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HARRISBURG — After working with people with substance use disorder for nearly a decade, it’s second nature for Clayton Ruley to remind them not to share syringes for injecting drugs. But over the past three weeks, he’s had to add a new refrain:
“Don’t share pipes or cigarettes or anything that touches your mouth,” he explains. “The droplets of saliva could spread coronavirus.”
That’s new information for a lot of people, said Ruley, the director of community engagement and volunteer services at Prevention Point Philadelphia, which offers harm reduction services like sterile syringe exchange and overdose prevention kits. Many people in active addiction haven’t received information about the coronavirus or how to stay safe, Ruley said.
“If you’re actively using, you don’t have the means to check CBS or NBC all the time,” he said.
And people in addiction may not trust messages from police or government officials as much, he added. That’s where sterile syringe programs come in.
As food pantries close, homeless shelters stop taking new entrants, and hospitals prepare to meet overwhelming demand, sterile syringe exchanges are one of the last places where people in addiction can turn for vital care and public health information amid the COVID-19 pandemic.
Although technically illegal in Pennsylvania, about 20 syringe exchange programs operate across the state, according to the Pennsylvania Harm Reduction Coalition. They allow people to access free sterile syringes and dispose of used ones in an effort to stop the spread of disease.
The programs have been deemed a “life-sustaining” service by the Department of Health, allowing them to stay open amid the shutdown of other businesses and nonprofits. Advocates hope this could be a sign that the state is finally ready to legalize sterile syringe programs.
“The COVID-19 outbreak is exposing holes in all our systems,” said Devin Reaves, executive director of the Pennsylvania Harm Reduction Coalition. “One of those gaping holes in Pennsylvania is the lack of legal services designed to serve drug users and people who live outside. … I believe — and hope — in the future people will be more open and ready to listen to public health officials [about the benefits of syringe services].”
Syringe exchanges are legal in more than two dozen states, including neighboring Delaware, Maryland, New Jersey, and New York. They have been shown to reduce the rates of HIV and hepatitis C transmission, and increase the chance of someone entering treatment.
Bills to legalize the programs have been introduced several times in the Pennsylvania legislature, but one has never passed. Just before the outbreak of COVID-19, Sens. Pat Browne (R., Lehigh) and Anthony Williams (D., Philadelphia) published a bipartisan memo saying they planned to try again.
Now the issue seems even more pressing, both said.
“After the virus subsides, certainly we will all be talking about areas of health care that push back pandemics and fight viruses,” Williams said. “Sterile syringe exchanges do just that. So I’d expect it to be at the forefront of a lot of conversations as we go forward.”
Browne said “anything we’re doing to alleviate the health care system,” like reduce infections and overdoses, is crucial. “That’s one of the reasons syringe programs have relevance not just for the opioid crisis but for the current one.”
For Pam, a former home health aide who runs syringe exchange services in the greater Wilkes-Barre area, legalization would provide peace of mind. (She asked that her last name be withheld for legal protection.)
Pam started the services after her 22-year-old daughter died of a drug overdose and her brother nearly lost his leg to an infection from a dirty needle. For more than a year now, she’s been providing syringes, naloxone — the overdose reversal medication — and food to about 20 individuals a week.
She recently switched the services to every two weeks and is keeping more distance during hand-offs. Last week she brought the participants six bottles of Dial hand soap and five jugs of water. She’s been texting them reminders to wash their hands and practice social distancing.
“I don’t know how else they would get the info,” she said. Even the soup kitchen that many of them visited has limited hours and switched to takeout only.
At Prevention Point Pittsburgh — the only syringe exchange program outside of Philadelphia that is also legal under a local ordinance — staff have been trying to raise awareness of COVID-19 for weeks. Since early March, they have been including a tipsheet in the supply bags that discusses coronavirus transmission and isolation measures.
If someone shows symptoms, they’re given gloves, a face mask, and extra harm reduction supplies so they can self-quarantine, said Aaron Arnold, executive director of the nonprofit. If the person wants medical help, the staff can arrange that, too.
Although the program has traditionally served people who inject drugs, Arnold said they have recently been handing out more pipes and mouthpieces for people who smoke cocaine or methamphetamine and are concerned about transmission through saliva.
The organization first started offering safer smoking equipment two years ago when there was a hepatitis A outbreak in Pittsburgh, Arnold said.
“Now people are starting to see it’s not just about hepatitis or HIV. Our services can provide a direct protective factor for COVID-19, too,” he said.
In Central Pennsylvania, the Lancaster Harm Reduction Project has added bars of soap and bath wipes to the supplies they hand out to nearly 100 people in multiple cities each week. Melinda Zipp, director of outreach for the project, said clients are finding it increasingly difficult to access social services, housing and shelters, and even bathrooms to wash up.
Staff at each of the syringe service programs said they’re taking precautions with social distancing and using protective gear like gloves and masks when available, but their main focus is keeping services running for the people who need them.
“We take running syringe service sites as seriously as hospitals take running emergency departments,” said Arnold of Prevention Point Pittsburgh. “Hopefully people will start seeing us as a critical part of the health care infrastructure — pandemic or no pandemic.”
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