The Clergy for New Drug Policy Weekly News Round-up
“Let justice roll down like waters.”
Dear Friends and Colleagues,
We are in the midst of the Christian season of Advent. It is a time of waiting and anticipation that culminates in celebrating the incarnation.
This is when those of us who are Christians celebrate that the Word became flesh and dwelt among us. God and God’s grace not just as a far-off promise but as an imminent presence.
Mary prophetically sang upon the news of her coming child:
He has brought down the powerful from their thrones
and lifted up the lowly;
he has filled the hungry with good things
and sent the rich away empty.
(Luke 1:52-53 NRSV)
It is a song that calls us to flip our view of the world upside down. We see the world, not through the eyes of those in control, but through those who have been disinherited. Our primary moral concern is not with those who already have, but with those who are in need.
Across the country, Syringe Service Programs (SSPs), also referred to as Syringe Exchange Programs or Needle Exchange Programs, serve some of the most vulnerable people in our country. They are community-based programs that provide access to safe disposal of clean needles and syringes. In addition, many SSPs offer integrated services to address overdose, addiction, unintended pregnancy, neonatal abstinence syndrome, and other complications of injection drug use (IDU).
SSPs are not new. In fact, 55 SSPs were operating across the United States in 1994. Since 1994 the number of SSPs has only continued to grow. Today, there are approximately 185 SSPs operating nationwide.
More than three decades of peer-reviewed research have shown that SSPs reduce rates of HIV and HCV, increase proper disposal of used needles, encourage engagement with treatment, and do not increase crime in areas surrounding the programs.
Last week, a new study on SSPs was published prompting headlines like, “America’s syringe exchanges kill drug users.” In our roundup this week, you’ll read some of the challenges that SSPs face as well as the evidence for their effectiveness.
At Clergy for a New Drug Policy, we are always open to new evidence about what works when it comes to protecting health and wellbeing. But, if the message sounds like keeping the powerful on their thrones and sending those in need empty away, we are going to start with a healthy dose of skepticism.
SSPs aren’t designed to reduce overdose deaths but rather improve the health and well-being of people who use drugs. But the idea that they cause additional overdose deaths should be met with a great deal of skepticism.
Establishing correlation is one thing, but proving causation is a high bar. SSPs tend to operate in areas of highest need. Blaming SSPs for overdose deaths, as one researcher put it, would be like blaming increased fire hydrants in high-risk areas for starting fires.
It is possible that with more research, we may also discover that some SSPs have better results than others. Or, that they can do even greater good by offering more services, like providing drug testing, that can reduce overdoses.
What we do know is that SSPs meet people where they are and are often run on shoestring budgets and rely on dedicated volunteers. They are a starting point in helping people who use drugs take care of their own health. Can they be improved? Absolutely. But that requires additional investment, not abandoning the strategy entirely.
In this Advent season may we all be reminded that grace is not just an abstract concept but may come in the lowly form of a clean syringe.
Keep the faith,
Timothy McMahan King
Senior Fellow, Clergy for a New Drug Policy
Before we get into SSP coverage, thanks to all of those who have added their voices to our letter supporting overdose prevention centers. The DOJ has once again asked for an extension of two months before making their decision. There is still more work to do!
Zachary Siegel breaks down some of the methodological limitations of the study:
- SSPs may be dramatically undercounted. 50 to 60% of SSPs may not have been included and could skew the results.
- The study notes that rural SSPs seem to have the highest correlations. Those also are likely to be the programs with the least amount of funding and may have difficulty accessing other services like naloxone.
- It isn’t clear how SSPs could increase overdoses. A more likely explanation is simply the spread of illicit fentanyl into the drug supply.
We know SSPs are cost-effective and promote public health.
SSPs improve health outcomes and save lives. When combined with other harm reduction interventions, SSPs are associated with a 50 percent reduction in the spread of HIV and HCV. SSPs decrease unsafe needle sharing by 20–40 percent while providing a critical point of entry into the treatment system, testing, and counseling. In fact, research demonstrates that SSP clients are five times more likely to voluntarily participate in evidence-based drug treatment and three times more likely to stop using drugs than individuals who lack access to such services. SSPs also keep first responders and the public safe by promoting the safe disposal of used needles.
However, legal and monetary challenges remain.
Although 31 states and the District of Columbia legally authorize SSPs, some have ambiguously worded laws that make implementation and expansion of SSPs difficult—and severely limit the number of people they can reach.
For instance, nine of the 32 also require local approval for SSP implementation, which is a challenge because SSPs often face community opposition. This additional layer of approval means local jurisdictions can effectively prohibit new SSPs from opening through policy or zoning changes, although courts may deem these local ordinances a violation of the federal Americans With Disabilities Act or Rehabilitation Act because ordinances discriminate against people with substance use disorder (SUD).
Additionally, state drug paraphernalia laws typically prohibit the possession of syringes for the purpose of illicit drug use. This tension can precipitate police encounters with SSP participants even when the programs are authorized by the state.
Further, SSP managers cite funding as a constant challenge. Without public funding, programs have to rely on a patchwork of temporary private grants that can each have their own requirements and restrictions, limiting the sustainability and scope of SSP operations.
Thankfully, the Centers for Disease Control and Prevention (CDC) just announced that it has awarded $6.9 million to the NASTAD and nearly $750,000 to RTI International in year one of a five-year project.
NASTAD, in partnership with grassroots organization VOCAL-NY, is planning to provide direct funding to at least 40 SSPs nationwide. The aim is to increase resources to bolster SSP capacity, providing lifesaving front-line infectious disease and overdose-prevention services as well as serve as a vital touch point for people who use drugs.
Many researchers are suggesting that expanded SSPs are urgently needed.
A study published in June 2022 found that SSPs had a profound effect in Indiana. In 2015, Austin, Indiana experienced the largest concentrated HIV outbreak in the United States. At that time, 5 % of its population became infected with HIV from sharing needles while injecting opioids. The emergency authorization of an SSP at that time helped contained the outbreak.
To prevent further loss of lives from the opioid epidemic and related complications including HIV and HCV, the remaining 19 states without legalized SSPs need to urgently legalize and fund SSPs. Clear laws supporting the use of SSPs would reduce the stigma associated with supportive programs for individuals with substance use disorders and allow rapid expansion. The expansion of these evidence-based programs is urgently needed and would greatly reduce preventable overdoses and drug-related mortalities and morbidities.