An act signed by President Barack Obama on December 18th, 2015 finally allowed federal money to be used to fund syringe exchange programs (SEPs), lifting a ban that had lasted almost continuously since 1988. New guidelines about how state, local, tribal and territorial health departments can apply for this funding have just been issued.
One of the organizations that has long campaigned to end the ban on federal funding is the Harm Reduction Coalition. Their policy director, Daniel Raymond, tells The Influence that the current opioid crisis “has really moved the dial” politically, in a way that the AIDS crisis of the 1980s did not. It is, he adds, “notable that it is a Republican Congress that has led the charge.”
Raymond sees two important aspects to the new development. The first is “a tangible effect in terms of available resources.” Access to federal funds will particularly make a “huge difference” for rural SEPs in states like Kentucky, Indiana, Ohio and West Virginia, Raymond says, where HRC has worked to help new SEPs with training and capacity-building, and where money to start or maintain such programs is scarce. He notes a “sense of urgency” in West Virginia, for example, which opened its first SEP last year, and where rates of hepatitis C are high, with rates of hepatitis B associated with injecting drug use also growing.
The second important aspect is “a symbolic effect—a sign that we are no longer going to play politics with this issue,” Raymond says, adding that “maybe Indiana would have moved more quickly” to address the HIV crisis that broke out there a little over a year ago if the new law had been in place, although it’s hard to be sure.
The guidelines on applying for federal funding explain some significant restrictions. For example, while federal money can be used to pay for numerous costs involved in running SEPs, the money cannot be spent on actually buying syringes or drug-preparation devices like cookers.
“It’s obviously less than ideal, but it will be workable,” says Raymond of this restriction. “It’s the price we’ve had to pay to get people who are more conservative on this issue to buy into it.” He points out that buying syringes and preparation devices is usually a much smaller expense for SEPs than paying salaries or rent, meaning that this “imperfect compromise” will work both fiscally for the programs and symbolically on a political level (because taxpayers’ dollars won’t be seen to buy syringes directly).
Another restriction requires local health departments to first demonstrate that their community has experienced a significant increase in blood-borne diseases relating to injecting drug use, or is at particular risk of such an increase. Again, Raymond feels that this will not greatly decrease the effectiveness of the new funding: “Sadly, in practical terms, this is not going to be a very high bar for most of the communities that need these programs.”
After almost three decades of ignoring the best available evidence about protecting public health, the change in federal policy gives solid grounds for optimism. But as Raymond notes, a lot more remains to be done: “We still need dedicated federal funding to support these programs, and changes in state laws to allow more communities to establish syringe access programs. Syringe access programs are on the front lines of the overdose and hepatitis C epidemics, and our best opportunity for engaging people who inject drugs in counseling, health care and treatment.“