A discarded needle is seen Thursday in an alleyway in Lewiston. City officials are in discussions with the Church of Safe Injection, which operates a needle exchange program in Lewiston, about how to reduce needle waste while maintaining policies focused on harm reduction for people with substance use disorder. Andree Kehn/Sun Journal

LEWISTON — As the spring thaw melts the snow, a winter’s worth of litter is uncovered.

In Lewiston in recent years, that litter has included discarded syringes, which can routinely be found in public parks, playgrounds, in trash cans or lying in the street.

Two weeks ago, a Public Works crew picked up 3,600 pounds of litter downtown in a single day, including more than 100 needles. It’s a visible reminder of the opioid epidemic that has ravaged the country, with Maine’s largest cities taking on an outsized role in confronting the issue.

While needle waste has been a source of ongoing public concern for several years, Lewiston officials reignited a debate last week over needle exchange programs and whether the status quo is sustainable for a city that’s trying to reshape its image.

‘An epic fail’

Councilors have said they find needles in the streets on daily walks, and that businesses find them in doorways. The Lewiston Public Library has recently put a shorter time limit on bathroom use, with patrons sometimes finding used needles left behind.

Speaking to her fellow councilors last week, Councilor Eryn Soule-Leclair said local needle exchange programs are “an epic fail,” and that Lewiston should have licensing control over them. She and fellow Councilor Susan Longchamps questioned how much “exchanging” is actually happening, and they pointed to one organization in particular.

“The blame falls on the users and suppliers, and we have a supplier sitting right on Main Street,” Soule-Leclair said.

The Church of Safe Injection, at 195 Main St., is one of two syringe service programs in Lewiston, which are certified and overseen by the Maine Center for Disease Control and Prevention. The organization operates a needle exchange program, in which used needles are traded for new ones, but also provides sterile supplies, Naloxone and services like health testing.

Zoe Brokos, executive director of the Church of Safe Injection in Lewiston, assembles sharps containers at her desk Thursday night at the harm reduction nonprofit on Main Street. The organization takes steps to reduce needle waste, she says. “Collecting as many used syringes as possible is our goal too.” Russ Dillingham/Sun Journal
Buy Image

COSI operates under a harm reduction model, which is meant to reduce the shame and stigma of substance use while offering access to clean supplies in order to reduce transmission of blood-borne diseases like hepatitis C and HIV.

Zoe Brokos, COSI’s director, said the work of her organization and others like it is largely misunderstood. She’s planning to meet with the council soon to discuss their work and is willing to team with Public Works staff in cleanup efforts.

But, Brokos said, she’s wary of any policy changes that could make the organization’s work more difficult.

The prevalence of discarded needles in Maine cities where exchange programs operate has been a source of contention in recent years. Some point to a 2022 change that moved away from a one-to-one needle exchange to a more needs-based model, under which programs can give out as many as 100 clean needles at a time. But advocates say research has proved its effectiveness and that programs generally take in as many needles as they give out.

“Collecting as many used syringes as possible is our goal too,” Brokos said. “We don’t want people seeing them on the street. Ensuring that we get as many used syringes back is really important to us.”

In Portland, a recent attempt to return to the one-to-one model failed, with officials instead initiating a pilot buyback program, which has been deemed successful in its first two months. The early optimism has some Lewiston officials eyeing a similar effort.

Hundreds of syringes

It’s not uncommon for someone to bring back hundreds or even thousands of needles to the Church of Safe Injection office at one time. Brokos said that’s part of the difficulty of giving an accurate picture of the program.

COSI is required to submit monthly and annual reports to the CDC on the number of syringes it takes in and gives out. The most recent annual reports show that the organization gave out between 25%-50% more syringes than it collected. But, she said, depending on when the data is taken, it can be a skewed number.

The organization gives out some larger sharps containers, which can hold hundreds of syringes, and people don’t typically return them until they’re full. She said that means someone might bring back a few thousand syringes the month after the annual report is filed.

In January 2024, COSI collected 14,238 syringes and distributed 19,400. In January of this year, it collected 10,580 and distributed 9,200. In February, it collected 4,335 and distributed 9,380.

A sharps container filled with used needles is pictured Thursday night at the Church of Safe Injection on Main Street in Lewiston. Russ Dillingham/Sun Journal
Buy Image

The Main Street office sees an average of 25-50 people a day, with most people exchanging anywhere from 10-100 needles at a time. It often depends on factors like the person’s living situation; someone who’s unhoused might only take a small number, with the knowledge that they can return the next day if needed.

Brokos said that when a participant comes in COSI to exchange needles, there’s essentially a negotiation that takes place between the participant and staff. The number of needles handed out is based on several factors, including the relationship the organization has with the individual, how often the person is able to come in, or if they’re traveling from far away. Then staff determines a number that works for both the individual and the organization, Brokos said.

Brokos said since COSI has limited funding, they don’t want to be giving out more supplies than are needed either.

“We don’t just give someone 100 syringes when they come in,” she said. “That doesn’t work for us, and it certainly doesn’t work for the community.”

The Maine CDC’s syringe service report from 2023 states that needle exchanges handed out 1.16 syringes for each one they collected.

But still, the needle waste in Lewiston continues to pile up, and in very public places that are popular with children. There are often posts on the popular Lewiston Rocks community Facebook page regarding needle waste and locations to watch out for.

‘Anger and frustration’

During the recent council discussion, Longchamps said the amount of needles being distributed is “definitely a danger to our community.”

“Many people have gotten stuck, from trash collectors to just people trying to pick up their yard,” she said.

Soule-Leclair said the city’s Public Works Department “should not have to be responsible for what’s happening.”

City staff and COSI have held recent talks about how to make the sharps disposal program more effective, which could include COSI taking a more active role in monitoring or emptying sharps boxes.

A used needle sits Thursday under the bushes on the edge of Dufresne Park in Lewiston. Andree Kehn/Sun Journal

Brokos believes some of the boxes — which the organization helped get installed — should be placed in different locations. According to the city, there were a dozen boxes installed initially but only seven remain due to theft or damage.

Council President David Chittim said he and some city staff met with COSI last week and “made significant progress toward a cooperative arrangement.”

He said while he was reluctant to share details until a formal agreement is in place, “I can say that both COSI and staff were pleased with the direction we’re headed” and that they will meet again in April. He said COSI will then make a presentation to the council in June.

The city could also pursue a buyback program like Portland’s, or more local control over needle exchanges.

Councilor Josh Nagine said he agrees with harm reduction as a health model, but believes Lewiston needs local control through licensing and ordinances “to address some of the unintended consequences of needle exchange operations in the city.”

“While needle exchanges are not the only source, improperly discarded syringes are a serious public health, safety, and image issue,” he said. “I’m open to a combination of approaches, including a limited pilot buyback program funded by opioid settlement funds.”

According to city staff, Lewiston has $169,207 in opioid settlement funds remaining. Portland’s buyback program was established in October using $52,000 from the city’s opioid settlement fund and is expected to last just one year.

When asked about the potential for local licensing, Brokos said COSI wants to “be part of the solution, and at the same time the last thing I want is for a municipality to implement something that makes it harder to do our work or goes against our harm reduction philosophy.”

A used applicator for Narcan, an overdose-reversal drug, sits Thursday on the side of Middle Street in Lewiston. Andree Kehn/Sun Journal

“This issue triggers a lot of feelings in people,” Brokos said. “I hear the anger and frustration from councilors, and want to use it as an opportunity to educate.”

The Church of Safe Injection, which has had a rocky relationship with the city, isn’t the only needle exchange program in Lewiston: Spurwink operates a program on outer Lisbon Street.

But COSI’s location downtown, near businesses that rely on foot traffic, has some officials concerned, and makes the organization a target for those frustrated with needle waste.

During the recent council discussion, Longchamps said the Main Street building looks like “a dump,” and that the organization shouldn’t be located there.

Nagine said it’s “difficult to picture a Gifford’s Ice Cream next to COSI as it exists today,” and he reminded fellow councilors that “we have the ability, regardless of the state laws, to control by ordinance and zoning what we want to see in our community.”

“They’re not looking to be a problem in our community, but that doesn’t mean there aren’t needles everywhere,” he said.

Hopeful discussions

But Brokos said she’s hopeful based on recent talks that they can work with the city to move past some of the static and address the complicated problems.

“It’s not helpful, and it certainly doesn’t protect our participants, if we’re operating in a way that is not supported by the municipality we’re in,” she said, adding that the organization has plans to renovate the Main Street building.

COSI’s relationship with the city was fraught from the start. Its late founder, Jesse Harvey, took an approach more akin to civil disobedience, which Brokos said didn’t help the organization with its goal of implementing evidence-based public health strategies. She said ultimately Harvey’s approach “wasn’t necessary because you had the research and the medical community to back you up.”

Brokos said she’s heard from both staff and some councilors that they don’t want to implement something that goes against the goals of harm reduction, which requires flexibility in order to work well.

“We have continued to show through time, whether it’s HIV outbreaks or rises in overdoses, that it’s critical we can respond to the needs of our community, and that changes over time,” she said. “We don’t want to be in the position of knowingly letting people walk out the door to go reuse used equipment.”

Church of Safe Injection Executive Director Zoe Brokos, pictured Thursday in Lewiston, says she doesn’t want the city to make changes that would threaten the organization’s ability to provide public health services to residents through its needle exchange program. Russ Dillingham/Sun Journal
Buy Image

In 2021, the U.S. Centers for Disease Control and Prevention reported that Maine had the second highest rate of transmission for hepatitis C in the nation.

The CDC states that needle exchange programs “are safe, effective, and cost-saving, do not increase illegal drug use or crime, and play an important role in reducing the transmission of viral hepatitis, HIV and other infections.”

Rowan McFadden, health promotion coordinator for Healthy Androscoggin, also facilitates the Lewiston Auburn Area Recovery Collaborative, which developed a five-year plan to address opioid overdoses.

McFadden said research has continued to show that “access to safe and sterile syringes through (needle exchanges) across the nation has either no effect or reduces community syringe waste.”

He said the collaborative’s work in 2024 identified a “gap in services” regarding syringe disposal locations.

“When looking at the issue of needle waste within communities there is no question that this is a multifaceted issue, but there continues to be research supporting additional interventions, as opposed to a reduction or restriction of interventions,” he said.

This week, in response to proposed legislation that would return Maine to the one-to-one exchange model, the Legislature’s Health and Human Services Committee said municipalities should decide themselves.

Mayor Carl Sheline said last week that harm reduction work is frequently misunderstood and that “the recent rhetoric hasn’t been helpful in the fight against substance use.”

“We need to get past the tired talking points and develop real solutions that protect area businesses and keep our parks free of needles while still making progress for our neighbors suffering from substance use,” he said. “I look forward to working with COSI to take concrete steps to address this issue.”

Others on the council said they are interested in the buyback program option, but are hesitant until Portland sees more data.

Harriman said it can be tempting to want to simply close needle exchange programs, particularly one that’s so visible. But he said he hasn’t “seen any information that would indicate that shuttering (needle exchanges) would reduce the amount of syringe litter.”

“One major service they provide is the proper disposal of syringes,” he said. “We need to be careful not to trade one particular public health issue for a worse one.”