Needle exchanges are proven to be effective. So why is it still such a challenge to fund them?
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Last year, Prevention Point Philadelphia handed out more than 2.8 million syringes to people who inject drugs—and it's made a huge difference. In 1992, when PPP opened its doors, nearly half of all HIV infections in Philadelphia were among people who shared used syringes.
"If you fast-forward to the latest data available, which is 2016, that went from 47 percent to five percent," says Jose Benitez, the program's executive director.
But the Pennsylvania city's only authorized needle exchange—one of the largest in the country—still isn't protected under state law. It's only via an ex-mayor's executive order that PPP are allowed to offer clean injection supplies. Elsewhere in the state, syringes are considered drug paraphernalia. Step outside of Philadelphia or Allegheny County and suddenly you're a criminal.
For years, comprehensive research from the American Medical Association, the Centers for Disease Control, the World Health Organization, and others has pointed to one thing: Syringe services programs (SSPs) reduce the spread of blood-borne diseases, encourage drug users to find treatment and do not increase substance abuse. Such institutions are an essential tool in fighting the opioid epidemic.
Yet, across the country places like Prevention Point struggle for legal status while rural areas—those hardest hit by the opioid epidemic—have little to no access to clean needles. There are 200 syringe access programs across the US, but a recent CDC study estimated 2200 additional SSPs are needed to stave the rapid nationwide rise of hepatitis C and HIV infections.
At least thirteen states have implemented limited syringe exchange laws since 2015—but many of these states are still struggling heavily with overdose deaths and blood-borne diseases.
In West Virginia, the state reeling hardest from the opioid epidemic, nearly 84 percent of people with hepatitis C live more than ten miles from a needle exchange. Florida, which leads the country for new HIV infections, opened one SSP last year in Miami, but offers no state funding for it and, for a while, cops were still harassing participants.
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When Mike Pence was governor of Indiana, the state's rural communities saw skyrocketing HIV infections. Pence initially opposed introducing syringe programs, but had a change of heart. Yet today, some facilities face closure while the state attorney general has been clashing with the CDC.
In 2009, the Obama administration removed federal restrictions for funding needle exchanges. However, a Republican Congress reinstated the ban in 2011. In late 2015, a measure was snuck into spending package again removing the ban—but it allowed funding for everything except the syringes themselves.
Nonetheless, because of Pennsylvania's convoluted syringe laws, its syringe exchange programs haven't seen a dime of that funding. Pennsylvania ranks 4th highest for heroin mortality and 7th highest for opioid mortality in general. It also has a higher than average rate for hepatitis C and syphilis.
If they're proven to be so effective, why is it such a challenge to fund and spread SSPs?
"People have stigmatized these kinds of programs and so what most lawmakers may think is that they're indulging or enabling people to use drugs," Benitez explains. "There's a whole litany of stigma that comes around this issue with how people think about it. Then you get the data and the data tells you something different and people have a hard time reconciling those two differences."
Pennsylvania House Rep. Ed Gainey has been working to undo that bias against SSPs by introducing HB 196, which removes syringes from the definition of drug paraphernalia. That's it—it doesn't provide funding for needle exchanges or anything else, but it would allow volunteers to pass out safe injection equipment without fear of arrest.
This is the third time Gainey has introduced this type of legislation. In the past, his bills haven't gotten off the ground—and HB 196 is expected to suffer a similar fate.
Rep. Matt Baker, who is chair of the House Health Committee, is the one who needs to bring HB 196 to the floor for a vote. Baker is allegedly opposed to SSPs, but has proposed legislation that would force overdose victims into treatment. Baker's office did not respond to a request for comment.
"A lot of people are scared, saying if we do things like that it's like we're giving them the freedom to get high," Gainey says. "Well, if you can go to the corner and get a bag of dope quicker than you can go to the supermarket and get a bag of chips, how much more freedom do they need? The freedom is there—the problem is it's not regulated."
Rep. Gainey's struggle is illustrative of the broader push for syringe access and how even in the face of overwhelming evidence, many are still reluctant to tolerate these programs. Even if Gainey loses this battle again, he says he will continue to fight.
"You have to create policies that are going to help people, but also you have to transform the mind, and that only comes through education," Gainey says. "A lot of times people think it's a promoting of drugs, but really what we're talking about is saving of lives."
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