The author Thomas Vato defined groupthink as a process where “everybody goes where everybody goes,” an observation that I find has merit in assessing the relationship between needle exchange services and intravenous drug abuse in our city.

The result of groupthink, in this case, is a public health strategy aimed at suppressing the transmission of blood-borne infections which now presents a daunting hazard to Portlanders.

Despite best intentions, we are awash with discarded hypodermic needles. Despite the best efforts of our public works staff and park rangers to remove these biological hazards from our public properties, the constant tide of needle waste does not abate. Private citizens are granted little choice when confronting chronic needle waste on their properties but to step up and do what they can to make their spaces safe again.

During 2023, city health officials deployed almost 750,000 needles into the community and recovered only 500,000 contaminated needles in the exchange process. Needle waste is a public safety hazard of our own making.

Needle-exchange services arose from the harm reduction movement’s advocacy for social justice for illicit drug users. The philosophy was readily adopted by public health practitioners to counter the stigma of drug abuse. Harm reduction sidesteps social expectations and clings instead to the idea of a “safe” drug injection with less attention spent on treatment options that might dissuade people from continuing their self-destructive behavior.

Harm reduction holds that a needle client will eventually make an informed decision for themselves about their IV self-abuse. The policy also assumes an IV drug user will exercise responsible behavior in disposing contaminated needles.

We heard similar assertions about choice and personal autonomy during the process of clearing encampments. Portland City Council chose instead to balance the needs of the unhoused with those of the public and not normalize camps. Now we are called to strike a similar balance between the health interests of open-air drug users and the public’s expectations for safety.

Compassion without clear limits is no compassion at all; it’s an implicit agreement to allow addiction to continue. The hard truth is that any one injection can be fatal. The harm of an overdose death is irrevocable. Despite our ability to prevent death with Narcan, we must reconsider a policy that provides 100 needles for second, third and multiple other chances for addicts to taunt the finality of their own lives.

As a result of the undeniable tide of discarded needles that I have witnessed, especially throughout our downtown neighborhoods, I am left to consider that evidence and conclude we must challenge the assumptions of our current needle exchange policy.

But groupthink is a tough adversary.

Numerous studies combine in their unwavering support for needle exchange programs; however, they all share almost identical, boilerplate pronouncements concerning needle waste. Waste is treated as a policy afterthought, espousing an expectation that citizens will do their part in collecting that waste in service to their community.

Portland residents and business owners, however, no longer want to go where everyone is going. They have had their fill of a policy where the presence of discarded needles has gone from good to bad and, in some parts of the city, intolerable.

Advancing equity for both community and addict interests must be the foundation of a needle exchange program. In October, I will present the City Council with a resolution to initiate a public discussion on reducing the number of needles in a single exchange from 100 to a 1-to-1 ratio as a needed step to decreasing the volume of needle waste in the city.

My hope is the council will support this proposal while the Health and Human Services Committee continues to explore strategies at improving the needle exchange program, ensuring the public interest is fully recognized in that process.