In some ways, people who inject drugs in the United States are enjoying unprecedented lawful access to supplies to keep themselves safe, namely syringes and needles. In February 2021, one month into the young United States presidency of Joe Biden, harm reduction was revealed to be explicitly included in the executive’s drug policy, an historic first. The proposed National Drug Control Budget, published in May, added even more promise, suggesting that syringe service programs (SSP) may finally get the financial support from Washington, DC that they’ve lacked for decades. And states are moving to decriminalise syringes: New York and Delaware are on the brink for possession and distribution, respectively.
In other ways, syringe access is facing a wave of revamped aggression. From rural counties to capital cities, regional US governments are limiting, shuttering, and even outright banning SSPs. What’s been a long-standing political hostility towards harm reductionists providing injection equipment appears to be reaching a boiling point in some localities, with a slew of anti-SSP laws being introduced and enacted since the beginning of the COVID-19 pandemic, the response to which has itself been found to devastate services.
It’s unclear if there is any one unifying driver of the attacks on SSPs. “There is something deeper and more visceral in the backlash we’re seeing to SSPs across the country that can’t be pinned on dollars and cents,” Drew Gibson, senior policy manager for drug user health at AIDS United, told TalkingDrugs. “Some legislators seem motivated in large part by a very vocal minority within their constituency who dedicate much of their time and energy to vilifying people who use drugs as menaces to society and erroneously casting SSPs as the cause of the overdose crisis, rather than its potential cure. Others seem to just want the entire question of drug user health and drug use in their communities to just go away, as if shutting down an SSP is going to eliminate discussions of overdose and HIV and syringe litter from public discourse.”
It’s also unclear if and how this public health crisis itself has agitated harm reduction’s opposition. “Whether it was influenced directly by the COVID-19 pandemic or simply happened in parallel with it,” said Gibson, “there has been an increase in anti-SSP, anti-drug user health sentiment that is pretty alarming.”
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During the COVID-19 pandemic, two jurisdictions––Kanawha County, West Virginia and Scott County, Indiana––lost their SSPs due to hostile legislation, even after having suffered or currently grappling with HIV outbreaks of national alarm.
In Kanawha County’s capital, Charleston, one of two SSPs is slated to effectively shut down through a combination of local and state laws. The program, SOAR (Solutions Oriented Addiction Response), would have faced a criminal penalty if they were to continue distributing supplies. In April, state Senate Bill 334 was signed into law, requiring all lawful SSPs to obtain state certification; on the local level, Charleston City Council passed Bill No. 7893, adding the threat of criminal prosecution to the state mandate. Months prior to this legislation, SOAR’s then-voluntary state certification had been rejected.
Some Charleston community members have loudly opposed SOAR. Yet recent research showed that most residents actually want an SSP. “Given the amount of debate in the community, I was personally surprised the results were primarily positive in regard to the need for harm reduction and syringe exchange,” Dr. Susan Bissett, president of the organisation behind the study (West Virginia Drug Intervention Institute), told Filter. “I expected there to be a bit more divide between those that responded ‘Yes’ and ‘No’ to the question asking if participants supported harm reduction in the community.”
“In West Virginia, even speaking the words ‘harm reduction’ has become taboo,” Lill Prosperino, the National Harm Reduction Coalition’s Southern States Regional Organizer located in southern West Virginia, told TalkingDrugs. “While there is a lot of broad public support for harm reduction, the government continues to stand behind a terrible law written by a racist, far-right legislator who only wanted to punish people who use drugs even though half the state or more is using drugs. We need to accept reality, meet people’s needs in this way, and move on.”
Needs left unmet could spell more disaster than what the region already faces: Kanawha is embroiled in what the CDC has called the “most concerning [HIV outbreak] in the United States.” Simultaneously facing the COVID-19 pandemic like the rest of the world, Kanawha County also faced a startling outbreak: the number of new HIV cases among people who inject drugs skyrocketed from 15 in 2019 to 39 in 2020, according to state figures.
SSPs were innovated to reduce this exact problem. Since at least the 1990s, researchers have known that SSP closures increase the risk of HIV transmission for their participants. A mathematical model showed that SSPs are the difference between an HIV crisis and few HIV seroconversions. The model was constructed using the conditions of an infamous 2015 outbreak in Scott County, Indiana, to which 235 HIV cases have been attributed. In response, a public health emergency was declared, by the foot-dragging then-Governor Mike Pence, reversing the ban on such programs.
The SSP that helped get the Scott County crisis under control has now faced a similar fate as SOAR’s during the pandemic. On June 3, an ordinance in Scott County was adopted by their local legislative body to close the SSP currently operated by the local Health Department. The Scott County Commission’s decision ran counter to the recommendations of both the current and former Indiana Health Commissioners, the latter of whom was also the US Surgeon General in the Trump Administration, as well as both the current and former Scott County Sheriffs.
“We are disappointed that the decision was made to end our syringe service program in January [2022],” Michelle Matern told TalkingDrugs. “Despite local, state and national experts repeatedly informing our elected officials the importance of the program, they chose to end the program. It is somewhat of a relief [that] there will be time to prepare for the closure and it was not effective immediately.”
But she added: “Of course, we are concerned of another HIV outbreak occurring in our community once the program is officially closed.”
There have been at least three other, albeit lower-profile, closures byway of local ordinance. In northern California on December 11, 2020, the City Council of the city Eureka voted to close syringe access efforts by Humboldt Area Center for Harm Reduction (HACHR), an organisation that’s long suffered and resisted attacks by politicians and community members. HACHR is still authorised to provide other harm reduction services. When the group was first greenlit by the state in 2018, allegations of disregard for syringe litter were made by city government officials and police; by 2020, the accusations changed to claims of drug sales and use at HACHR’s site. It was local undercover police that made the claim, paralleling law enforcements’ unsuccessful attempt to delegitimise SOAR in West Virginia by conducting a criminal investigation.
A month later elsewhere on the West Coast, a county in the state of Washington ended its publicly-operated SSP with an ordinance similar to the others passed around the country. Just like Scott County, two of the three County Commissioners on the Board voted on January 14, 2021 to approve the closure, making good on campaign promises in the run up to their November 2020 elections. According to a local news site, the two were recently elected and had campaigned on it. As of April 1, funding for the operation of Grays Harbor County Public Health and Social Services Department’s Syringe Exchange Program ceased. The text of the ordinance writes, “Board of Health believes that the operation of a syringe exchange in Grays Harbor County is not an appropriate use of taxpayer money.”
More recently, a county in the state of Michigan is facing, to a lesser degree, the hostility shown in Indiana and West Virginia. On May 24, officials in Kalkaska County’s Clearwater Township requested that the organisation Harm Reduction Michigan temporarily cease syringe access operations in the area. The harm reductionists complied.
Once again the allegation of increased syringe litter is involved in the dispute, a local news site reported. It appears to be trumping something that poses a far more immediate threat to public health: Kalkaska County has been identified as at high risk for an HIV or hepatitis C outbreak by both Michigan authorities and the federal CDC, the latter of which also correctly identified Scott County, Indiana and Kanawha County, West Virginia where alarming outbreaks have indeed occurred.
Now, the fate of a harm reduction organisation in Atlantic City, New Jersey is up in the air.
>> Read Part 2 to find out more.
*Sessi Kuwabara Blanchard is an independent drug journalist and transgender critic. Previously, she was the original staff writer at Filter, an online publication dedicated to covering harm reduction and drug policy. Follow her on Twitter, @SessiBlanchard.
