Every Friday for the past six months, a group of young volunteers has set up a table in Bangor’s Pickering Square, and loaded it with free toothbrushes, snacks and other hygiene basics. Passersby sometimes stop by to grab a bottle of shampoo or a pair of socks for themselves or someone they know.
But the table is also a place where people addicted to opioids — or their friends and family — can stop by to pick up clean syringes and doses of the overdose antidote naloxone.
The mobile syringe exchange in Bangor — which is a chapter of a larger organization called Church of Safe Injection — has handed out more than 600 kits of naloxone and hundreds of clean syringes in its six months. While much of the attention on Maine’s opioid epidemic has focused on treatment, the church volunteers have more immediate concerns about stemming the spread of diseases such as HIV and Hepatitis C through dirty syringes, and preventing overdose deaths among active drug users. Their approach is called harm reduction.
“People are overdosing when naloxone is readily available,” said Dave Carvagio, the leader of the church’s Bangor chapter. “Out here we’re not giving naloxone for middle-class people to keep in their homes. We’re trying to get it to the active-use community in Bangor, to those that are more affected by it.”
Now, the Bangor chapter is branching out into helping people access free insulin as well.
“The fact that people can’t afford their insulin is a tragedy, so we’re trying to offer free referral to services that will allow people to navigate the process that does exist to get reduced-cost or free insulin,” Carvagio said.
The entire time the Bangor volunteers have been trying to help drug users, they’ve been doing so unauthorized. State rules require an entity applying for a permit to run a mobile syringe exchange to have a primary fixed location — the Church of Safe Injection does not — and to operate a one-for-one exchange, distributing a clean syringe only when someone turns in a used one. Users must enroll to use a permitted exchange.
“We definitely encourage people to bring us their dirty syringes and use their local syringe exchange program to dispose of them safely, but the need for clean syringes is greater than the one-for-one exchange provides,” Carvagio said.
Carvagio does not reveal where he obtains syringes and naloxone, though he said he obtains the supplies for free. (In addition to distributing them in Bangor, Carvagio is a supplier for other Church of Safe Injection chapters, and he helps other church branches start up.) Also, Carvagio is not his real name.
Carvagio said he knows the exchange is under observation by police, but no volunteers have been arrested despite a warning.
The Church of Safe Injection began last year out of the back of a car in Lewiston when Jesse Harvey, a Portland-based recovery coach, started handing out clean needles and naloxone despite not being an authorized needle exchange. In Lewiston and Auburn, police have warned Harvey and other church volunteers that they could face criminal charges for distributing syringes.
Harvey’s efforts grew into a grassroots organization that spurred 24 branches of the church in 11 states. In six months, the organization handed out 6,452 clean syringes, and between the Lewiston and Bangor chapters, more than 1,000 kits of naloxone.
A few weeks ago, a member started the first international branch of the church in Kathmandu, Nepal.
In Bangor, the need for the church is evident even though an authorized syringe exchange, run by the Health Equity Alliance, is available, Carvagio said. “Most people in active use feel uncomfortable entering a really clinical environment,” he said.
The church is planning to apply for a permit to become an authorized needle exchange program through the Maine Center for Disease Control and Prevention, said Harvey, who added that the church is also on its way to becoming a nonprofit.
Since Harvey started the church last fall, a new administration has taken over in Augusta with a new focus on addressing opioid addiction. Harvey said he has been in touch with Gordon Smith, the state’s director of opioid response, about his harm reduction work.
Smith did not talk directly about the Church of Safe Injection, but he said Gov. Janet Mills’ administration supports harm reduction practices and shares Harvey’s goal of expanding statewide access to clean syringes.
“The administration is a strong supporter of legal, appropriate harm reduction strategies,” Smith said, “one of which is the promotion and distribution of naloxone, and the expansion of syringe exchanges based upon state regulations.”
In Bangor, where the exchange now operates every Saturday instead of Friday, Carvagio said he does not agree with the one-for-one exchange rule the church would have to follow as a permitted syringe exchange, but that the church is willing to follow it to help people.