THE PATH OF THE NEEDLE

What Neighborhood Face When Drugstores Sell Needles Like Cigarettes

Rough night. Just couldn't sleep. Needed something, something strong,
a pop to it. Quick stop at the CVS; bottle of water, a lighter, and a
pack of needles.

Here we go.

Junkie or diabetic, this is how easy it is going to be: If you're 18
or older, walk into a pharmacy — your local neighborhood shop, the
Brooks, CVS, Walgreens or Wal-Mart. Walk up to the pharmaceutical
counter. Buy 10. Leave.

Despite the fury of the neighborhood activists who have fought the
sale of hypodermic needles so hard and for so long, and despite Gov.
Mitt Romney's efforts to the contrary, beginning on Sept. 18, anyone
over the age of 18 will be able to buy disposable needles over the
counter, having no more trouble than they would picking up a pack of
Marlboros. And if some needle harm-reduction activist/advocates have
their way, legal and illegal needle users will be able to dispose of
their sharps in several secure "drop boxes" located throughout the
city. It's a movement with some momentum, especially considering the
new law allowing sales calls for some sort of disposal system. (As
this article was going to press, city leaders were scheduled to hold
a hearing on the so-called "Operation YellowBox" yesterday,
Wednesday, Aug. 16.)

The needles are here; they have been for a while. What's changed
comes down to this: It is now legally sanctioned to purchase — over
the counter — and possess one of the oldest forms of medical device.
It will totally reshape the way sharps are acquired and, more
important, the way they're handled after use; how they're disposed of
and where they end up. This is the new path of the needle.

For years, activists and advo-cates, pro and con, have fought a
battle over how available needles should be and where junkies leave
them. It's a vicious fight with few boundaries. There was the
incident in 2004 when Main South neighborhood activist/developer
Frank Zitomersky and City Councilor Barbara Haller confronted an
outreach worker handing out needle bleach kits on Main Street (See
"The battle of Castle Park," Worcester Magazine, July 8, 2004).
Zitomersky — one of the residents who, for years, has worked to clean
up Castle Park practically with his bare hands — got so heated, he
overturned the worker's table. Charges were later filed against him
for allegedly pushing the man. The needle exchange effort got a
little quieter after that.

There's something inherently territorial, something very "West Side
vs. Main South" about the entire controversy. When AIDS
ProjectWorcester director Edla Bloom says, "The person who is a drug
addict is not going to have a sharp dispenser," she is talking about
the homeless user behind the P&W tracks, not the 40-year-old
professional shooting up in his West Side basement while the family
sleeps. This is about poor people and their needles. Let's not
pretend it's about anything else.

Where the path begins

When legalized needle sales start at local pharmacies — and
indications are they will, just as the state bill takes effect on
Sept. 18 — they will be available in almost every corner of the city.
Although the bill does not require pharmacies to sell the clean
needles, several of the larger chains have indicated that they plan
to do so once the law goes into effect. Representatives from both
Wal-Mart and Brooks Pharmacies told The Boston Herald in July that
they would be selling needles, while CVS, Stop&Shop, BJ's Pharmacy
and Walgreens said they would wait until they found out what the new
guidelines would be. But in other states, needles are commonly
available at pharmacies, and one could assume that they would be here
as well. One local pharmacist says that his business is waiting for
more information before they make a decision.

Brian Ambrefe of the Mass. Pharmacists Association says he will
personally allow sales in his Lynnfield store. Still, he admits,
"there is some concern on how to deal with someone who is obviously
under the influence of drugs. There is some trepidation from some
owners in areas with more drug abuse."

While the exact plans aren't clear, one could draw a parallel to the
state's 2005 effort led by Sen. Harriette Chandler (D-Worcester)(and
the similar voluntary effort by big-chain pharmacies) to reduce the
production of crystal meth by placing pseudoephedrine products behind
the counter. Under the new law, you don't need a prescription; but
you have to go to the pharmacist to pick them up. At this point, it
becomes more about controlling needle distribution through required
ID checks than preventing people from getting their hands on them.

Here's an idea of how cheap it's going to be. You can order a 1-inch,
22-gauge needle — the right size for "muscling" (shooting up directly
in the muscle) — from imed.com for $8.13. Of that amount, $7.99 of
that is for shipping; so figure that at the store, that's a 14-cent
needle. Or how about this: For $20.20 including shipping, you get a
100-unit order of 3cc 20-gauge 1-inch syringe/needle combinations.
That needle's a little too big for shooting meth — but the price
isn't much different for something of a better size. And if buyers
are limited to 10 needles per purchase, as proposed, it'll be even cheaper.

And when we say they'll be accessible everywhere, that means
everywhere. This is what really scares opponents of needle
availability: There are more than 50 pharmacies in or right around
the city — more than one per square mile, on average — including
chains (Big Y, Brooks, CVS, Shaw's, Walgreens, Wal-Mart, Price
Chopper, Stop&Shop) and the little guys (Beacon Pharmacy, Park Ave.
Pharmacy, Haig & Haig). If every pharmacy starts selling needles,
opponents claim, no less than utter chaos will result. Not only will
needles litter every park in the city, they say, but giving drug
users easier access means more needles. More needles means more
shooting up; more shooting up means more overdose-related deaths, if
you follow their logic.

On the other hand, advocates say that a better availability of clean,
sterile, disposable needles (partnered, of course, with the Operation
YellowBox, detailed below), will mean a lower instance of shared
needles, thus meaning a lower transmission rate of blood-borne
diseases, most notably HIV/AIDS and hepatitis. As an aside, they also
say it makes obtained needles slightly easier for legal users — those
who have diabetes or another disease requiring needles — who
currently need a prescription to get them. Sen. Chandler is clear:
"I'm not going to tell you it's going to be dramatic," she says,
rather saying there will be a "slight diminishment."

The end of the official path

As the current plan stands, if the drop boxes are approved — and it
looks like with the new law it'll happen this time around — they will
first be placed at seven locations: AIDS ProjectWorcester, The Great
Brook Valley Heath Center, The PIP Shelter, The Willis Center, the
Meade Street home of the Worcester Department of Health & Human
Services, a private practice on Belmont Street, and at the Graham
Putnam Funeral Home at 833 Main St. The placement of the boxes is
entirely up to whoever runs the building they're placed at, hence the
locations at agencies and businesses that are in high-risk
neighborhoods or that have long supported harm-reduction programs.
Still, every single location is bound to be controversial.

For one, the location of the boxes is heavily weighted toward Main
South. Four of the seven are within a short walk of each other; two
on Main Street (The PIP Shelter at 701 Main St. and the Graham Putnam
Funeral Home) and two on the other side of the railroad tracks (AIDS
ProjectWorcester on Green Street and the DPH on Meade Street). No two
of those boxes will be more than a mile from another. Indeed, Haller
says, "My initial reaction was to be insulted that the five locations
were all inner-city locations."

On the other hand, even advocates of the boxes admit there aren't
enough agreed-upon locations, especially in "high-risk" areas like
Great Brook Valley, which only has one proposed box as of press time.
If the goal is to reduce the number of needles being left behind in
parks and back alleys and abandoned lots by chronic users, you need
to have more than one box in a high-risk area.

But that is really the heart of the dilemma: NIMBYs and opponents
will criticize Operation Yellowbox either way — either there are too
many boxes in high-risk areas, essentially encouraging users to hang
around there and continue to shoot up and the like; or there are not
enough boxes, and thus their purpose isn't being fulfilled.

The other big question opponents raise is whether or not drug users
will bother to place used needles in the boxes, or will be willing to
walk up to them in daylight to toss their waste. Two of the most
vocal opponents of any needle legitimization, Main South's Billy
Breault and Haller, have long stood against any plan that would make
it seemingly more "right" for addicts to possess needles. Both have
also voiced the opinion that many of their peers share: that the
"true" users — and by that, they mean the hardcore junkies sprinkled
through Main South, not the "high-class" user — will never use a drop
box system, even if its available. "I'm not sure whose going to be
using these boxes," says Haller.

Nonetheless, Chandler says the boxes should allay some fears. "That's
the last piece that worries people — how to dispose of them," she says.

Advocates maintain that the boxes will have some good positive
effect. Maybe not all needles will end up in the drop boxes, but if
half do, it's a win.

Bloom is optimistic. "I do think people will dispose," she says.
"Let's provide the vehicles so the syringes will not get dropped on
the ground."

In her eyes, it comes down to the simple philosophy of harm
reduction. Needles are already in play, so let's reduce their
negative impact on public health, the theory goes.

"The person who is a drug addict is not going to have a sharp
disposer," she says, bringing up the old chestnut, "People who are
drug addicts are just like the rest of us — they're people."

Bloom also cites the success of the program in other cities, but the
list of communities is certainly shorter than those offering needle
exchange programs. Baltimore tried an "Operation Red Box" for a short
time in the 1990s; the Greater Seattle area has a comprehensive
harm-reduction program that includes 12 drop boxes and several other
needle disposal sites in the King County area. According to a report
issued by Worcester Health Commissioner Leonard Morse, there are also
drop-box programs in California, Maryland, Rhode Island, New York,
Florida, Minnesota, Iowa, New Mexico and Wisconsin. The report also
cites limited Massachusetts programs in Franklin County and Haverhill.

If you accept that the boxes (or at least the places where they'll be
located) are centered at least somewhat strategically, you can also
get a pretty good picture of where the needles will be left when they
aren't properly disposed.

Within walking distance of the Main Street drop boxes alone are
several parks that have a long standing history with needles and drug
paraphernalia — Castle Park, University Park and Beaver Brook Park.
And then there are the abandoned lots, shantytowns and train-track
hideouts that dot the landscape in between. Having fought for so long
to get the needles out of their neighborhood, it is understandable
that the three — Haller, Breault, Zitomersky and the rest of their
ilk — would adamantly oppose anything that would endorse needle use.
"I don't think continuing to stigmatize inner-city neighborhoods is
the way [to solve this]," says Haller. "If we have to go the
yellow-box route, I'd say we have to put them all over the city. I'm
not coming to the table convinced."

What they really want

Even advocates who pushed for the OTC needle sales and drop-box
program admit it isn't the full boat that they wanted. Edla Bloom
says a fully supported program working with injection drug users
"wasn't meant to be. Although we feel a real full harm/risk reduction
program is very important, you have to take smaller steps," she says,
quickly adding that she isn't proposing that the city turn to a
needle exchange program at this point. Still, you can hear it in her
voice, and in the whispers of the harm-reduction crowd: A full needle
exchange program would be the ideal.

State Sen. Harriette Chandler says that a needle-exchange program is
"not necessarily" her goal, but she does admit that there are some
shortcomings of the OTC sale and drop-box program. "We're talking
about clean needles in both cases. Making it just a bit easier to use
clean needles, and not get/share infection. But in one case [needle
exchange], not only do they get a clean needle, they also get some
assistance in terms of rehab. They don't get that here. There's no
advocacy for rehab."

Despite that, Chandler says that she sees the benefit of only going
this far. "One of the chief complaints from opponents of exchange
programs is that having the state pay for needles is essentially
endorsing drug use," she says. "Under the new law, however, at least
the state is not paying for the needle — they're buying it.

"We tried to do this bill before," says Chandler. "Its taken people
awhile to understand that it's not going to cause an epidemic of
needles. It hasn't in the other 46 states [with programs]."

—S.Z.

As much as social service siting divides people, needle programs have
the potential to be the most polarizing issue in the city. Needle
advocates paint a picture of it being a public health concern,
opponents turn around and raise the same issue from a different point
of view. It gets ugly: listening to opponents, you would think that
drop box and OTC sale advocates were supporting open heroin use.

It's one of those issues so divisive, rivals even disagree about the
facts. In one letter sent out by Breault's Main South Alliance for
Public Safety in May, a bolded statement called out a major argument
of needle-sale advocates: "Claims that Massachusetts is one of only
three states that have not decriminalized needle sales are false and
misleading."

The fight isn't over the availability of needles to control diabetes
or the like. What the battle boils down to is the question of the
health hazards, to innocents and themselves, of junkies on the
streets. On one side is the trash and threat to the community that
has to host the wasted. On the other side, there's the threat of
HIV/AIDS between users who share needles they can't get otherwise.

Well, now the state has made its choice and we're al