People learn how to administer naloxone, a reversal drug for opioid overdoses, in a Baltimore City Health Department needle exchange van. (Jabin Botsford/The Washington Post)

Needle-exchange programs for drug users could be coming to six counties across Maryland, 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 a heroin epidemic.

The efforts are being led locally and are at various stages, but state officials are encouraging the programs, and are 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 led by the local jurisdictions.”

The counties in some stage of planning or 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. Baltimore City has the state’s only operating program, begun 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 money to promote drug use and cause drug users to congregate at exchange sites. Although the Baltimore program has been around for years, the state passed legislation only in 2016 allowing the programs to be established elsewhere around the state. The Republican-controlled Congress also passed legislation in early 2016 that allows federal funding for needle-exchange efforts.

Anaedozie said the state’s push began in 2015 after rural Scott County in Indiana began reporting a spike in HIV and hepatitis C infections related to the opioid crisis there.

Maryland has not seen a related increase 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 prevention, treatment and “harm reduction” measures that can be folded into needle programs.

Overdose deaths continue to climb statewide, with more than 2,000 in 2016, 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, 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 naloxone, a drug that reverses the effects of opioid overdose.

The counties have been working to get backing from local law enforcement agencies and elected officials, as well as neighborhoods and treatment communities — a requirement by health officials in the state, which passed a law in 2016 that allows the 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 that already offer services. Some counties will open physical locations and others will operate mobile vans.

In Anne Arundel, County Executive Steve 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 that he wants to have an open mind and see if the programs could be effective.

Councilman John Grasso (R-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 “a needle is a hell of a lot cheaper.”

Peter Beilenson, a former Baltimore health commissioner who began the city’s program, said more public officials seem to be overcoming their concerns and reaching that conclusion.

He said there is a wealth of scientific evidence supporting the effectiveness of such programs at preventing disease and none that 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 such services, said Beilenson, now chief executive 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 said opposition generally comes from politicians who fear the programs suggest their areas have a drug problem, possibly hampering economic development.

State officials say support is crucial to begin the programs. Counties must seek the state health department’s permission for the programs, demonstrating in their applications that they’ve received local support and that they have a specific plan. However, the state’s sign-off is a formality if those conditions are met.

Counties also can apply for funding for specific needs, although 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 people 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 to use naloxone, the opioid overdose drug.

Leana Wen, Baltimore’s health commissioner, said she has 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 half a million clean needles a year, in addition to providing other services.

Wen said a lot of stigma remains associated with drug use in general, but she hopes to clear misconceptions about needle programs that she said can prevent disease. She said when the city program began 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, although she has seen resistance nationwide.

“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

Pamela Wood and Phil Davis contributed to this report.