“How do I get others to care?” is a question I hear all the time.
It is a perennial challenge for activists and advocates of all kinds. There is no shortage of important issues and causes to which we can all give our time and attention. But how do we get others to share our passion?
While there isn’t an easy answer to this question, there is one practical tip I like to give:
Start where people are at, not where you want them to be.
Most people aren’t looking around for a new cause. If they were, our job would be easy. We all live with many competing demands on our time and attention. Engaging new people in an important cause often comes through connecting it to other interests and priorities they already have.
The Christian season of Lent is coming soon. It is a time we feel the pain of loss and the promise of new life to come. It is a season that calls us to reflect on many of the same themes we see in stories of addiction and recovery.
Churches and pastors across the country have found Lent a valuable time to engage their congregations and communities in reflection on the challenges of addiction in our society and the hope the Church can bring for healing by ending our culture of violence and punishment.
I’m partnering with the Center of Addiction and Faith to host a Zoom meeting next week about engaging churches around addiction, overdoses, and the War on Drugs this Lenten season. While the conversation will center around the Christian tradition, all people are welcome to attend to see how they might apply these lessons in their context.
While there are lots of ways to connect Lent to these issues, I’ll focus on some of the themes of my book Addiction Nation: What the Opioid Crisis Reveals About Us. And provide resources and strategies for using the book as a conversation starter in your community.
This will be a Zoom meeting to allow for discussion and questions. During the meeting, you will:
Learn more about how Lent connects with themes of addiction and drug policy.
Receive a free 6-week study guide to accompany Addiction Nation.
Have an opportunity to sign up to have the author join your book group for a virtual Q&A for free.
Get the opportunity to bulk order books for up to 50% off retail price.
If you’ve been looking for a way to start a conversation in your community, we hope you’ll join us. Starting these kinds of conversations can be challenging, and we hope to support you on that
Keep the Faith,
Timothy McMahan King Senior Fellow, Clergy for a New Drug Policy
THE CLERGY FOR NEW DRUG POLICY WEEKLY NEWS ROUND-UP
“Let justice roll down like waters.” Amos 5:24
Dear Friends and Colleagues,
Pain resists words. We use stories, songs and poems to express great love but great pain finds its deepest expression in the screams and groans that aren’t words at all.
“To have great pain is to have certainty; to hear that another person has pain is to have doubt,” writes philosopher Elaine Scarry. The difficulty of expressing pain in words, as well as the often hidden nature of physical, emotional and spiritual pain can make it difficult to address.
Many people, especially chronic pain patients, understand what it is like to have pain dominate their lives while feeling that those around them are constantly questioning if the pain is real, and if it needs to be treated.
As I wrote in Addiction Nation, I had no problem managing the pain that came from putting a chainsaw into my leg, but acute necrotizing pancreatitis was different. It was the opioid-based pain medication that gave me even a slight breath of relief. I wrote:
The only moment that I remembered I was still a person—that pain was an experience I was having and not my entire existence—was the moment every fifteen minutes when I pressed a small button. That button sent a pump whirring and boosted the slow trickle of that blessed, blessed, blessed analgesic.
While I did develop an opioid use disorder, I might not have survived the pain of that condition without the drugs I was given. While I was lucky that my pain resolved after nine months, there are many others that deal with chronic pain for years.
Tragically, some of these chronic pain patients are dying by suicide after losing access to pain medicine that had been working for them. Dana Farber, one of the country’s leading cancer research institutes, is warning that even terminal patients are having difficulty accessing end-of-life pain management.
In the last newsletter, we covered a new report from the Cato institute about the dangers of politicians and law enforcement taking over the practice of medicine. This week, we want to highlight some additional stories of how that goes wrong.
The primary media narrative about the overdose crisis begins with the deceptive marketing of Purdue Pharma and overprescribing doctors. This led to a wave of addiction and then finally, overdoses.
But the real story is much more complicated. Purdue Pharma was criminally deceitful and many doctors subsequently underestimated the likelihood of addiction, especially among young people. But, roughly 75% of those who develop an opioid use disorder didn’t start with a doctor’s prescription but diverted drugs typically obtained through a friend, family member or dealer.
While there was some early correlation between the rise in opioid prescribing and opioid related overdoses, that has not been true for more than a decade (possibly two). In fact, overdoses skyrocketed after crackdowns on opioid prescribing as those who were addicted moved to more dangerous street drugs.
Drug policy and trends in the United States often bounce between extremes. From the false belief in a “non-addictive” opioid that made billions for those peddling a lie to draconian enforcement by the DEA that leaves doctors in fear of law enforcement and pain patients suffering.
The people who end up bearing the burden are the ones who are most vulnerable. Reducing the story of the overdose crisis to the actions of Big Pharma (as bad as they may have been) distracts from the ongoing driver of overdose deaths today, failed federal drug policy.
Keep the faith,
Timothy McMahan King Senior Fellow, Clergy for a New Drug Policy
Research and roundup compiled by Cassidy Willard, Research Associate
Most nonmedical opioid users are not yesterday’s patients.
High-dose opioid prescriptions (90 MME or greater) fell by 58% from 2008 to 2017, deaths involving opioids rose by 500% between 1999 and 2018.
Since 2010, deaths involving heroin and fentanyl have risen much more dramatically than those involving prescription opioids. In fact, “based on likely understated CDC data, fentanyl or heroin was involved in 75% of opioid-related deaths in 2017, up from 28% in 2010. Just 30% of opioid-related deaths involved prescription analgesics such as hydrocodone and oxycodone in 2017, down from 52% in 2010, and roughly 40% of those 2017 cases also involved heroin or fentanyl. In other words, approximately 18% of total opioid-related deaths in 2017 involved prescription analgesics without heroin or fentanyl.”
Sadly, the catastrophic nature of the current policies have been on full display in the last three months.
On November 1, 2022, the DEA suspended Dr. David Bockoff, a chronic pain specialist, license to prescribe controlled substances such as opioids. The DEA has said that Bockoff received an “Immediate Suspension Order” which is warranted in cases where the agency believes the prescriber poses “an imminent danger to public health or safety.”
One of Bockoff’s patients was Danny Elliot, a 61-year-old chronic pain patient that was nearly electrocuted to death in 1991. Elliot struggled to keep a doctor, telling Vice that Bockoff was his third doctor to be shut down by the DEA since 2018. Elliott described “each transition meant weeks or months of desperate scrambling to find a replacement, plus excruciating withdrawals due to his physical dependence on opioids, followed by the return of that burning eyeball pit of despair.”
On November 8, 2022, after frantically trying to find another doctor to help him manage his chronic pain, Elliot and his wife died in a “dual suicide.” Elliot left behind a note that reads in part:
“I just can’t live with this severe pain anymore, and I don’t have any options left. There are millions of chronic pain patients suffering just like me because of the DEA. Nobody cares. I haven’t lived without some sort of pain and pain relief meds since 1998, and I considered suicide back then. My wife called 17 doctors this past week looking for some kind of help. The only doctor who agreed to see me refused to help in any way. What am I supposed to do?”
Jessica Fujimaki, 42, died in December, shortly after the DEA shut down her pain doctor. IMAGE VIA GOFUNDME CAMPAIGN.
Tragedy struck again on December 10, 2022. Another Bockoff patient, 42-year-old Jessica Fujimaki, died. Many believe her cause of death was complications related to opioid withdrawal and medical conditions that caused severe chronic pain. Fujimaki suffered from a rare disorder called arachnoiditis that causes debilitating pain characterized by severe stinging and burning pain and neurologic problems.
In a recent court filing by the DEA, lawyers argue that Bockoff’s patients only needed treatment because of “his unsafe practices contributing to their opioid dependency and addiction,” and that “while it would be regrettable that Dr. Bockoff’s patients may face hardships,” there are other resources available, such as detox and rehab programs.
However, we know Detox and rehab will not help chronic pain patients. As Gretchen’s brother told Vice, “In my mind, what the DEA is essentially doing is telling a diabetic who’s been on insulin for 20 years that they no longer need insulin and they should be cured. They just don’t understand what chronic pain is.”
Tragedy struck again on December 10, 2022. Another Bockoff patient, 42-year-old Jessica Fujimaki, died. Many believe her cause of death was complications related to opioid withdrawal and medical conditions that caused severe chronic pain. Fujimaki suffered from a rare disorder called arachnoiditis that causes debilitating pain characterized by severe stinging and burning pain and neurologic problems.
In a recent court filing by the DEA, lawyers argue that Bockoff’s patients only needed treatment because of “his unsafe practices contributing to their opioid dependency and addiction,” and that “while it would be regrettable that Dr. Bockoff’s patients may face hardships,” there are other resources available, such as detox and rehab programs.
However, we know Detox and rehab will not help chronic pain patients. As Gretchen’s brother told Vice, “In my mind, what the DEA is essentially doing is telling a diabetic who’s been on insulin for 20 years that they no longer need insulin and they should be cured. They just don’t understand what chronic pain is.”
These stories of chronic pain sufferers who have killed themselves after losing access to opioid medication are not unique.
So, what happens now? How can we help chronic pain patients? Maia Szalavitz, addiction expert and journalist, has some ideas.
First, the surgeon general needs to make a strong national call for healthcare professionals to pay attention to the 2022 updated C.D.C guidelines for opioid prescribing. Doctors need to be warned that involuntary dose cuts for existing patients puts them at high overdose risk.
Second, the U.S. attorney general needs to tell the D.E.A. to stop perusing doctors solely because they prescribe high doses of opioids. Without other reason to believe there is criminal intent, it should not be an issue for law enforcement. If doctors are not providing a high level of care, it should be an issue for medical boards or an issue of civil malpractice.
Third, if the D.E.A. does discover criminal diversion of prescription opioids, great care should be taken to ensure that existing patients are not suddenly abandoned. Cutting off these prescriptions without support for those using them will only lead to more overdoses.
We cannot let more pain patients become the latest victims of the War on Drugs.
The prayer of confession in the Book of Common Prayer contains the familiar phrase, “what we have done and what we have left undone.”
In many religious traditions, there is the concept of sins of “commission”, the wrongs that we do, and also “omission”, what we fail to do. We aren’t just held responsible for a bad action but also the failure to do good, support justice or defend the vulnerable. The Hebrew prophets make this especially clear that those who are in power are held to account for their failure to help those in need.
A new report from the Cato Institute takes an important look at our current overdose crisis. Instead of telling a story that reduces the opioid epidemic to the actions of Big Pharma and overprescribing doctors they detail the history of law enforcement and the federal government restricting the ability of doctors to practice medicine. Sometimes the greater danger lies in when doctors are unable to prescribe as they should more than when they prescribe when they shouldn’t.
In theological terms, they tell the story of the sins of omission and what has been “left undone” often at the behest of powerful interests restricting the medical judgment of doctors.
When I have told the story of my own hospitalization and subsequent development of an opioid use disorder, I’ve often had others respond with an immediate condemnation of the doctors who prescribed me opioids.
I have had to repeat over and over again: the doctors did nothing wrong by prescribing me opioids. They were medically necessary and appropriate.
Even once I developed an opioid use disorder the greatest threat to my life and health was not my prescription to opioids. What would have been most dangerous, and I was lucky to avoid, would have been a rapid taper or immediate stop to my prescription. This could have led me to seek far more dangerous and unregulated alternatives from an illicit market as so many others have felt forced to do.
The reality was that I was simultaneously addicted and still in severe pain that required pain medication. My doctor understood this and continued to allow me access to prescription opioids while I received treatment through cognitive behavioral therapy and began experimenting with alternative pain management therapies as we found what worked for me.
What would have harmed me the most was not a sin of commission (the prescription) but one of omission, failing to provide needed pain medicine from a safe and reliable source.
As the Cato report details, many doctors today live under fear that if they exercise their best medical judgment, they may become a target of law enforcement. As a result, doctors are abandoning pain patients, living under the threat of law enforcement or even being arrested for practicing medicine. Pain patients are losing access to the medications they need and are turning to a dangerous illicit supply or even dying by suicide.
Our roundup today gives you highlights from the new Cato report as well as work from journalist Maia Szalavitz about the harsh consequences of these systemic failures.
Yes, it is important that opioids are prescribed responsibly. Yes, doctors should be held responsible to medical boards if they fail to practice medicine to the highest standards. Yes, law enforcement has a role if they discover actual “pill mills.”
But we also need to talk about the sins of commission when politics gets in the way of doctors practicing responsible medicine or law enforcement starts dictating standards of public health.
It’s not just about what is done, but what is left undone.
Keep the faith,
Timothy McMahan King Senior Fellow, Clergy for a New Drug Policy
The War on Drugs has greatly impacted the practice of medicine. In particular, pain patients have been harmed as policymakers pressure doctors to taper or discontinue prescribing opioids.
A recent study by the CATO Institute analyzed how the government and law enforcement increasingly surveil and influence the way doctors treat pain, psychoactive substance use, and substance use disorder.
Authors Jeffrey A. Singer and Trevor Burrus explore how two discernible waves, Drug War I and Drug War II have destructively intruded on the patient-doctor relationship. The authors argue that both waves were shaped by law and society’s view of people who use opioids and cocaine as immoral.
Research and roundup compiled by Cassidy Willard, Research Associate
Although it seems surprising to many of us, opium and its derivatives were broadly legal in the United States before 1914.
“The image of the opioid user was entirely different in the late 19th century from today. Doctors prescribed opium for many ailments because it often helped.”
In fact, opium was often prescribed as a cough suppressant, and to alleviate pain, soothe nerves, and calm anxieties.
Additionally, “opioid users of the time were usually regarded as less morally reprehensible than those who habitually consumed “demon rum” in saloons, burning through their paychecks night after night and leaving their families destitute. Opium users with a reliable supply could be, and often were, upstanding members of society. As long as they could maintain a supply, opioid addiction did not necessarily entail almost any of the imagery we associate with users today: gaunt, pale, sickly “junkies” willing to do anything to get the next fix.”
This view of opioids began to change with the federal Harrison Narcotics Act.
“The Harrison Act was the first significant federal drug law in the United States and, as amended, was the basic federal drug law for 56 years until the Controlled Substances Act was passed in 1970. There were earlier laws, such as the Opium Exclusion Act of 1909 that regulated the importation of opium, but the Harrison Act was the first to domestically regulate the sale and possession of opium and its derivatives.”
The interpretation and enforcement of the Harrison Narcotics Act created new problems for physicians. The statute did not define key terms like the requirement to “personally attend” to patients, or “professional practice” and “good faith.”
The Harrison Act finally reached the Supreme Court in December 1915. The court took numerous challenges of the statute but “was careful to choose those cases in which the doctor’s behavior was egregious.” In 1922, the Supreme Court decided United States v. Behrman. Ruling “against the doctor, the six justices decided that not only would they read substantive medical standards into the statute—defining “professional practice” when the statute intentionally did not—but they would enforce their own views, rather than medical experts’ views, as to what constitutes acceptable medical practices.”
This ruling unleashed what drug‐war historian Rufus King deemed “a reign of terror.”
“Treasury agents began ‘threatening doctors who had anything further to do with drug addicts, and sending a goodly number of recalcitrant practitioners off to prison with the Behrman formula…the addict‐patient vanished; the addict criminal emerged in his place.’ Whereas Treasury agents had initially been charged by the Harrison Act with policing professions that provided opioids and keeping the trade visible and above ground, they now were hounding everyone and throwing thousands of people in jail, while the market for opioids began moving underground.”
Although a later decision in Linder v. United States vindicated a doctor who prescribed maintenance doses in good faith, “the government essentially pretended that the Linder decision didn’t exist.”
The treasury department had essentially unfettered power to regulate, police, and prosecute doctors prescribing opioids.
Today, the cycle continues. Doctor-patient relationships are again being dictated by federal law enforcement and policed by government agencies.
Today, the cycle continues. Doctor-patient relationships are again being dictated by federal law enforcement and policed by government agencies.
Substance use is a health issue and must be viewed as one. Law enforcement and government officials are not trained in pain management. “The management of acute and chronic pain involves the same nuanced medical decision-making as does the treatment of hypertension, diabetes, infectious diseases, and psychiatric disorders.”
“Although the reduction in opioid prescriptions has had no impact on the overdose deaths from medically used opioids, the same cannot be said for opioids as a whole. It is now widely accepted that as the supply of relatively safe prescription drugs was slashed, both users and abusers have turned to heroin and, more recently, fentanyl, which is responsible for 87% of the 30,000 spike in drug overdose deaths in 2020.”
Yet, “policymakers refuse to reassess their assumption that the overdose crisis was caused by doctors overprescribing opioids.”
“The study also provides empiric evidence of what health‐care providers have been seeing ever since policymakers began pressuring them to taper or discontinue prescribing opioids to their patients in pain: tapering the opioids that were controlling their pain was associated with a 68% increase in overdoses and doubling of mental health crises, which can be subdivided into depression (up 346%), anxiety (up 79%), and suicide attempts (up 430%).”
The question then becomes “How can we possibly even consider, let alone implement, policies that result in such damage?
According to author Maia Szalavitz pain patients that genuinely need painkilling drugs are now subject to random reports to the doctor’s office for pill counts, prescription limits, extra refill appointments, urine testing, and other restrictions.
Although the classic government line is that the opioid epidemic is linked to increased use of pain medications being prescribed; however, “the overwhelming majority of addictions do not start with a prescription—and most opioid prescriptions do not cause addiction. Instead, opioid addiction usually begins in the same place that all other addictions start: in the childhoods, traumas, mental illnesses, and genes of those affected.”
Pain patients are suffering because the government refuses to acknowledge their missteps.
“Mistreating patients doesn’t stop addiction; that requires compassionate care.”
The Clergy for New Drug Policy Weekly News Round-up
“Let justice roll down like waters.”
Amos 5:24
Dear Friends and Colleagues,
To all those in the midst of Hanukkah celebrations, Hanukkah sameach! And for those in the midst of Advent, a very merry Christmas!
We’ll be off next week and hope you get a chance to rest and enjoy the holidays. But this week, we have a fun and fascinating intersection of drugs and… Santa Claus.
Those in the Christian tradition know that aside from gifts and generosity, the Santa Claus of popular culture has little to do with Saint Nicholas. This video has gained popularity over the past few years painting an interesting story of where the red-suited man with flying reindeer may have found his origin.
The Amanita muscaria is the classic mushroom you’ve likely seen before with its distinctive red cap dotted with white spots. It is also psychedelic and believed by some to be the powerful and mysterious “soma” referenced in Vedic religious traditions and widely used by shamans throughout Siberia.
Over the winter solstice, shamans dressed in red robes lined with white fur would visit waiting and expectant members of their tribe to bring mushrooms along with gifts of healing, knowledge, and insight. If the snow was particularly deep, the shaman might even need to enter the yurts of those he visited through the hole in the roof.
It wasn’t just the shamans, or those they worked with, that would eat the mushrooms. Reindeer, sometimes used to pull sleighs, also enjoyed the red-capped fungi.
Today, a variety of psychedelics are in clinical trials as they are being successfully used to address treatment-resistant depression, PTSD, end-of-life anxiety, and even treat substance use disorders.
While the therapeutic benefits are still being explored, there is also a long-standing connection between these psychedelic experiences, spirituality, and religion. This week we have a few different stories and studies for you to learn more.
The hypothesis about Santa’s origins is fun to consider. What is clear is that we are still exploring the many healing gifts and possibilities that come from the plants and fungi that grow all around us.
A happy holidays from all of us at Clergy for a New Drug Policy.
Sacred heart church – Moulins, France. Via Getty Images.
Christian and Hebrew scriptures provide multiple examples in which spiritual fervor and intoxication are mistaken for one another. Eli the priest mistook the prayers of Hannah at the temple as drunkenness (1 Samuel 1:13); after Pentecost the disciples needed to defend themselves against a charge of drunkenness (Acts 2:15); and from Paul to the church in Ephesus, “Do not get drunk with wine, for that is debauchery; but be filled with the Spirit …” (Ephesians 5:18, NRSV). There might be some similar feelings along the way, but one path leads to life and the other is poison.
Today, studies have shown that psychedelic treatment and mystical experiences could play a significant role in the treatment of addiction.
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.
Another study looked at data from 214,505 U.S. adults in the National Survey on Drug Use and Health (NSDUH) from 2015 to 2019 and found an association between past use of psilocybin—at any time in their lives—and a reduced risk of opioid use disorder. The researchers looked at 11 criteria that scientists use to diagnose opioid use disorder (for instance, spending a significant amount of time getting and using drugs), and found that past psilocybin use was significantly correlated with lowered odds of seven of the items on the list, and with marginally lowered odds of two others.
In a recent study more than 80% of those who were given the psychedelic treatment had drastically reduced their drinking eight months after the study started, compared to just over 50% in the antihistamine control group. At the end of the trial, half of those who received psilocybin had quit drinking altogether, compared to about one-quarter of those who were given the antihistamine.
The Clergy for New Drug Policy Weekly News Round-up
“Let justice roll down like waters.”
Amos 5:24
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.
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.
