As a recent Arizona transplant and co-director of the Rural Center for AIDS/STD Prevention at the Indiana University School of Public Health-Bloomington, I watch with interest Arizona’s policy process to allow syringe-service programs. SSPs are public-health efforts providing sterile syringes and myriad other services to people who inject drugs.
While states are unique laboratories for policy innovation, bilateral state learning is often helpful. In 2015, Indiana considered and passed syringe-access policy following an HIV outbreak among people who injected drugs in Scott County. Prior to this, it was illegal to distribute and possess syringes for non-prescription drug use. As a result, 231 people are now infected with HIV in that rural community.
I offer a few insights for Arizona’s consideration in the spirit of bilateral learning.
First, SSPs are expressions of good public-health policy because they provide critical linkage to public-health services for populations disconnected from them. Services often include HIV and hepatitis C (HCV) testing, access to clean syringes and naloxone — the opioid overdose-reversal medication — and primary care, addictions treatment and social-service referrals. These actions directly benefit those receiving them, their families and the wider community because they decrease overdose death, HIV and HCV infection, and facilitate access to addictions and primary-care treatment.
Second, SSPs are “public-health multipliers” because program participants extend the public-health reach deep into their communities by providing peers with clean syringes and naloxone kits. This is important, because 50 percent to 80 percent of those who inject drugs will become HCV-positive within five years of initiation. Further, according to a 2014 national study, 82 percent of those who administered naloxone at the time of overdose were drug-using peers. Reducing HCV, HIV and overdose among those who inject drugs would not be possible without SSPs.
Third, SSPs are not emergency response programs, but are part of the “upstream” public-health effort to create environments where healthier choices can be made — such as whether or not to use contaminated syringes, test for HIV, HCV or fentanyl, deliver naloxone to someone overdosing or access health services. This point should not be missed here in Arizona.
I recall an 11th-hour legislative amendment last year that mirrored our Indiana law requiring communities to declare an “epidemic” of HIV or HCV in order to establish an SSP. This requirement killed Arizona’s bill last year and continues to strangle Indiana’s efforts because it is untenable. Indiana Representative Ed Clere, R-Floyd, who led the effort for syringe access equated this thinking to “waiting to install smoke detectors after the house is engulfed in flames.” I would ask Arizona policy partners to recognize such a requirement for what it is: a public-health barrier.
Fourth, there are 30 years of solid public-health research documenting that SSPs are cost-effective, lead to reduced syringe sharing, disease and adverse health outcomes among program participants, and do not facilitate increase drug use or increases of discarded syringes . The evidence is overwhelming and conclusive.
Finally, to those feeling cautious about syringe-access policy because they may not be acquainted with drug use or addiction in their families, and to those who hold positions of zero tolerance, I can only offer this: Public health is about collectively creating the conditions for health. This means having a harm-reducing approach (think: nicotine patches, seat belts, etc).
Public health is about making lives less dangerous and more healthy. Everyone — every one — in our communities deserves public-health access. Together, we can strengthen our community’s health through syringe-services programs. With this effort, Arizona can teach Indiana something.