.

On Oct. 25, a hearing was held in Hampden Superior Court to halt operation of the needle exchange. O’Neill argued that allowing the program to continue violates the public interest by denying elected officials their right to vote on the needle exchange. Newman countered that city officials acted within their powers when they implemented the program without approval of the city council.

City Councilwoman Rebecca Lisi was one of the two council members who had been opposed to legal action, though she agreed the council needed to be consulted on the issue.

“I always felt that the process aspect that we would be disputing in court would be conflated with the legality of a needle exchange or the merits of a needle exchange program in the city and I really didn’t want to support a witch hunt of any sort,” Lisi said. “I felt the science is behind the program.”

The 1993 law allowing needle exchanges in Massachusetts communities was passed, in part, to combat the growing number of intravenous drug users infected with HIV.

More than 21,000 people had been infected with AIDS in Massachusetts through December 2008, according to the Centers for Disease Control. Massachusetts has the 10th highest infection rate in the country.

In the Paper City, the annual rate of HIV infection is 18.7 per 100,000 residents, double the state average, according to a 2011 report by the Massachusetts Department of Public Health. 739 Holyoke residents have died due to complications from AIDS.    Injection drug use accounts for approximately 30 percent of HIV cases in western Massachusetts, compared to 12 percent throughout the Commonwealth.

In a letter to the editor of The Holyoke Sun, City Councilwoman Linda Vacon wrote that she doesn’t believe the needle program would solve the city’s infection problem. “While it is a commendable goal to reduce illness, the scourge of drug addiction with its collateral damage from robbery, assault, and deaths, as drug addicted individuals seek any and all avenues to satisfy their drug cravings, is unaffected by this program,” she wrote.

She also worried about the effect the program would have on the city’s reputation. “What happened to the image of Holyoke and the marketing for businesses downtown?” she asked. “Who will be the first to open their new business next to the needle exchange? This is hardly the image we need to renew our city.”

Vacon recommended drug users instead travel to Northampton for Tapestry Health services.

The Northampton needle exchange opened 17 years ago. Tapestry Health President and CEO Leslie Laurie says that approximately 35 percent of the Northampton program’s users transition into addiction treatment, a goal she believes could be met, or surpassed, in Holyoke if their program remains open.

“Quite a number of the individuals who are using our facility [in Holyoke] and have used it since August are some who never were able to get to Northampton, so these are individuals who come from this community that we feel really good to serve and individuals who otherwise would not get services,” Laurie said.

On their walk through downtown Holyoke, the Tapestry outreach workers recognized a client, one who has used clean needles from the program since their doors opened during the summer.

The man, who wished to remain anonymous, had held down a stable job and was supporting a family when he injured himself exercising. Doctors prescribed Oxycontin, a narcotic painkiller, when we was recovering from surgery.

“The doctors told me it was fairly addictive, but never told me it would change my life,” he said.

He soon became hooked. For a time, he went from doctor to doctor, searching for a scrip. “I couldn’t even sit through the day without getting high,” he said. While at work, he would secretly swallow the little yellow pills.

Once he could no longer buy from pharmacies, he turned to the street, where Oxycontin can cost as much as $80 per pill. Then, a dealer offered him a cheaper alternative: heroin.

Before long, he was fired from his job, estranged from his family and without a home. “It takes everything from you,” he said.

As an addict for six years, he worries about coming down from the drug, trying to get clean without medical attention. Whenever he doesn’t use, he becomes violently ill — vomiting, sweating and getting chills.

“I’m at a point where I use so much I’m scared of coming off. That’s pretty much what I’m doing just keeping myself from getting sick,” he said. “I’m really kidding myself if I’m going out to actually feel a high anymore.”

Pulling his cell phone from his jeans pocket, he smiled and clicked through menus until he found a photo of large, muscular man — the man he once was. He shared several more photos, his image thinning in each picture, his facial features increasingly sunken. By the time he clicked to the most recent photo, his smile had disappeared and his brow furrowed.

He is currently on a waiting list for treatment at centers in Springfield and Rhode Island. Each day, he calls to see if a bed has opened up.

“It’s hard to pick up the phone and call. Some days you really want to go and you want to go now, and some days you don’t want to go,” he said. “I have kids, I don’t want to go to jail for this. I don’t want to end up dead. I love my kids and I’m not ready to die.”

Until a bed opens, he intends to continue going to Tapestry for clean needles, though he hopes to get into treatment soon.

“I don’t believe I can go on living like this much longer,” he said. “This is pretty much my rock bottom.”

On Nov. 21, approximately  a month after the lawsuit was filed against the Board of Health, Mayor Morse and Tapestry Health, Hampden Superior Court Justice Richard J. Carey denied the preliminary injunction against the program.

Though he allowed Tapestry to remain open for the time being, Carey indicated the Holyoke City Council must vote and approve the program for it to remain permanently.

“While we expect this challenge to Holyoke’s needle-exchange program to go forward, we see this ruling as a vindication of the importance of needle exchange programs to public health,” the ACLU’s Newman said in a release.

The city council could take up the issue as early as their December 3 meeting, and Councilwoman Lisi said the final vote is likely to be close. She noted that only seven of the council’s 15 members attached their names to the lawsuit, and said she knew of three or four councilors who had voted for legal action on procedural grounds, but probably would not contest the public health merits of continuing the needle exchange.

“The judge’s order makes everything very clear for us as legislators. If there’s merits to the program, we’re going to leave it open, [but] it requires local approval,” Lisi said. “I think the court’s refusal of the injunction shows that there really is a scientific, data-based need to continue the needle exchange program.”

Pending a vote from the city council, Whynott and Cheatle continued to walk the city streets, disposing of dirty needles and providing new kits to those in need.

“I would never let anyone’s opinion on the needle exchange influence me to stop doing the work,” Cheatle said. “For me, it’s like adding fuel to my fire.”