Multnomah County is considering cutting back on a public health program that experts say is extremely effective at reducing the transmission of life-threatening diseases.
In some quarters, that will come as welcome news.
Every Wednesday in Gresham, a white van parks between a gated fence and a speedy, two-way street. Inside the van is one of the county's mobile needle exchanges, where intravenous drug users can pick up clean needles to reduce the rates of disease spread by reusing dirty ones.
If the county's 2020 budget is passed without change, the Gresham mobile exchange will shut down in June.
Multnomah County knows needle exchanges work. They've been shown to decrease the contraction of HIV and other bloodborne diseases by distributing sanitary needles to drug users, which ultimately saves public coffers money.
The county has placed six needle drop boxes around the city to safely dispose of sharps, and it contracts with several nonprofits that offer needle exchanges. The county collects 7 million needles a year.
But the county has proposed shaving its Harm Reduction program, which operates needle exchanges, by roughly $200,000 in next year's budget. The county will present its final budget in late May.
The proposed budget would get rid of one of two mobile exchange sites, in Gresham on Southeast 190th Avenue—and it would also discontinue handing out sharps containers for dirty needles citywide.
The Multnomah County Health Department, like all county agencies, was asked to trim its budget by 3 percent this year. It picked this program to make a portion of the cuts.
The health department says it had little choice. "Because of restrictions on using federal funds to support syringe exchange programs," says Rachael Banks, the public health director for the health department, "Harm Reduction relies more heavily than other programs on [the general fund]—the area hardest hit by budget restraints."
It's not unusual at budget season for government agencies to propose cuts to popular programs. But in this case, some residents have expressed distaste for the sites.
In Portland, hypodermic syringes scattered on the streets have become an emblem of the region's struggle to deal with opioids and homelessness. Needle return reduces the mess—but it also creates gathering points for people with addictions, and a target for the frustrations of others.
Advocates fear cuts will embolden critics.
"No matter how [the county tries] to spin it, they have chosen to cut needle exchange in the middle of a devastating opioid epidemic, which indicates a likely caving into political pressure by NIMBYs," says Tabatha Millican, who works for Portland People's Outreach Project, a nonprofit that provides clean needles to addicts and trains them to safely use naloxone, a drug that reverses opioid overdoses.
County officials adamantly deny that neighborhood politics played a role in the decision to cut needle exchange funding.
Commissioner Sharon Meieran, a practicing physician who's worked in substance abuse prevention for years, says she recognizes the health department's budget crunch but remains "concerned" by potential cuts to the needle exchange programs.
"We have made major strides over the years in expanding Harm Reduction work and, importantly, reducing stigma that can keep vulnerable people marginalized," Meieran tells WW. "I'm concerned about losing any ground on that front."
After WW contacted Meieran with questions about the cuts, she announced that she and Commissioner Jessica Vega Pederson plan to introduce a budget amendment to restore the program's funding.
Still, a stigma around these programs persists.
Last week, The Portland Mercury reported, a man dumped a bucket of used syringes in front of the needle exchange at the nonprofit Outside In. In the Montavilla neighborhood in Southeast Portland, a neighborhood watch group has railed against what it perceives as "chronic crime and livability issues" due in part to the needle exchange on Southeast 82nd Avenue.
Jeff Church, an organizer of the watch group Montavilla Initiative, fears visitors to the Gresham exchange will migrate to the Montavilla site if the budget passes.
Church says the county is "running what actually amounts to an open injection site and drug bazaar." Church calls the site the county's "sacred cow" and that "they will do anything, including slandering neighbors, to protect it."
Last fall, members of the Montavilla Initiative spent an evening watching the exchange and took photographs of visitors—claiming some shot up outside the clinic and others defecated outside nearby homes.
Banks tells WW the health department planted a security guard outside the site to protect visitors once neighbors caught wind of the exchange.
"When we take the time to talk to neighbors, people express support for the program and its mission," Banks says. "We hope it also leads to a bit more compassion for those still caught in the grip of addiction."
The health department chose to close the Gresham exchange, Banks says, because it was remote and open only two hours a week.
But Portland, like many other cities, has seen its low-income residents pushed to the outskirts of town by rising housing costs. The mobile exchange on Southeast 190th Avenue, the one slated to be shut down, is the site farthest east.
The decision to cut the budget for sharps containers, Banks says, made sense because common household items, such as water bottles, can be used as safe disposal mechanisms instead.
Millican agrees: Despite the visceral fear many feel when they see a syringe on the ground, "the chances of you contracting a disease are incredibly, incredibly low," she says, "even if you accidentally poke yourself."
But Millican has a different concern: If the county no longer hands out sharps containers, more syringes will wind up on the sidewalk—further politicizing the issue and undermining the county's efforts to garner support for needle exchange sites.
Leslie Corless, who collects needles once a week for the Portland People's Outreach Project, says no longer handing out sharps containers would be "bad policy." "If you're going to say there's a safe way to dispose of something," she says, "you also need to provide the means of that disposal."
Oregon has been applauded for acting to stanch the rate of opioid overdoses. Needle exchange programs have been a critical part of this effort by giving out naloxone. In 2013, Oregon passed a law making it easier for family, friends and needle exchanges to hand out naloxone doses. It worked—death rates from heroin overdose plummeted by nearly half in Multnomah County within six months of the law being passed.
Last week, WW visited the white van in Gresham.
Bonnie, who prefers WW not use her last name, picks up clean syringes every week for her roommate and herself, who both use heroin. She says she's visited the mobile exchange in Gresham about seven times in the past few years. Bonnie uses heroin two or three times a week now, down from daily just a few months ago, and is in the process of getting clean. "I'm getting there," she says.
"It's like an antidepressant for some people," Bonnie says. "It's a disease, it's not something you want to do."
Millican says cutting the Harm Reduction budget slights those who are already disenfranchised. Portlanders talk about supporting the most vulnerable, she says, until it jeopardizes their own sense of security.
"People do like the idea of human rights, hopefully," she says. "Until it's at the expense of their own comfort."