Discarded Syringes Reveal Stigma's Role in Growing Opiate and Hepatitis Epidemics

Turners Falls is a picturesque unincorporated village in Western Massachusetts near Springfield. The small, former mill town is nestled in the Berkshire Mountains and has gained a reputation as a center for arts and crafts. But now it's garnering unwanted notoriety: The rural community is experiencing an increase in heroin addiction. "Discarded syringes are turning up everywhere," reported New England Public Radio in a segment broadcast April 28 on National Public Radio. Now that the long, hard winter is over, Police Chief Chip Dodge has taken the unusual step of asking residents to help locate discarded syringes.

"It's gotten worse, Dodge says, since Massachusetts legalized possession of hypodermic needles in 2006," the report added without question. "That meant less spread of disease through needle-sharing but more needles around."

Not exactly.

Massachusetts is one of at least 37 states and the District of Columbia that allow some form of the sale of non-prescription, sterile syringes. But it's too simplistic and stigmatizing to blame those laws for an increase in discarded syringes, according to policy and harm reduction advocates. The discarded syringes are indicative of three public health challenges: A surge in injection drug use across the state, the ongoing challenge of safe and accessible syringe disposal and the rise in infectious disease -- namely hepatitis.

A public health emergency across the commonwealth was declared in March 2014 to address an increase in opiate use and fatal overdoses across the state.

The statewide emergency was declared after 185 opioid overdoses were recorded between December 2013 and February 2014. The 902 total confirmed fatal opioid-related overdose deaths in 2013 was already a 27% increase over the previous year, according to a December 2014 report from the Massachusetts Department of Public Health.

"This is another example of a community that has to catch up with the rates of injection drug use that are happening right in their backyard," said Daniel Raymond, policy director for the New York City-based Harm Reduction Coalition. "The question should be, 'How can we facilitate safe syringe exchange disposal?' We know from syringe exchange programs that people who inject drugs want to be responsible in the disposal of their syringes. But there usually are not places to dispose syringes."

Stigma is also a considerable barrier to safe syringe disposal. "People fear that they will be arrested if syringes are found on them or targeted for other charges," added Raymond.

In fact, Massachusetts adopted aggressive regulations to address syringe disposal at the same time that over-the-counter syringe sales were implemented in 2006. New regulations banned the disposal of syringes in trash or recycling, and cities and towns were tasked with establishing syringe disposal systems. The Massachusetts Department of Public Health purchased disposal kiosks across the state, and a statewide directory documents hundreds of these syringe and medical waste disposal locations across the commonwealth.

But there is no listing for Turners Falls.

Nationwide, there has been an explosion of heroin and injectable opioid drug use in rural areas. The trend began in the early 2000s with the introduction of the powerful painkiller OxyContin. "Many of these people eventually began injecting heroin because it is cheaper than painkillers and more accessible," explained Raymond.

The rural heroin epidemic has received national attention in recent weeks. About 150 new HIV infections have been reported in a rural region in Southern Indiana near the Kentucky border. Republican Gov. Mike Pence authorized a syringe exchange program "but it's not running according to best practices," reported the New York Times on May 5.

Syringe exchange programs have also been recently authorized in Kentucky and Ohio. These "are not perfect programs but they are steps in the right direction," said Drug Policy Alliance Executive Director Bill Piper. "The fact that conservative rural states are beginning to do this is a good sign that the politics are shifting."

About 15% of the 1.2 million Americas who are living with HIV infection inject drugs, according to the U.S. Centers for Disease Control and Prevention.

In Massachusetts, men who have sex with men and injection drug users are the leading transmission categories for HIV infection. Those categories accounted for 37% and 19% of all reported HIV cases in 2013, according to the Massachusetts Department of Public Health's Office of HIV/AIDS.

New HIV infections among injection drug users have steadily declined across the state. But the rural opioid epidemic has also fueled a surge in hepatitis C virus (HCV) infections, according to state health officials. More than 2,000 new HCV cases have been identified in Massachusetts in the past few years and most cases occur in people under the age of 30 who inject drugs and share contaminated needles, according to Massachusetts Department of Public Health data quoted in an April 15 article in the Worcester Telegram.

There are only about five syringe exchange programs across Massachusetts. Those are located in Boston, Cambridge, Holyoke, Northampton -- around 20 miles from Turners Falls -- and Provincetown.

Across the country, the surge in injection drug use has taxed the already under-resourced small town and rural public health infrastructure. "Many of these rural communities do not have many public health resources or drug treatment facilities," said Raymond. "They certainly do not have much history with HIV and hepatitis."

Rod McCullom has written and produced for ABC News and NBC, Scientific American, The Atlantic, Ebony, Poz and many others. He will become a Knight Science Journalism Fellow at the Massachusetts Institute of Technology later this summer. His website is Rod20.com.