February 20, 2020

A Tale of Three Cities – Variations on Syringe Exchange and Site Policies

Opinions vary widely about the rights and needs of people who use drugs across our country. Within the U.S., the spectrum of public opinion runs from cities determined to provide Safe Consumption Services where people can inject safely (using their own drugs), to legislators struggling to re-criminalize publicly funded syringe exchanges and ban all harm reduction services.

These sharp differences are also shifting across cultures and over time. In Scotland, for example, injection drug use was booming in 1985, with escalating HIV transmission right behind it. In 1986, the U.K.’s National Health System acknowledged this problem as “largely confined to marginalized communities — in Glasgow’s case, a small group of less than 200 injecting drug users.” Over half of that population was already testing HIV positive so the British government established syringe exchange programs and began providing methadone. Subsequently, HIV incidence rates declined.

Now, over three decades later, the trend started to climb again in Glasgow (a city of about 600,000 people). New HIV infections escalated from 47 diagnosed in 2015 to 160 in January 2020. Apparently, the price of cocaine in the area dropped below that of heroin, making injectable cocaine much more affordable and triggering increased injection rates. To address it, the U.K. is considering opening Safe Consumption Services, an approach already used in seven E.U. countries, as well as in Switzerland, Norway and Canada. Scottish Health Minister Joe FitzPatrick and the Scottish National Party approve the idea but the U.K.’s Home Office has declined the pilot program, arguing that drug consumption rooms would “condone” drug availability and use.

On our side of the Atlantic, some exchange programs administered by Health Departments are now closing (despite their apparent success) due to political opposition. A successful syringe exchange program in Charleston, West Virginia was forced to close in 2018 and a state legislator there is now proposing a bill to prohibit all syringe exchanges, even those not affiliated with state offices. Dozens of syringe exchanges have opened in the U.S. in the last decade, but a significant proportion have also been shut down due to political opposition.

A third alternative is emerging in the hope of saving lives. In Philadelphia, (a city of 1.57 million), more than 3,000 people died of drug overdoses between 2017-2019. This catastrophic toll has inspired a coalition of HIV and harm-reduction advocates, local NGOs, city health departments, community activists, and local residents to create Safehouse — possibly the first safe injection site in the U.S. For the last few years, the federal Justice Department has been blocking the project’s progress on the grounds that it facilitates drug use. Through judiciary appeal after appeal, Safehouse founders and supporters have countered their claims. Last October, U.S. District Judge Gerald A. McHugh concluded in his decision that “the ultimate goal of Safehouse’s proposed operation is to reduce drug use, not facilitate it.”

According to his response in the Philadelphia Inquirer, U.S. Attorney William M. McSwain has vowed “to use all enforcement tools at his disposal to shut down any site that opens before the appellate process plays out.

The Academy is proud to stand with Safehouse and all other long-term efforts to establish safe environments in which people who use drugs can get the medical care and support they need. Since a significant number of people living with or at risk for acquiring HIV are in need of these services, our active support for Safe Injection Sites is a component of our commitment to responding to the health care needs of people living with HIV. For more information, please see the Public Policy Column from October 3, 2018 and our Public Policy Statement on Harm Reduction.