What Happened With Last Year’s Syringe Service Bill?

Despite widespread and bipartisan support for Arizona’s Syringe Service Bill, House bill 2389 stalled in Legislature last session after being amended in the Senate. Republican Representative Tony Rivero of Peoria sponsored the original bill which would legitimize Syringe Service Programs (SSP’s) throughout the state. The bill’s intent was to combat the spread of infectious diseases such as HIV and Hepatitis through legal operation of SSP’s, where IV drug users can obtain clean syringes and safely dispose of their used hypodermics. The bill would have defined legality regarding SSP’s in what is now considered to be in a “grey” area of operation through the eyes of the law. Currently, and in spite of law enforcement’s widely permissible attitude towards these programs, volunteers and participants alike are at legal risk and can technically be charged with distribution/possession of drug paraphernalia, a felony in Arizona.

What happened:
Republican Representative Tony Rivero initially introduced HB-2389 back in February of 2018. The bill was supported unanimously in-favor-of and immediately passed in the State House, uncontested. Despite overwhelming support for the bill in its original form, the AZ Senate Committee on Government imposed an amendment, making it necessary to first wait for a public health emergency to occur before legally allowing SSP’s to operate. Although there is no definitive explanation for the amendment, there is speculation that bill would simply not gain the support of Arizona’s Governor, Doug Ducey. The bill was sent to a Special Committee for further discussion of the amendment and it eventually became overshadowed by a wave of political activity within the state such as the Red for Ed movement, and the fact that it is an election year. Subsequently, this is where the bill died. Meanwhile, Arizona remains exposed.

The Amendment/Remember Indiana:
The amendment to HB-2389 was intended to make it necessary to first declare a public health emergency prior to sanctioning legal operation of SSP sites. This means that Arizona would need to demonstrate a significant increase in “significant” outbreaks of infectious disease to constitute as a public health emergency, according to the US Department of Health and Human Services. This very occurrence unfolded in 2014 in Scott County, Indiana where over 200 HIV incident cases were reported among IV drug users from 2014-2015. The Indiana State Department of Health initiated an investigation in early 2015 and declared a public health emergency by springtime, 2015. It wasn’t until that point in which Governor Mike Pence authorized state officials to establish programs aimed towards prevention of new HIV infections. Pence has been a longtime opponent of syringe service Programs and he viewed the decision as an exception to his moral calculus in an attempt to balance his personal faith and public health. Consequently, Pence remains under a level of political and public scrutiny on the basis of inaction, which resulted in what many deem a preventable outbreak of HIV within his home state.

Backed by Research:
Syringe Service Programs date back to the 1970’s, with the first government approved initiative taking place in the 1970’s, Netherlands. The onset reduction in the spread of infectious diseases was noticeable and the concept naturally made its way to the West by the 1980’s. Statistically and scientifically, SSP’s efficacy in reducing the transmission of infectious diseases is palatable and evidence based, and even backed by numerous government studies. The Institute of Medicine, National Research Council concluded that SSP’s “can be an effective tool for preventing HIV transmission and do not increase drug use”. The Office of Surgeon General found “conclusive scientific evidence” that SSP’s are an effective strategy for reducing HIV transmissions. In 2002, the Institute of Medicine, National Academy of Science noted that “Improving access to sterile injection equipment is a critical component of HIV prevention” while also noting SSP’s as being “highly cost effective”. The report also concluded that SSP’s do not lead to increased drug use, criminal activity, or discarded syringes.

Back to Indiana:
The Indiana incident back in 2014-2015 is one of many examples that demonstrate an overwhelming need for syringe service Programs in the US. The spike in infectious disease cases came without warning and it’s irresponsible to think it won’t happen again. The local government’s position on SSP’s and the subsequent delay in action to mobilize SSP’s in the face of a public emergency was a monumental failure that sustained meaningful consequences for the community. Scott County’s scar mustn’t rest in vein and Arizona has an opportunity to reap the benefit of a hard lesson learned. syringe service Programs and harm reduction techniques prevent the spread of infectious diseases and save lives, respectively. A reactive mentality has proven to be ineffective and dangerous, while showcasing why it’s even more crucial to not attach conditions surrounding them such as the need to produce evidence of an outbreak. The damage is done, and damage control is hardly a strategy.

Law Enforcement:
In a 2009 report released by amfAR, The Foundation for AIDS research concluded that SSP’s protect law enforcement from needle stick injuries. Other key takeaways from the report included:

* SEPs reduce needle stick injuries among police officers and can help lower the number of contaminated syringes in communities
* A study of police officers in Rhode Island found that nearly 30 percent of them had been stuck by a needle at one point in their career, with more than 27 percent experiencing two or more needle stick injuries
* A study of Connecticut police officers found that needle stick injuries were reduced by 66 percent after the implementation of syringe exchange programs

SSP’s and Harm Reduction/Stigma:
Syringe Service Programs however, are much more than what the name merely suggests. They are also the leading distributors of the opiate/opioid reversal drug, Naloxone. Also known by the brand name Narcan, Naloxone is an opiate antagonist that quickly counter effects the deadly symptoms of overdose, particularly suppressed or ceased respiration. Shot In The Dark, a Maricopa County based volunteer organization with 9 SSP sites throughout the Valley has reported over 5500 overdose reversals with the use of naloxone so far in 2018. Participants of SSP’s can also take advantage of screening options for infectious diseases such as HIV and Hepatitis, while receiving results in as little as 20 minutes.

By focusing on the harm reduction aspect of today’s drug related crises and epidemics, groups like Shot in Dark make a measurable impact on the reduction of casualties experienced as a result. Perhaps one of the more powerful features of syringe service Programs often evading recognition, is the sanctuary from stigma that so many users experience from the outside looking in. Maybe it’s not that it goes unnoticed, but rather that it’s just too multifaceted and complex to be commoditized. It’s not a clean syringe, it’s not naloxone and it’s not an HIV test. It’s safe environment for personal and communal connection and growth for people who use drugs.

Call to Action:
As we can see, Arizona needs Syringe Service Programs. Representative Tony Rivero will be reintroducing the Syringe Service Bill this January and we need to make sure our legislators understand how crucial SSPs are in reducing overdose and supporting those who have nowhere else to go for services. We need to act, raise our voices, and reduce harm at the legislative level.

Sonoran Prevention Works has numerous opportunities to get involved and advocate for SSPs in AZ. Check out their website at Advocate and get plugged in. On February 4th there will be an Advocacy Action Day at the State Capitol in Phoenix where myself and advocates from across the state will be deploying in teams of two to speak with our state legislators about the need to support SSPs. Join us and make your voice heard!

- Jay Dassele

Stigma Culture in the Overdose Crisis

As it trends today, the US is currently tracking approximately 130 opiate/opioid related deaths per day. Despite the staggering figure, the societal cry, once a piercing shrill, seems to be settling globally into the duller waters of an ever-more-painful and long-term form of simple acceptance. Darker, and a much more dangerous and depressing implication in that it suggests that there are simply just differences between you and me, right and wrong, good and bad. Even more disheartening is that it sort of implies that you (me) might in fact be, alone.

The debate about how to address the opiate epidemic is vast and varied and typically met first by responses that derive from fear, evidenced by enhanced law enforcement, more arrests and increased sentencing. Not far behind lies potential for the issue to be exploited in order to further serve other narratives like immigration, therefore creating a smoke-screen effect with ungaugable progress and a whole new eco-system of distractions. What’s left over is what existed from the beginning, the stigmatic attitude towards the sick, which alone perpetuates a cyclical divide.

I can’t help but notice that as a society, we tend to feel that people need to learn lessons, and hard ones goddamnit! And as spectators, the harder the better. Hell, we take great pleasure in consuming the pain you excrete while you learn your little lessons in life. And us? In those moments, we’ll simply block our own internal circuit boards that carry even the slightest bit of relatability to you, further impending your sense of isolation. Our lessons in life were hard learned and we’d feel deeply cheated if they weren’t for you too.

But as a society and a species, are we truly sadistic in nature, or is it that we simply just fear the unimaginable discomfort of self-reflecting, relating and connecting? Do we really insist that our fellow suffers in order to progress, or are we merely hyper-vigilant in protecting our own state of vulnerability? An objectionable notion, but possibly one that plays an influential role in the stigma of a drug user, or any unparalleled lifestyle that doesn’t make “sense”. Psychologically, it’s common to write-off a suspected user immediately. Age-old thinking can carve a neural algorithm that basically translates to a quick and common determination: “You’re not like me, and probably got what you deserved”. With that said, it’s no surprise to learn that the most effective asset in combating addiction, is another recovering addict. They understand firsthand what it’s like to have judged and to have been judged, and often times possess an intuitive duality of the two vastly different perceptions. An incredible gift to behold. Carl Jung dubbed this concept “The Wounded Healer”, where he implies that to effectively treat the sick, Jung had to be consciously aware of his own personal wounds. Another common judgement levied upon users are speculations as to why they use – usually summed up by simple pleasure-chasing and evading responsibility. Thankfully, this novel generalization isn’t holding up and as it slowly weakens, a little more light gets shed on the true origin of a user’s pain.

In some states like Arizona, efforts are in place to focus on the overdosing aspect of the opioid crisis. Non-profit groups such as Sonoran Prevention Works distribute lifesaving supplies to the public, such as Naloxone and clean syringes. Naloxone is an opiate/opioid antagonist that essentially acts as an antidote to lethal doses of heroin or opioids by restoring abnormal respiration. Shot In The Dark (SITD) is another non-profit organization that focuses on clean-needle exchange programs, giving users the opportunity to acquire clean syringes while safely and properly disposing of old hypodermics.

Organizations such as SPW and SITD are becoming lauded as the tip of the angel’s spear in combatting the opioid crisis. In addition to minimizing the spread of disease and reducing overdose related deaths, these programs communicate an even-more powerful message to the sick. It highlights that they are anything but alone. More importantly, they are accepted and within a short period of time, connected. They’ll take it from there and need not to be “fixed”, at least not by underdeveloped opinions that evolve throughout one’s lifetime, uninformed judgements, or any ideology. We sometimes think that we teach our children to physically speak during development, but they do that on their own. They’re human beings and the most intelligent organism we know of so far in the universe. Parents still play the most vital role however, and I’d argue that role is more along the lines of being an influential conduit for love and support, unconditionally. Perhaps our role in this existence is less defined by our external virtues and subsequent will to align with the like-minded and indoctrinate others, and better defined by our ability to first humble constantly through reflection, then influence with affection.

- Jay Dassele