Needle exchange programs for drug users could be coming to six counties across the state, including Anne Arundel and Baltimore counties, as state health officials work with local leaders to stop the spread of infectious diseases in the face of the heroin epidemic.
The efforts are being lead locally and are at various stages of formation, but state officials are encouraging the programs and offering technical assistance and some funding, said Onyeka Anaedozie, deputy director of the Maryland Department of Health's Infectious Disease Prevention and Health Services Bureau.
"We've talked to leadership in the jurisdictions about the importance of having a standing syringe services program," she said. "We want the efforts lead by the local jurisdictions."
The counties in some stage of planning or at least consideration include Anne Arundel and Baltimore in the metro area, Frederick and Washington in Western Maryland, Dorchester on the Eastern Shore and Prince George's near Washington, D.C. Baltimore City currently has the state's only operating program, launched in 1994. It relies largely on mobile units, which provide services in 16 locations around the city 26 times a week.
The growing acceptance of needle exchange reflects changing attitudes toward the often controversial programs, which critics say use taxpayer dollars to promote drug use and cause drug users to congregate at exchange sites. While the Baltimore program has been around for years, the state passed legislation only last year allowing the programs to be established elsewhere around the state. The Republican-controlled Congress also passed a law early last year allowing federal funds to be used for needle exchange.
Anaedozie said the state's push began in 2015 after rural Scott County, Ind., began reporting a spike in HIV and hepatitis C infections related to the opioid crisis there.
Maryland has not seen a related jump in infections; federal data shows HIV cases have been trending down in the state in recent years especially among IV drug users. But officials recognize drug use poses risks and leaders in the state have pursued a number of prevention, treatment and "harm reduction" measures that can be folded into needle programs.
Overdoses deaths continue to climb across the state, with more than 2,000 deaths last year, up 66 percent from 2015. Most deaths were linked to heroin and fentanyl, opioids that can be injected.
Needle programs in some Maryland counties could be up and running by year's end or early next year and are expected to offer clean syringes to users, disease testing and counseling and referral for treatment for infections and substance abuse, Anaedozie said. Some drug users not yet ready for treatment could still get needles and perhaps a dose of the opioid overdose reversal drug naloxone.
The counties have been working to get backing from local law enforcement and elected officials as well as neighborhoods and treatment communities — a requirement by the health officials in the state, which passed a law last year allowing expansion of needle exchanges around Maryland.
"It won't work unless there is buy-in from all the groups," Anaedozie said.
Getting such support is time consuming, she added. The counties need to determine how to provide testing for HIV and hepatitis and how to link people to care. Some health departments will do the work in house and others will rely on federally supported health centers already offering services. Some counties will open physical locations and other will operate mobile vans.
In Anne Arundel, County Executive Sheve Schuh directed health officials to consider such a program because the transmission of HIV "remains a public health concern in the county."
A spokesman for Schuh said the executive continues to have reservations that such programs would encourage people's drug habits but wants to have an open mind and see if the programs could be effective.
Councilman John Grasso, a Republican from Glen Burnie, said he would support the program.
"I would rather give someone a clean needle and prevent them from the possibility of getting AIDS," he said, adding that "a needle is a hell of a lot cheaper."
Dr. Peter Beilenson, the former Baltimore health commissioner who launched the city's program, said more pubic officials seem to be overcoming their concerns and reaching that conclusion.
He said there is a wealth of scientific evidence supporting such program's effectiveness at preventing disease and none to show an increase in drug use. And most opposition is political rather than community based. In fact, the Baltimore program initially went only to neighborhoods that requested the services, said Beilenson, now CEO of the Baltimore health insurer Evergreen Health.
"In the first five years of the program, I had seven people calling me about needle exchange: five positive and two negative," he said. "There were no problems whatsoever with NIMBY," or not in my back yard.
He believes opposition generally comes from politicians who fear the programs suggest their locales have a drug problem, possibly hampering economic development.
State officials say support is crucial to launch the programs. Counties must seek the state health department's permission to stand up programs, demonstrating in their applications that they've gotten local support and they have a specific plan. However, she added, the state's sign-off is a formality if those conditions are met.
Counties also can apply for funding for specific needs, though the department could not say how much money would be available.
It's not clear how each program will take shape and all are likely to look a little different. In Baltimore County, for example, health officials have proposed adding needle exchange to the services provided to patients with HIV and Hepatitis C, said Monique Lyle, a county spokeswoman.
Patients who are treated for those diseases at county health centers would be offered the ability to exchange their needles, Lyle said. Those patients also would be offered education on using clean needles, wound care, prevention of sexually transmitted infections and immunizations. The patients and their family members also will be trained in using the opioid overdose drug naloxone.
Dr. Leana Wen, Baltimore's health commissioner, said she's worked to make all her county counterparts aware of how the city program works and has provided more specific assistance to those who have requested it.
The city's program costs about $800,000 annually and dispenses about a half million clean needles a year, in addition to supplying other services.
Wen said so much stigma remains associated with drug use generally, but she hopes to clear misconceptions about needle programs that she said can prevent disease. She said when the city program launched 23 years ago, 63 percent of those with HIV were IV drug users. By 2014, the only 7 percent were IV drug users, contributing to one of the nation's largest drops in new HIV cases.
She called needle exchange programs "a powerful tool" to prevent harm, though she's seen resistance across the country.
"It's not about condoning or supporting drug use," she said. "The first principal of public health is to protect the population from harm. We've seen this result. … That is why it's important for us to share our experience."
Baltimore Sun reporter Pamela Wood and Baltimore Sun Media Group reporter Phil Davis contributed to this report.