Both advocacy campaigns are a sign of how controversial syringe exchanges remain, despite decades of evidence showing they decrease the spread of infections like HIV.
This week, advocates from across Pennsylvania are set to rally in Harrisburg in support of legalizing syringe service programs in the commonwealth, where the public health measure is still against the law — though some communities allow them to serve people in addiction.
At the same time, in New Jersey, where syringe services have been legal since 2006, harm reductionists are fighting to keep the state’s oldest needle exchange program open in Atlantic City.
Both advocacy campaigns are a sign of how controversial syringe exchanges remain, despite decades of evidence showing they decrease the spread of infections like HIV and connect people in addiction to desperately needed medical care and treatment. And the push for better syringe access in the region is taking place amid a record-breaking surge in overdose deaths.
Syringe service programs operate in more than 40 states, including Pennsylvania, though it is one of just a few whose laws explicitly prohibit the distribution of syringes. Amid the AIDS epidemic in the 1990s, Philadelphia activists defied the law and opened the needle exchange program that became Prevention Point, which has operated with the permission of the city government ever since. Pittsburgh’s needle exchange, also called Prevention Point, operates under similar leeway from its local government.
Several other needle exchanges operate with varying degrees of visibility throughout the state. But in many places, the state ban keeps outreach workers in constant fear of arrest.
“[In the rural areas], they’re smaller nonprofits, jumping in cars with syringes, fentanyl testing strips, and naloxone. They’re in the woods, in hiking boots, up the mountains, doing really targeted and focused outreach on individuals who have basically isolated themselves,” said Carla Sofronski, the cofounder of the Pennsylvania Harm Reduction Alliance, one of the rally’s organizers. “They’re doing amazing harm reduction work to keep people alive and safe. But they’re doing it in fear that any time they could be put in jail.”
In Philadelphia’s collar counties, people can travel to the city for clean syringes, but statewide legalization would eliminate that barrier, advocates say.
Susan Ousterman, of Bucks County, said her son Tyler Cordeiro contracted endocarditis last year — a life-threatening inflammation of the lining of the heart — because he could not get clean syringes. “He contracted it in May , and he was in the hospital for three months,” she said. “It was bad. His kidneys were failing, and he almost died.”
In August 2020, she said, her son was jailed for a probation violation in Bucks County after he was caught carrying a syringe. His medical benefits were suspended during his time in jail, and afterward, Cordeiro and his family struggled to find treatment — a task made more difficult by the fact that he had a medical marijuana card. (At the time, a Spotlight PA investigation found, confusion over federal regulations meant that some county drug and alcohol offices in Pennsylvania weren’t using federal funds to pay for addiction treatment for medical marijuana cardholders.)
“He lost his medical coverage, he couldn’t get funding to get into treatment — you can’t pinpoint one thing that was a failure. But definitely, access to clean syringes could have improved his outcome,” Ousterman said.
Four Pennsylvania lawmakers, including Philadelphia State Sen. Anthony Hardy Williams, have said they plan to introduce legislation legalizing syringe access programs, and Gov. Tom Wolf has signaled support for syringe exchanges. Advocates hope to speed up the push for legalization at Wednesday’s rally in Harrisburg, where Ousterman is planning to speak. She’s bringing a copy of her son’s medical bill from his hospitalization with endocarditis, totaling $750,000. She also hopes to meet with Bucks County lawmakers to talk about local syringe access.
As activists in Pennsylvania call for legalization, however, those in New Jersey — where exchanges have legally existed for 15 years — warn that this protection is no guarantee. In Atlantic City, activists have spent the summer battling to keep the seaside town’s exchange open after the city council voted to shut it down. Council members argued that the exchange and the people in addiction it serves aren’t compatible with the city’s tourism district, and that other communities should open their own exchanges.
But strict regulations around how and where a needle exchange can open in New Jersey can make that impossible. For instance, a community must have a certain number of HIV cases stemming from injection drug use before a site can open.
“It’s a restriction that no other type of health care faces,” said Jenna Mellor, the codirector of the New Jersey Harm Reduction Coalition. “What municipality or what zip code you live in shouldn’t dictate whether you have access to basic health care.”
Legislation has been introduced to relax those rules, allowing the state Department of Health to set up syringe exchanges and forbidding cities from shutting exchange programs down in an attempt to prevent another “crisis” like the one in Atlantic City, Gov. Phil Murphy said in a press release earlier this year.
Atlantic City’s needle exchange sued to keep its doors open, and a judge has issued a temporary restraining order that will allow it to operate until at least Nov. 12.
“My advice for Pa. is to learn from New Jersey — just because you have a law, doesn’t mean you have access. We’re still arresting people in New Jersey at high rates. We’re not able to open new syringe access programs. We’re seeing the one in Atlantic City threatened with closure,” Mellor said. “It’s not just about laws, it’s about how they’re implemented.”