A communication transmitted from Louis A. DePasquale, City Manager, relative to Awaiting Report Item Number 19-97, regarding safe needle disposal in City parks and buildings

TO: Louis A. DePasquale, City Manager FROM: Claude A. Jacob, Chief Public Health Officer, Cambridge Public Health Department Owen O’Riordan, Commissioner, Department of Public Works Branville G. Bard, Jr., Commissioner, Cambridge Police Department Gerard E. Mahoney, Acting Fire Chief, Cambridge Fire Department DATE: November 12, 2019 SUBJECT: Response to Policy Order #10, adopted 7/30/19 Excerpt of Order: That the City Manager be and hereby is requested to work with relevant City departments to post the information from the Cambridge Public Health Department about safe needle disposal in city parks and public buildings and to direct the Police Commissioner to establish stricter enforcement of city park hours and direct the Commissioner of Public Works Department to increase the level of hand-sweepers cleaning the city parks and to share what safety precautions the workers are using and to report back to the City Council on this matter by the September 9, 2019 City Council meeting. The Department of Public Works (DPW), Cambridge Public Health Department (CPHD), Fire Department, and Police Department are collaborating to develop strategies for reducing the number of discarded needles and syringes (“sharps”) in streets, homeless encampments, parks, and other public places; better publicizing what residents and workers can do if they find discarded sharps in public places; and ensuring the safety of anyone who might come in contact with discarded sharps. City staff assigned to this issue formed a working group in August to consider short-term actions related to this policy order and develop a longer-term strategy for reducing the number of sharps in public places. CURRENT PRACTICES AND PROTOCOLS Retrieval of Sharps in Public Places There are currently two systems in place in Cambridge for the safe disposal of needles and syringes found in public places. 1. Emergency Retrieval of Sharps DPW staff who find needles or syringes while on the job have been instructed not to touch sharps or throw them in the trash. Under a protocol developed in 2018, city employees and contractors who find needles/syringes in public places (e.g., parks, playgrounds, streets, gutters, municipal buildings) while on the job should call the city’s public safety 24/7 non- emergency number, [phone removed]. Staff should then wait for the arrival of fire or EMS personnel, who will safely dispose of the sharps.

2 Residents and visitors are also strongly encouraged not to touch needles or syringes found in the public way. Members of the public can report discarded sharps by calling the city’s public safety 24/7 non-emergency number, [phone removed], or using other contact methods listed it the city’s protocol for emergency disposal of needles and syringes: http://www.cambridgepublichealth.org/lifestyle/medication-needle-disposal/needle- disposal.php 2. Routine Searches for Sharps City personnel do not currently engage in sharps retrieval, such as “sweeping” parks for loose needles. However, the Access: Drug User Health Program (formerly the Cambridge Needle Exchange and Overdose Prevention Program) has an outreach team that connects with drug users, collects and distributes personal sharps containers, and retrieves needles and syringes on the ground in Cambridge and in five other communities. This state and federally funded program is based in Cambridge (359 Green Street) and operated by the nonprofit AIDS Action Committee/Fenway Health. The Access program does street outreach two to four days a week in Cambridge, visiting the following designated areas to pick up stray needles and syringes: • MBTA redline stations and bathrooms (Central, Harvard, Porter, Alewife) and homeless encampments near Alewife and along the Charles River. • Area around the CASPAR Emergency Service Center at 240 Albany Street. The shelter accepts people who are homeless and actively using alcohol or drugs. • Central Square, mainly along Massachusetts Ave. and Green St., including bathrooms accessible to the public and the Green Street Garage. • Harvard Square, including the Cambridge Common and Old Burying Ground. • Grassy alcoves along the route, as well as the two city parks on Memorial Drive near River St. and Western Ave. Pubic Information on Safe Sharps Disposal Information for residents and visitors on how to dispose of sharps found in public places is currently available on the Cambridge Public Health Department website: http://www.cambridgepublichealth.org/lifestyle/medication-needle-disposal/needle- disposal.php. Links to the health department’s web page are posted on the Police Department’s website (https://www.cambridgema.gov/cpd/communityresources/prescriptiondrugdropbox) and on the DPW “Get Rid of it Right” database (https://www.cambridgema.gov/Departments/publicworks/getridofitright). Worker Safety DPW staff who handle trash and clean parks, streets, and buildings are vulnerable to accidental sticks from discarded needles. Both in-house crews and contractors have been instructed to call the city’s public safety 24/7 non-emergency number, [phone removed], if they discover discarded sharps while on the job.

3 In September, DPW provided a formal staff training to all employees in safety sensitive positions about department protocols and preventing sharps-related injuries on the job. The training included information from the Cambridge Public Health Department about blood- borne illnesses and other diseases that can be transmitted from accidental needle sticks. The training will be offered annually, consistent with a recently enacted Massachusetts law that applies federal workplace safety standards to municipal workers. Sharps Collection Bins In addition to the large mailbox-sized sharps disposal kiosks at the health department, police station, and Access program, DPW has installed smaller sharps containers in restrooms in City Hall, two libraries, and several other city buildings. FINDINGS In August, the working group began collecting information and data to better understand the scale of the discarded sharps problem in Cambridge. The group wanted to get a sense of how many sharps were being discarded in public places and whether sharps were being found throughout the city or concentrated in certain locations. This type of information can help inform possible placement of additional sharps collection boxes and possible signage on city- owned property. Discarded Sharps Data The working group obtained the following data on discarded sharps from the city’s Emergency Communication Center and the Access program. • The Emergency Communications Center received 128 calls for Fire/EMS to pick up discarded sharps in 2018 and 130 calls in 2019, as of Aug. 28. The call summaries do not contain information about how many sharps were collected at a given location. • The Access program reported that its outreach staff retrieved 1,040 discarded syringes (sharps) in street/park locations visited in Cambridge in 2018, and 2,455 discarded syringes (sharps) in 2019, as of Aug. 31. By contrast, drug users brought 183,540 used syringes (sharps) to the Access program for disposal in 2019 (as of Aug. 31) and the program distributed 145,467 clean syringes (sharps) to users during this period. Locations of Discarded Sharps Based on conversations with DPW, Police/Fire, and the Access program, as well as data from the Emergency Communications Center and Access, it appears that discarded sharps are found most frequently in Central Square (multiple locations), Harvard Square (including the Cambridge Common and Old Burying Ground), and homeless encampments. Other areas where sharps have been retrieved, based on Emergency Communications Center data, are North Cambridge, East Cambridge, and along Memorial Drive. While several city parks have been identified as “hot spots” at various times, the vast majority of sharps are being found in streets, public bathrooms, plazas, and alcoves. Access staff emphasized that “hot spots” are fluid in Cambridge, and can change in a matter of weeks or months.

4 NEXT STEPS The working group identified the following short-term actions that will be implemented by city staff: 1. Address community concerns about sharps in parks and playgrounds: • The Police Department will continue to monitor parks for illicit activity and take action as deemed necessary, which could include arrest or connection to services. The Police Department prefers this approach to strict enforcement of city parks hours, which can target specific vulnerable populations. • The Police Department will continue to assign officers to conduct periodic, scheduled walks in parks where improperly disposed of syringes have been frequently observed. Officers stay with any found sharps until Fire/EMS arrive. 2. Better publicize the city’s protocol for emergency retrieval of sharps: • City website: A “Safe Needle and Syringe Disposal” topic will be developed for the "Services" and "I Want To" database on the city’s website. • City e-newsletters: Information will run periodically in the Cityview Weekly newsletter and the PIO update about safe needle disposal. • Media release: CPHD will send a media release to the Cambridge Chronicle, Cambridge Day, and other outlets about how to report discarded needles, locations of drop boxes, and safety tips. • Next Door: The Police Department will post the media release on its Next Door account. • Social media: CPHD and other relevant city departments will post safe disposal information on their social media accounts periodically. • Cambridge Business Associations: CPHD will reach out to the business associations to request that they share information about safe needle disposal (e.g., how to report discarded needles, locations of drop boxes, and safety tips) in newsletters or other member communications. 3. Promote additional locations of sharps disposal bins on city web pages. Currently, the only publicly promoted locations are the large kiosks at the Cambridge Public Health Department and Cambridge Police Department. The expanded list of locations would include the Access Program’s large kiosk and the smaller sharps bins in certain city buildings and libraries. 4. Continue to raise awareness about the protocol and preventing sharps-related injuries among city employees in safety-sensitive positions. 5. Improve data-sharing and communication between city departments involved in emergency sharps retrieval and the Access program. An immediate benefit of better information-sharing would be that the Access Program could add newly identified “hot spots” to its sharps retrieval route. The group also identified longer-term actions that largely focus on expanding the number of sharps collection kiosks in the city and determining the feasibility of outdoor collection boxes, which will include outreach to cities that maintain outdoor boxes.