Last year, Prevention Point Pittsburgh distributed more than 376,000 clean syringes to people in Allegheny County — 6,200 more than in 2015.
Demand for syringes and overdose prevention measures is “constantly going up,” said Aaron Arnold, executive director of the public health nonprofit, especially since 2012.
But even as demand increases, Prevention Point Pittsburgh only serves around 700 to 800 unique individuals each year. “That’s a very small proportion of the need,” he said.
Syringe exchanges are technically illegal in Pennsylvania, but they operate in a small number of municipalities, including Allegheny County and Philadelphia, with the cooperation of local officials and authorities. The commonwealth’s neighbors — Delaware, Maryland, New Jersey and New York — have all authorized the creation of syringe exchanges, which the Centers for Disease Control and Prevention recognizes as a way for people who inject drugs to “substantially reduce their risk” of getting a a blood-borne infection such as HIV.
“Pennsylvania is falling behind on this particular action,” Arnold said. That’s why he and other advocates are looking to the governor for help.
A public health emergency
While a member of the Pa. legislature has twice introduced legislation to allow syringe exchanges, the bills haven’t gone anywhere. One possible reason, Arnold put forth, is “a sense of reluctance or a fear that as a largely rural state that the public might not support this change.”
That line of thinking is ironic, considering the opioid epidemic is devastating the state’s rural communities, as hepatitis C and HIV cases skyrocket in Southwestern Pa. It also doesn’t match what Arnold is hearing on the ground.
“We’re hearing, ‘This makes total sense. Bring it on,'” he said. “‘We need all the help we can get.'”
There are two ways that Pennsylvania could allow syringe exchanges to operate statewide, according to Arnold. One, the Pa. legislature could pass a bill, although that seems unlikely considering the conservative stronghold Republicans have on both chambers.
The other option, Arnold said, is that Gov. Tom Wolf and Secretary of Health Karen Murphy could declare a public health emergency and decriminalize the possession of syringes without a prescription. Arnold was one of nearly 70 people, including members of Pittsburgh City Council and local doctors, to sign on to a letter asking for just that.
The letter, sent March 29 by the Syringe Access Network of Pennsylvania, asks Wolf and Murphy “to remove the clause in Pennsylvania’s Controlled Substances, Drugs, Device, and Cosmetics Act that references syringes as drug paraphernalia, effectively prohibiting expansion of proven effective syringe exchange programs (SEPs) in PA.”
The emergency is real. Last year, the CDC designated Cambria County, near Altoona, as one of 220 counties nationwide at risk for outbreaks of HIV and hepatitis C because of injection drug use. That’s also when the CDC lifted a federal funding ban for syringe exchanges in 14 states based on a “determination of need.” Pennsylvania was one, but the state can’t use that funding because of the prohibition.
That money could bring much needed security to already established programs like Prevention Point Pittsburgh. “We just don’t receive enough funding,” Arnold said, adding that two-thirds of his nonprofit’s budget comes from foundations, grants and individual donors. While there’s a growing interest from the philanthropic community in harm reduction programs, Arnold said it’s hard to plan for the future without government funding.
Wolf’s administration has signaled an openness to a statewide syringe exchange. Creating one is listed in a 2016 blog post as one of the seven steps the Wolf administration is taking to fight the heroin epidemic. That has yet to materialize.
Arnold said Friday the group hasn’t heard back about the letter’s request for a meeting. The governor’s office did not return a request for comment.
A bill without the red tape
As he did last session, Pittsburgh state Rep. Ed Gainey has introduced a bill to decriminalize syringe exchanges. Gainey said the legislation “creates a better health.”
“We’re not going to stop people by saying, ‘no, it’s illegal,'” he said of drug use. “We have to look at another way.”
Not only would his bill allow people to get syringes in a safe location, but it would also provide access to information about treatment, he said, adding that the cost of syringes is small compared to that of treatment for hepatitis C.
“Sooner or later, everybody wants to get clean,” Gainey said. “Nobody wants to stay dirty.”
Like his marijuana decriminalization bill, Gainey isn’t sure if the syringe exchange legislation will get a committee hearing or vote. The bill has bipartisan support from Allegheny County’s delegation: Democrats Dom Costa, Dan Frankel, Dan Miller and Harry Readshaw are co-sponsors as is Republican Jason Ortitay.
While Arnold said it’s “wonderful” that Gainey has introduced exchange legislation, his preference would be for a system with less bureaucratic red tape. Gainey’s bill authorizes DOH to create standards and authorize syringe exchanges, which could lead to some of the same issues experienced by Prevention Point Pittsburgh.
The Allegheny County ordinance allowing exchanges “has some strange requirements in it,” Arnold said. It originally mandated that exchanges couldn’t operate within 1,500 feet of a childcare facility or drug and alcohol treatment facility, which included places where groups like Alcoholics Anonymous meet. Armed with a study that showed the ordinance prevented Prevention Point Pittsburgh from opening new locations, the county amended the ordinance to get rid of the 1,500 foot rule within city limits. But it still exists outside of Pittsburgh.
There’s also a multi-layered process of approval for new sites that takes about a year to complete, Arnold said. At this point, Prevention Point Pittsburgh is authorized to stop in a van at two city locations, in Perry Hilltop and the Hill District, and to operate Sunday from the Pittsburgh AIDS Task Force’s building in East Liberty.
“We know that there are numerous other neighborhoods that could use our services,” he said.
A one-size-fits-all system instituted by the state could not only be onerous for small communities, Arnold said, it could also mandate requirements for municipalities that don’t work, much like Allegheny County’s 1,500-foot rule. “We’re hoping to avoid rules that don’t make any sense,” he said.
Decriminalizing syringes and allowing for their retail sale at pharmacies would be the “simplest and least costly” way of implementing exchanges statewide, the Syringe Access Network of Pennsylvania argued in a February white paper. Arnold said the group is talking to legislators to advocate for this approach.
“Hopefully that will be the next version of what’s to come,” Arnold said.