LEWISTON — Ryn Soule-Leclair is sick of seeing used needles on the ground.

The Lewiston councilor said finding needles in parks and near her place of work makes it hard to enjoy the city’s public spaces. She proposed an ordinance this year in hopes of limiting the city’s syringe services programs, which exchange used needles for sterile ones to reduce blood-borne disease transmission among injection drug users.

“If you bring your child to the playground, it’s quite possible they’re going to come in contact with a used needle. You can’t take your pet for a walk. I live a good distance outside of the city, and I still find them at the bus stop,” Soule-Leclair said.

“I was hoping that fewer needles going out are going to be fewer on the ground.”

Soule-Leclair, like other local officials across Maine, blames syringe services programs for the needle litter and public drug use she sees in her community. But public health experts say needle exchange programs significantly reduce the spread of HIV and hepatitis C without any evidence that they cause more litter.

“I think there’s just general misconceptions about what syringe services programs do,” said Kinna Thakarar, a MaineHealth doctor and infectious disease researcher. “As a mom, I also understand that people may be concerned about syringe litter, but I think the data thus far have shown that syringe services programs, if anything, really help our communities.”

Pushback against the programs comes during an ongoing HIV outbreak in Penobscot County and rising cases in southern Maine. Experts say ordinances and policy changes in Lewiston, Auburn, Bangor and Portland could impact the state’s ability to combat HIV and hepatitis C.

‘WON’T HAVE ANY CLEAN NEEDLES’

Lewiston’s ordinance passed after nearly a year of debate. Where Soule-Leclair wanted to limit needle exchange to one-for-one, the majority of councilors sided with guidance from the Maine Center for Disease Control and Prevention, which permits syringe programs to provide 100 syringes if a client asks for them.

Outside of council chambers, though, health officials say the need for services is increasing. Spurwink, a social service provider with a clinic in Lewiston, is the city’s only remaining syringe exchange program, and their visitors have ballooned from an average of 30 a month to nearly 200 in November.

Syringe services programs are one thread of a holistic approach called harm reduction. Started as a social justice movement in the 1980s and organized largely by people who inject drugs, harm reduction acknowledges that drugs are widely available in society and that their negative consequences can be reduced through social services, overdose prevention and reversal, sex education and syringe services.

Maine’s syringe programs are certified by the state CDC, which aims to raise awareness about the risk of contracting HIV, hepatitis and other infections through shared needles, Lindsay Hammes, spokesperson for the department, said.

In Bangor, the site of Maine’s largest HIV outbreak, CDC data shows that 94% of the 32 cases reported were among people who had used injection drugs within one year of their diagnosis, and the same percentage were also infected with hepatitis C.

The U.S. Centers for Disease Control estimates that syringe services programs can reduce HIV and hepatitis C transmission by about 50%. An analysis of studies about drug use and infectious diseases found that when syringe program access was combined with substance use treatment, hepatitis C risk was reduced by 74%.

At a public hearing this summer, Lewiston councilors heard health data in support of syringe programs from a slew of doctors, harm reduction leaders and a representative from the Maine CDC. Soule-Leclair said “they were there to tell us how wonderful the program is.”

“I haven’t seen any data,” she said in December. “I only know what they tell us when we’re sitting in front of them and we ask them the questions. They tell us there’s data, but we’ve never seen it.”

Because of Maine’s home rule law, which gives municipalities the authority to adopt ordinances and regulate anything that is not specifically mandated by the state, municipal officials can shape local needle exchange policy — even against the recommendations of health experts and advocates.

For Soule-Leclair, who lost her bid for reelection in November, the topic hits close to home. Her nephew was an injection drug user who received sterile needles from the Church of Safe Injection, a needle exchange program that was shut down by the state in August after the city condemned the building, leaving Spurwink as the lone provider in Lewiston.

After her nephew’s death by suicide in 2019, Soule-Leclair said she held a growing resentment toward the organization and the used needles strewn along her walk to work. She ran for office and introduced the ordinance in hopes of reeling in how many syringes the programs can hand out.

“I saw nothing wrong with going back to one-for-one,” Soule-Leclair said. “Other councilors were afraid that they won’t have enough to bring back, and then they won’t have any clean needles. And it’s like: Well, where is their accountability? Where’s their job in their addiction?”

She isn’t the only official concerned that, under Maine’s syringe services rule, a client can receive up to 100 syringes from a syringe program regardless of whether they return needles. In an address to the city earlier this month, Portland Mayor Mark Dion said the city’s needle exchange program is a good measure against transmission but “the 100-needle transaction ratio is something I can’t sell.”

However, a Maine syringe services report revealed that in 2023, participants brought in roughly the same number of needles they received. Syringe programs handed out 1.16 needles for each one they collected that year.

And Ernestine Perreault, community outreach supervisor at Spurwink, said the program serves as a gateway to connect community members with the wide range of services they can receive on Lisbon Street, such as counseling, testing and access to warm clothes.

“You see those conversations grow and grow when people stay longer in the clinic,” Perreault said. “They’ll come in for five minutes, and they’ll stay for 15-20, then they’ll be like: ‘Hey, remember you told me last time that you had rapid testing? I’d like to do that today.'”

‘HUMANIZES OUR COMMUNITY’

Local health providers have steadily built a network of aid across Maine. Bangor health leaders provide guidance to providers in Cumberland County, where five new HIV cases were reported last month. A provider in Portland distributes self-tests in Lewiston, and Spurwink ensures both cities have a steady supply of the overdose reversal drug Narcan and opioid prevention supplies.

With drug overdose deaths down this year in Maine, experts say those efforts are paying off.

But when it comes to syringe services, municipalities can write several of their own rules. Sanford officials recently voted to put a one-year pause on Maine Access Points, a harm reduction organization that brings syringe services to the city and other rural places, in a move that some say gives rise to legal gray area.

“If a municipality were to pass an ordinance that completely limits the operations of a syringe service program, there’s actually many legal experts who believe that would violate the Americans with Disabilities Act,” said Anna McConnell, executive director of Maine Access Points. “But of course, that would require a really substantial lawsuit.”

Or, she says, the state would have to tell municipalities they don’t have the legal authority to restrict syringe services programs, which McConnell said is unlikely. Even a recent amendment to Maine’s syringe services rule that would allow programs to operate mobile sites in a wider geographic area could be overridden by a municipality’s zoning laws.

While drafting Lewiston’s ordinance, some councilors argued to expand land use zones for syringe programs, citing the challenges in accessing Spurwink’s location. It’s two miles from the city center, up a wide, traffic-laden road that most people without access to transportation can’t trek on foot.

Soule-Leclair said that discussion was akin to “creating city policy around drug users, when it’s supposed to be creating it to protect the public.”

But people who use drugs are members of the public, McConnell says. Decision-makers, she said, should use syringe services programs as a bridge to building healthier, more empathetic communities ― where vulnerable residents are not left behind.

“I think that’s going to be really important in the next few years,” McConnell said. “To really help people see harm reduction work in a way that humanizes us and humanizes our community and humanizes the people that use our services.”