Syringe Services Programs (SSPs) for Alabama
Brandi McNeely
Addiction Research Foundation
Syringe services programs (SSPs) have in recent years been expanding throughout the
United States as a response to the opioid epidemic and response to injection drug use related diseases, which are continuing to spread across the US at higher rates. SSPs are qualified as a harm reduction method for addressing the growing rates of use and disease seen in this county. According to Faulkner-Gurstein (2017), harm reduction methods can be described as methods which seek to reduce the negative consequences of substance abuse, while not necessarily prioritizing abstinence above all other factors. Harm reduction methods have grown more popular and are being observed as a new crucial method of addressing drug abuse, as more traditional methods that prioritize abstinence, which was originally made popular after the War on Drugs was declared, have been shown to often fail substance abusers or not address the need for multi-model rehabilitation services.
The “one size fits all” intervention strategies are losing momentum throughout the
the country as harm reduction services, such as syringe services programs, is gaining more support. According to McGinty et al. (2018), a national web-based survey of 1,004 adults revealed the highest numbers of harm reduction syringe services programs within the literature. According to the survey, 39% of Americans support the legalization of syringe services programs within their communities. Furthermore, 29% of Americans support the legalization of injection and
consumption sites within their community. Although these response percentages need to increase in order to see the expansion of SPPs to the extent that the need is met within communities, presenting the benefits of SSPs is one way to gain support within Alabama.
Methods
For this research paper, the main method for gathering information was an interview with
Mathew Pagnotti, who is the Director of Policy and Advocacy for Aids Alabama. Mathew is heavily involved in the syringe services programs initiative that is currently progressing within Alabama. The initial interview questions that were asked to Mathew were, “Where is Alabama at in the progress of legalizing syringe services programs” and “What is some research that offers insight into the impacts of needle exchange programs.” Notes where taken during the interview and synthesized. Peer-reviewed literature was also gathered through the UAB Library database. Keyword combinations such as “harm reduction” and “syringe services programs” were used in order to obtain relevant and recent articles to include for the introduction.
Results
One of the biggest motivators for progressing syringe services program legislation in
Alabama is the amount of potential risk that is already seen within the state regarding injection drug use related disease spread. In 2015 Scott County, Indiana underwent a crisis level outbreak of hepatitis C and HIV within their small town. This was largely due to the rates of IV drug use within the county and made nationwide news due to the conservative, small nature of the county.
This outbreak sparked large conversation and influence throughout the country regarding the need for SSPs and safe injection sites, which has contributed to many states legalizing and implementing SSPs and safe injection sites in high-risk counties. The Center of Disease Control and Prevention has declared Walker, Winston, Franklin, and Marion County, Alabama, in the top 220 counties in the United States with the highest risk of IV drug-use related disease epidemic
outbreaks.
Since several counties have been identified as “high risk” for disease outbreak epidemics,
it was necessary for legislation to begin addressing the potential legalization of syringe services programs within the state. Legislation to address this issue began developing in 2012, yet SSPsare still not currently legalized within Alabama. The Alabama Injection Associated InfectionsDisease Elimination Act, sponsored by Senator Singleton, was introduced on April 4th , 2019.
According to the synopsis of this bill, it would establish the implementation of this act, allow for targeted counties to establish injection associated infectious disease pilot programs, and would offer criminal immunity for specified individuals in order to support participation in the syringe services programs.
This bill also emphasizes two important aspects of garnering support and expansion of
the services, specifically within Alabama. One emphasis is placed upon the importance of
educational materials and resources being offered at the SSP sites. The rationale for this is one that several SSPs across the United States have adopted and have led to extremely successful outcomes for their clients. For example, individuals that decide to participate in SSP programs are shown to be 5 times more likely to be referred to and enter into and rehabilitation service. Furthermore, new SPP clients are shown to be 3 times more likely to discontinue the use of drugs, compared to those who do not enter syringe services programs.
Another important aspect that the bill addresses is the aspect of first responder safety,
which is a bi-product of the syringe services programs, but has important influence within the Alabama legislature. Whereas states, such as Colorado or Organ (which have enacted safe injection sites) first presented SSP legislation centered around the safety and well-being of substance users or those at high risk of contracting injection drug-use related diseases, Alabama
SSPs for Alabamamaybe more successful in progressing legislation if it places larger emphasis on first responders and health providers safety. For example, first responders are at high risk of being stuck with a needle during their career, with 1 in 3 first responders reporting an incidence of accidental skin
exposure to contaminated needles.
Other legislation is currently being debating regarding the importance of amending the
current paraphernalia laws in Alabama. Alabama has some of the harshest and broad
paraphernalia laws in the United States. Because of this, needles are often considered to be illegal paraphernalia and can be punishable by law if provided to individuals. This results in issues with the distribution process of the SSP’s and their ability to cut down on contaminated needle sharing, which increases the likelihood of injection-related disease spread within communities.
Discussion
There is an argument against syringe services programs that are largely based on the idea that these programs enhance people’s ability to use drugs and actually encourages the use of injection drug use within communities. For example, according to an article reporting on the Alabama Senate debate of the Alabama Injection Associated Infections Disease Elimination Act, Alabama state senator Greg Reed expressed that he thought the SSP sites would encourage drug use among AL counties (alreporter.com). According to the U.S. Surgeon General, Dr. Adams,
“Syringe service programs do not increase drug use and in fact do the opposite. Studies have found that people who participate in SSPs are up to 5 times more likely to enter treatment for substance use disorder than people who inject drugs but do not participate in a syringe services program” (cdc.gov).
SSPs for Alabama
References
Center for Disease Control and Prevention. (2019). Syringe Services Programs (SSPs). Retrieved
from: https://www.cdc.gov/ssp/syringe-services-programs-faq.html.
Faulkner-Gurstein, R. (2017). The social logic of naloxone: Peer administration, harm reduction, and the transformation of social policy. Social Science and Medicine, 180, 20-27.
McGinty, E., Barry, C., Stone, E., Niederdeppe, J., Hendricks, A., Linden, S. & Sherman, S.
(2018). Public support for safe consumption sites and syringe services programs to
combat the opioid epidemic. Prevention Medicine, 111, 73-77.
Moseley, B. (2018). Senate Health Committee narrowly approves needle exchange program for addicts. Retrieved from: https://www.alreporter.com/2018/01/25/senate-health-committee-narrowly-approves-needle-exchange-program-addicts/.
Pagnotti, M. Personal interview.
