Beyond the Stigma: Buy-ins, setbacks for needle exchangeBy SHAWNE K. WICKHAM
New Hampshire Sunday News
June 16. 2018 9:10PM
MANCHESTER - The state's largest city is poised to start a syringe services program (SSP), which would provide clean needles, Narcan, testing for HIV and other diseases, and referrals to treatment for injection drug users.
It would be the fourth such program started in New Hampshire since the Legislature passed an SSP law last year.
But a plan to allow agencies to use federal funding to expand syringe programs here has hit a roadblock.
Tim Soucy, Manchester's public health director, said the health department is partnering with the New Hampshire Harm Reduction Coalition, which oversees an SSP in Strafford County. That program, Hand-Up Health Services, relies on volunteers who distribute supplies and collect used needles for safe disposal in Dover and Rochester.
In addition to providing sterile syringes, any agency that operates an SSP in New Hampshire is required by law to offer Narcan, the overdose reversal drug; condoms to reduce risk of sexually transmitted diseases; testing for HIV and other diseases; and referral to addiction treatment, medical care, mental health services and other support.
Soucy said the proposed plan is for Hand-Up to run the syringe distribution/collection program here, with the health department providing medical testing, Narcan and other health services. And he expects Manchester will use the same "backpack" model of outreach that Hand-Up deploys in Strafford County.
Manchester was considering applying for federal funds made available last month by the state to help start its SSP. The state Department of Health and Human Services issued a Request for Proposals on May 18 for "infrastructure development" of SSPs.
But on June 6, DHHS notified prospective bidders, including Manchester and Hand-Up, that it was canceling the RFP.
Soucy said his office had submitted a letter of intent to apply for the federal funds to start its SSP and was waiting for answers to its questions when the RFP was canceled.
Law has self-funding rule
Jake Leon, spokesman for DHHS, said the RFP conflicted with the language of the 2017 law that authorized community health centers, public health networks, AIDS service organizations, substance misuse treatment agencies and others to operate SSPs "if self-funded."
"The Legislature and the Department fully support the entities identified in RSA 318-B:43 to develop and implement a syringe service program," Leon said in a statement. "Because the 'self-funded' language in the statute prevents the Department from providing any state or federal funding granted to the Department for syringe service programs, the Request for Proposals has been canceled."
Leon said DHHS encourages those looking to develop such a program to reach out to the department for guidance and support through the process.
Kevin Irwin, chairman of the N.H. Harm Reduction Coalition, said he doesn't know who flagged the RFP as problematic but said, "It's profoundly disappointing, obviously."
"I think it's a shame that there's a lost opportunity for the state and the department to be able to demonstrate its full support for this really important community-based response to the negative consequences of substance use that we're all dealing with," he said. "That is really unfortunate."
Last month, Beth Daly, chief of the Bureau of Infectious Disease Control at the state health department, told the Sunday News the state was planning to use HIV prevention funding from the Centers for Disease Control and Prevention to expand SSPs to other areas of the state.
Federal funding can't be used to buy "sterile needles, syringes and/or any other drug preparation equipment," according to Daly, but it can be used for other services such as HIV testing and syringe disposal if the CDC gives permission to do so. Last fall, state health officials obtained that approval.
Daly said her bureau supports expanding such programs as "a good public health measure." And, she said, "At the end of the day, this is saving lives."
Irwin served on the commission that developed the SSP bill that became law. He said the language about "self-funding" was critical to its passage.
"It was stated in the commission quite flatly that this legislation won't pass if there's any kind of a fiscal note attached to it, or expectation of funding," he said.
But he said the language was meant to prevent state funds from being used for SSPs, not to bar federal funding for such programs.
Sen. James Gray, R-Rochester, sponsored the 2017 SSP law after its original House sponsor was not reelected. He said lawmakers "were looking for the compromise" to get the bill passed.
But Gray said he'd be willing to sponsor a change in the law to allow the state to accept federal funding for SSPs. "These things are marathons, not sprints," he said.
Syringe programs in NH
Hand-Up organizers in Rochester and Dover are hoping to expand, and they're seeking donations and new volunteers.
The Southern New Hampshire HIV/AIDS Task Force runs an SSP in Nashua.
A third program, started in Claremont last year by Dartmouth medical students, was suspended because it was too close to a school, contrary to the state's SSP law; organizers hope to restart it soon.
The state law requires SSPs to report quarterly on their activities. Between last June, when the law took effect, and March 31, those three SSPs distributed 54,510 syringes and collected 16,346, according to Daly. They referred or tested 32 people for HIV testing and 33 for hepatitis C testing; distributed 624 kits of Narcan; and referred 47 people for treatment.
Wary of federal strings
Irwin said he would be cautious about using federal dollars for SSP programs if they come with a lot of administrative rules. "That doesn't serve start-up syringe programs well," he said. "The way to get syringe programs up and running is to reduce barriers and reduce burdens."
Irwin said New Hampshire has been "very resourceful" in creating a program with simple reporting requirements. And that's key, he said, especially for a program that depends on volunteers.
Soucy said his department has budgeted about $40,000 to run the syringe program for a year; there's some funding available from a harm reduction grant the city has already been awarded. He also plans to seek funding for a part-time coordinator to get the program up and running.
Soucy said he hopes the Manchester SSP can start in late summer or early fall. He said it has the support of Mayor Joyce Craig and Police Chief Nick Willard.
"We really look at it purely from a harm reduction standpoint," he said. "It's about meeting people where they're at, and that's what we want to do."
Beyond the Stigma, sponsored by the New Hampshire Solutions Journalism Lab at the Nackey S. Loeb School of Communications, is funded by the New Hampshire Charitable Foundation, Dartmouth-Hitchcock Medical Center, NAMI New Hampshire and private individuals. Contact reporter Shawne K. Wickham at firstname.lastname@example.org.