Maine is a rural state, where many people who use drugs may be forced to drive three or four hours to access naloxone or sterile drug-use supplies. When Jesse Harvey founded the Church of Safe Injection (CoSI), distributing harm reduction supplies from the trunk of his car, he understood the needs of people who use drugs here. And those needs included being able to stock up on however many syringes they asked for; they might not see him again for a while.
Before his death in September 2020, he was hesitant about CoSI becoming the authorized syringe service program (SSP) it is today—we have to comply with the state policy that limits SSP from giving out more syringes than participants brought back to us used.
The “1:1” restriction forces us to put people directly in harm’s way. It’s really that simple.
It’s our job as SSP workers to help people who use drugs reduce harm, but the “1:1” restriction, as it’s often called, forces us to put people directly in harm’s way. It’s really that simple.
On February 1, the state is holding a public hearing on LD1909, a bill that would allow SSP to give out sterile syringes to everyone who needs them, regardless of whether they return any used ones. It would also allow them to take more than 10 syringes at a time. There is hope that this bill will pass—although amendments or a veto by the governor are possible.
Sterile syringes are basic medical necessities for people who inject drugs. When people don’t have access to new syringes, they often can’t wait until they do. Reusing syringes increases risk of abscesses and serious, sometimes life-threatening infections. Sharing syringes increases risk of transmitting blood-borne viruses like HIV and hepatitis C.
We are not adequately engaging with people who use drugs in Maine, and it shows. In 2021, at least 636 people died of overdose. Hepatitis C cases were rapidly rising even before the pandemic. We need to update the rules for SSP in Maine, and in every state with its own version of this restrictive policy, to allow people to access the number of syringes they actually need.
Needs-based syringe distribution is how we protect public health—for everyone, whether they use drugs or not.
Needs-based models are considered the best public health practice by the Centers for Disease Control and Prevention as well as SSP workers. In Maine, SSP workers and participants saw the benefit of removing 1:1 when, early in the pandemic, it was temporarily suspended and everyone was able to operate without it. Executive Order 27 had also allowed SSP to order supplies by mail and to expand our outreach capabilities.
However, on August 31, 2021—International Overdose Awareness Day—that suspension ended. Maine SSP have since been forced to operate according to 1:1.
Needs-based syringe distribution is how we protect public health—for everyone, whether they use drugs or not. And for those who do, it helps us connect them with support and resources, and treat them with the dignity and respect they deserve.
It is time to end the disastrous, baseless 1:1 restriction and support models that connect people to the lifesaving harm reduction resources they need. Even if it’s from the trunk of a car.
Photograph via US Department of Veterans Affairs
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Kari is the executive director of the Church of Safe Injection, a person living with HIV and a former sex worker and injection drug user.
Kinna is an infectious disease and addiction medicine physician who works with community organizations in Maine to reduce risk of infections among people who use drugs.
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