Portland Threatens Shutdown of Public Health Center, Needle Exchange

By Brian Whitney 04/29/16

The India Street Public Health Center provides services such as HIV care, a needle exchange, and the only STD clinic in the state.

Needle Exchange Bin

People that live in Maine have become accustomed to questionable moves by their Governor Paul LePage, particularly when it comes to drug policy. There was the time that he suggested that drug dealers should be put to death by guillotine, and who could forget when he said that guys named "D-Money" were going to come to Maine to impregnate the white women?

As much as LePage can be unintentionally comical, there is nothing amusing about Maine’s drug problem. There were 272 overdose deaths in Maine in 2015, which was up a stunning 31% from 2014.

In this environment, public health services for drug users are needed more than ever. So why is the progressive city of Portland threatening to close down its well-respected needle exchange program? The program collects 150,000 syringes a year and offers vital HIV and hepatitis C testing, overdose prevention education, and harm reduction education. In Maine, Narcan, the opioid overdose antidote, is available with a prescription; the benefit of the needle exchange being housed within a clinical setting means that the clinicians can write prescriptions for staff to distribute Narcan kits to those at risk of an overdose. There is no plan in place to continue this program, which is currently operated with donated supplies.  

Needle bins inside the clinic.

Portland City Manager Jon Jennings has proposed a budget that would eliminate funding for the India Street Public Health Center, a city-run clinic that houses several different programs including the needle exchange, the only STD clinic in the state, and Positive Healthcare, a Ryan White program which provides primary care and HIV specialty care to individuals living with HIV. All of the programs run through the public health clinic are 85% grant funded and the city contributes toward infrastructure costs and fringe benefits for the employees.

These services are not duplicated anywhere else in the city, or in the state, and transitioning them without a clear plan could result in many vulnerable people falling through the cracks with potentially disastrous results. Jennings and other city officials argue that the city should move away from providing direct service and instead rely on the support of hospitals and other nonprofits to provide direct clinical care. According to Jennings, the municipal role should focus on the basics of the city charter such as paving roads, fixing sidewalks, and speeding up the process for securing a building permit. In addition, the budget includes funding to expand the city-run golf course and restaurant.

Portland Mayor Ethan Strimling opposes the plan to close the programs, and said in a speech to the council that Jennings is devoting more resources to public works than public health. Strimling sent The Fix his speech which said in part: “The proposed transition is a hypothetical plan, with no current oversight or contracts in place to assure seamless transition and continued quality of care for some of the hardest to reach and most vulnerable members of Portland. To assume that another community agency could continue the quality of services, provided in the same wraparound manner, by the same compassionate individuals is irresponsible and shortsighted.”

Annie Spencer, who is a PhD researcher writing a dissertation on the opioid epidemic who volunteers with India Street's Needle Exchange Program told The Fix that “Shuttering the clinic would be massively destabilizing to our community. In one day last July, 14 people overdosed in our tiny city. Detox facilities have shuttered their doors in the midst of the crisis, citing lack of funding. We need more public dollars for public health care, to not do so produces more suffering and premature death by overdose, [more cases of] infectious disease, [and] incarceration.”

Jennings and other city officials are proposing that all programs operated at the India Street Public Health clinic are transitioned to the Portland Community Health Center (PCHC), and the non-profit federally funded Federally Qualified Health Center. 

The transition plan doesn't take into account the complex nature of the HIV positive patients who currently have strong relationships with their providers and can receive their care all in one medical home. These relationships cannot simply be transferred to new providers. Additionally, there is no guarantee that PCHC will be awarded the Ryan White grant to serve HIV positive patients. There is no plan in place to continue providing walk-in low barrier STD screening services as well as HIV and hepatitis C testing, and no appropriate location to house the needle exchange.  

The leadership of Preble Street, a Portland-based nonprofit social service agency that works to meet the urgent needs of people experiencing homelessness, hunger and poverty, and advocates for solutions to those problems, has serious concerns about the possibility of the transition. “There are some really strong staff at PCHC we work with everyday, but they don’t have the capacity to support fully what the city offered before,” said Mark Swann, Executive Director at Preble Street.

On Thursday, protesters took to the street to urge city council members to vote against closing the clinic. The council is scheduled to vote on the budget May 16.

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Brian Whitney has been a prisoner advocate, a landscaper, and a homeless outreach worker. He has written or coauthored numerous books in addition to writing for AlterNetTheFixPacific Standard MagazinePaste Magazine, and many other publications. He has appeared or been featured in Inside Edition, Fox News, People.com, Cracked.com, True Murder, Savage Love and True Crime Garage. He is appearing at CrimeCon in 2019. You can find Brian on Facebook or at Brianwhitneyauthor.com.