Charting the syringe access landscape in 2009
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Charting the Syringe Access Landscape in 2009. Daniel Raymond Policy Director Harm Reduction Coalition [email protected] (212) 213-6376 x29. Current Federal Policy. Blanket prohibition on use of federal funds to distribute syringes since 1988

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Charting the Syringe Access Landscape in 2009

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Charting the syringe access landscape in 2009

Charting the Syringe Access Landscape in 2009

Daniel Raymond

Policy Director

Harm Reduction Coalition

[email protected]

(212) 213-6376 x29

Current federal policy

Current Federal Policy

Blanket prohibition on use of federal funds to distribute syringes since 1988

  • Labor/HHS Appropriations

  • Authorizing bills

    Last major campaign to lift the federal funding ban failed in 1998

Charting the landscape

Charting the landscape

  • Diversity of programs, practices, policies

  • Legal and regulatory patchwork

  • Public health vs. paraphernalia laws, stigma, community concerns (NIMBY, safe disposal)

  • Mixed environment evolved in the context of federal funding ban: local and community-driven innovation and experimentation

  • Syringe access often remains outside of HIV and hepatitis policy and planning processes & structures at federal, state & local levels

Epidemiological context

Epidemiological context

  • ~ 1 million injection drug users in the U.S.

  • Sustained declines in HIV incidence: 7,160 estimated new infections in 2006 (includes Puerto Rico, but not MSM/IDU)

  • Evidence for parallel but more modest decline in HCV incidence (but overall prevalence remains very high)

Syringe access categories

Syringe access categories

  • Pharmacy sale w/out prescription

  • Syringe exchange

  • Physician prescription

    Other models outside of U.S. include vending machines, supervised injection facilities

Pharmacy sale and syringe access

Pharmacy sale and syringe access

  • “Clearly legal” in nearly half of all states; “clearly illegal” in six states

  • One in four states have passed laws to increase syringe access since 1987

  • Subject to discretion, limitations, rules (e.g. record keeping, ID requirement)

  • Effective implementation engages pharmacists & staff, law enforcement, injection drug users

Measuring the impact of pharmacy sale

Measuring the impact of pharmacy sale

New York State since 2001:

  • Documented shift in source of most recent syringe (supplements syringe exchange)

  • Broad participation from pharmacies (over 3,000)

  • Estimated syringe sales now match numbers of syringes distributed by syringe exchange programs

  • Average syringes sold per pharmacy: 67.1 per month in 2006

Syringe exchange landscape

Syringe Exchange Landscape

  • 186 known programs operating in 36 States, the Indian Nations, Washington DC, and Puerto Rico

  • Broad diversity in size, service delivery models and settings, organizational type, data collection methods, program philosophy, and operational constraints (legal/political)

Funding issues

Funding issues

  • 61% of syringe exchange programs receive some public funding (city/county/state)

  • Total SEP budget in 2007 (70% reporting): $19.6 million (including $14.4 million in public funding)

  • Few private/foundation funding sources (Syringe Access Fund: 148 grants totaling $4.4 million since 2004)

  • 56% of programs report lack of resources/lack of funding

Federal funding ban in appropriations bills

Federal Funding Ban in Appropriations Bills

Labor/HHS/Education Appropriations:

SEC. 505. Notwithstanding any other provision of this Act, no funds appropriated in this Act shall be used to carry out any program of distributing sterile needles or syringes for the hypodermic injection of any illegal drug.

Ban in authorizing legislation

Ban in Authorizing Legislation

  • HOPE Act of 1988 (authorizing HIV/AIDS prevention funding): ban with exemption based on Surgeon General determination (42 USC 300ee-5)

  • Ryan White CARE Act of 1990: complete ban (42 USC 300ff-1)

  • ADAMHA Reorganization Act of 1992: applies HOPE Act ban language to SAMHSA substance abuse prevention & treatment block grants to states (42 USC 300x–31)

  • Runaway, Homeless, and Missing Children Protection Act of 2003: complete ban in Runaway and Homeless Youth funding (42 USC 5752)

Options for lifting the ban

Options for Lifting the Ban

  • Remove annual rider from FY 2010 Labor/HHS Appropriations

  • Community AIDS and Hepatitis Prevention Act (H.R. 179):

    “Notwithstanding any other provision of law, nothing shall prohibit the use of Federal funds to establish or carry out a program of distributing sterile syringes to reduce the transmission of bloodborne pathogens, including the human immunodeficiency virus (HIV) and viral hepatitis.”

Visions for the future

Visions for the Future

  • Ubiquitous syringe access – anyone who provides services to any IDUs also provides syringes

  • Comprehensive drug user health initiatives link HIV, viral hepatitis, STDs, overdose, addiction, mental health, and primary care with education, social services, housing….

  • Destigmatization & legitimation leading to removal of political, legal, funding barriers

  • Reframing debates on syringe exchange, harm reduction, IDUs, and drug policy for a shifting political environment

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