January 16, 2020

Surgeon General OKs Syringe Services Programs – But Some EtHE States Disagree

Last Wednesday, Jerome Adams, MD, U.S. Surgeon General, spoke at the Cato Institute in Washington, D.C. on the status of Syringe Services Programs (SSPs) in the U.S. and the administration’s views on their role in the recently-launched Ending the HIV Epidemic (EtHE) initiative. Prior to his current role, Dr. Adams, an anesthesiologist and a vice admiral in the U.S. Public Health Service Commissioned Corps, was Indiana’s State Health Commissioner from 2014–2017. In 2014, he was at the helm (with former Indiana Governor Mike Pence) when a sudden outbreak of new HIV infections occurred in Scott County, IN. At least 142 people were determined to have acquired HIV by sharing syringes to inject Opana, a prescription pain-killer.

Dr. Adams is a strong supporter of SSPs, calling them under-utilized tools. He announced at his Cato Institute presentation that federal “core prevention funding” can now be used to support them. In a 2019 webinar, HIV.gov stated that SSPs “are associated with an approximately 50% reduction in HIV and hepatitis C virus (HCV) incidence… and are a key strategy of the Ending the HIV Epidemic.”

The federal government’s endorsement of SSPs, however, does not mean that all states will follow suit. Last Friday, State Senator Eric Tarr introduced Senate Bill 286 in the West Virginia Legislature to amend the state code “prohibiting the development of syringe exchange programs; providing for the closure of existing programs; and providing for civil penalties.”  This opposition to SSPs has been growing in his state since 2015.

The rise and fall of West Virginia’s largest SSP is detailed in a study published in May 2019. In 2015, the state Health Department opened it in Charleston (the state capital) and it rapidly became a popular point of access to Narcan, clean syringes and respectful assistance to its clients. It also offered screening for a number of infectious diseases including HIV and HCV.

Opposition to it began to build among local politicians who “began criticizing the health department in the media, claiming the city was experiencing a spike in crime because of the syringe program,” the report notes. Pressure increased and the Charlton SSP was closed in 2018.

Senator Tarr’s newly introduced bill verifies that this political battle persists. Shannon Hicks, President of the Exchange Union (a volunteer organization providing SSP services in the state) is struggling to maintain services elsewhere in the state. She said, “you take away the sterile syringes, and people don’t stop injecting drugs. They just start sharing syringes.” If the bill is passed, the Exchange Union and “any needle exchanges still operating would face a fine up to $25,000,” reports a local radio station, WSAZ.

Kaiser Family Foundation data show that in 2018 SSPs were available to varying extents in 39 states, as well as Puerto Rico and the District of Columbia. While most of the remaining states have since adopted some form of SSP, Alabama and Nebraska have not. Mississippi has no legislation on the subject.

Alabama and Mississippi are both included in the EtHE plan and will be receiving federal funding to reduce their substantial HIV rates, including among people who use drugs and acquire HIV. What happens if you live in a state participating in EtHE that also declines to implement SSP – then what? Presumably the dilemma will have to be resolved with advocacy – and we are fully ready to have our voices heard in support of the Academy’s position in support of SSP.