Syringe Exchange Programs and the Opioid Epidemic

Syringe exchange programs and safe injection services are outside-the-box interventions increasingly being used by governments, nonprofits and citizens to address dire issues percolating in tandem with America’s burgeoning opioid epidemic. People who inject drugs (PWID)—almost a million Americans annually—commonly use painkillers such as heroin and fentanyl, as well as methamphetamine, benzodiazepines, barbiturates and cocaine. Yet the users themselves are often obscured or marginalized by the bigger picture. This collection of essays covers policies and practices aimed at preventing both opioid-related deaths and related infections of hepatitis and HIV.

Joaquin Jay Gonzalez III, Ph.D., is vice provost for global affairs as well as chair and Mayor George Christopher Professor of Public Administration at Golden Gate University. He founded GGU’s law enforcement and security program and is a San Francisco advocate for the safety and security of Filipino American kids and their families.

Mickey P. McGee, DPA, is professor of public administration and director of the Doctor of Business Administration Program at Golden Gate University. He co-developed GGU’s Urban Innovations Program including the course, Inclusion, Diversion, Equity, and Accessibility. He has consulted for the U.S. Agency for International Development and the International City/County Management Association.

Edited by Joaquin Jay Gonzalez III and Mickey P. McGee
Format: softcover (7 x 10)
Pages: 285
Bibliographic Info: appendix, glossary, notes, index
Copyright Date: 2022
pISBN: 978-1-4766-7311-0
eISBN: 978-1-4766-4110-2
Imprint: McFarland

Acknowledgments vii
Preface 1
Part I. The Opioid Epidemic
1. Opioid Epidemic Causing Rise in Hepatitis C Infections and Other Serious Illnesses
Thomas J. Stopka 7
2. Syringe Services Programs (SSPs) Fact Sheet
Centers for Disease Control and Prevention 10
3. An Ethical Dilemma for Doctors: When Is It OK to Prescribe Opioids?
Travis N. Rieder 13
4. The Opioid Epidemic Is Finally a National Emergency—Eight Years Too Late
Erin Winstanley 16
5. As the Opioid Epidemic Continues, the Holidays Bring Need to Support Those in Grief
Emily B. Campbell 19
6. Keeping Away from Criminalization
Sarah Sweeney 21
7. Stepping Up, Then Stepping Back
Brenda Bond-Fortier 23
8. Needle Exchanges Find New Champions Among Republicans
Victoria Knight 25
Part II. Syringe Use and Infection Risks
• A. HIV •
­ 9. Syringe-Exchange Programs Are Part of Effective HIV Prevention
National Institute on Drug Abuse 31
10. Needle Exchanges Can Now Get Federal Funding
Anna Gorman 36
11. Trump Pledges to End HIV Transmission by 2030. Doable, But Daunting
Carmen Heredia Rodriguez 39
12. The Unexpected Public Health Emergency
Jenna Tyler 43
13. An Addiction Researcher Shares 6 Strategies to Address the Opioid Epidemic
Nabila El-Bassel 46
14. Why Are HIV Survival Rates Lower in the Deep South Than the Rest of the U.S.?
Susan Reif and Carolyn McAllaster 49
15. Should You Be Tested for HIV? Why June 27 Is a Good Day to Do It
Jodi Sutherland 52
16. Violence Against Women Is Overlooked in Its Role in Opioid Epidemic
Nabila El-Bassel 54
17. Fighting HIV in Miami, One Dirty Needle at a Time
Amy Driscoll 57
• B. Hepatitis C •
18. Addressing Increases in Hepatitis C Infections Linked to the Opioid Epidemic
Don C. Des Jarlais 63
19. Hepatitis C and Injection Drug Use
U.S. Department of Health and Human Services 65
20. A “Safe” Space to Shoot Up: Worth a Try?
Stephanie O’Neill 68
21. Treating the New Hep C Generation on Their Turf
Pauline Bartolone 71
Part III. Practices, Programs, and Policies
of Governments and Nonprofits
• A. Federal •
22. New Rules for Safe and Secure Prescription Drug Disposal Options
U.S. Drug Enforcement Administration 75
23. Safely Using Sharps (Needles and Syringes) at Home, at Work and on Travel
U.S. Food and Drug Administration 77
24. HRSA Implementation Guidance of Syringe Services Programs
U.S. Department of Health and Human Services 83
25. Implementation Guidance for Syringe Services Programs
U.S. Department of Health and Human Services 85
26. Injection Drug Use
Centers for Disease Control and Prevention 89
27. Syringe Services Programs (SSPs) FAQs
Centers for Disease Control and Prevention 92
28. The Safety and Effectiveness of Syringe Services Programs
Centers for Disease Control and Prevention 96
29. CDC’s Role in Safe Injection Practices
Centers for Disease Control and Prevention 102
30. CDC Program Guidance for Syringe Services Programs
Centers for Disease Control and Prevention 105
31. Medical Waste
U.S. Environmental Protection Agency 112
32. Opioid Overdose Reversal with Naloxone
National Institute on Drug Abuse 115
• B. State •
33. Syringe Exchange Programs in California: An Overview
California Department of Public Health 118
34. California Legal Code Related to Access to Sterile Needles and Syringes
California Department of Public Health 122
35. Florida Is the Latest ­Republican-Led State to Adopt Clean Needle Exchanges
Sammy Mack 125
36. Syringe Exchange in Southern Indiana to Respond to an Increase in HIV Cases
Jeannie D. DiClementi 128
37. HIV, STDs, and Hepatitis C
New York State Department of Health 131
38. Utah Syringe Exchange Program
Utah Department of Health 135
39. Arizona Declares Opioid Emergency, but Signals Are Mixed Over Best Response
Will Stone 142
40. Unable to Arrest Opioid Epidemic, Red States Warm to Needle Exchanges
Shefali Luthra 145
• C. County and City •
41. The Competing Views and a Way Forward
Elissa Velez and Mickey P. McGee 149
42. Harm Reduction Services in San Francisco: Executive Summary
San Francisco Department of Public Health 155
43. Syringe Access and Disposal Programs in San Francisco
San Francisco Department of Public Health 159
44. Syringe Disposal Practices of Intravenous Drug Users in Monterey County
Jaime Teeter Householder and Mickey P. McGee 163
45. How Did Ohio Local Government Leaders Dramatically Reduce Opioid Deaths?
Gerald Young 170
46. How Lowell Is Fighting the Opioid Crisis
Audrey Fraizer 172
47. How One City Went “All In” to Fight the Opioid Epidemic
International City/County Management Association 175
48. The High Cost of Opioid Abuse in Your Community
Marty Harding 178
49. Boston’s Heroin Users Will Soon Get a Safer Place to Be High
Martha Bebinger 181
50. In Boston’s “Safe Space,” Surprising Insights into Drug Highs
Martha Bebinger 184
51. What’s Next for “Safe Injection” Sites in Philadelphia?
Elana Gordon 186
52. “Crackhouse” or “Safehouse”?
Nina Feldman 188
• D. Nonprofits and Associations •
53. Offering Syringes Along with Prayers, Churches Help IV Drug Users
Taylor Sisk 191
54. San Francisco AIDS Foundation’s Syringe Access Services Evaluation Results
Elissa Velez and Mickey P. McGee 194
55. Leading the Fight Against the Opioid Crisis
Geoff Beckwith 204
56. Statement of Policy: Opioid Epidemic
National Association of County and City Health Officials 209
57. Statement of Policy: Syringe Services Programs
National Association of County and City Health Officials 218
Part IV. The Future
58. Some Good News on Opioid Epidemic: Treatment Options Are Expanding
William Greene and Lisa J. Merlo 225
59. Sterile Needles Can Stop the Spread of Disease in Prisons—Here’s How
Jack Wallace 229
60. Meth vs. Opioids: America Has Two Drug Epidemics, but Focuses on One
April Dembosky 232
61. Big Data for Big Disease
H. Daniel Xu 235
62. Chittenden County’s Hub and Spoke Model for Combatting Opioid Deaths
Paul C. Prevey 237
Appendices
Appendix A. Glossary of Syringe Exchange and Opioid Terms, Abbreviations and Acronyms
Joaquin Jay Gonzalez III 243
Appendix B: Syringe Exchange Programs (2019): North American Syringe Exchange Network
Centers for Disease Control and Prevention 251
Appendix C. Adopting a Harm Reduction Policy for Substance Abuse, STD and HIV
San Francisco Health Commission Resolution No. 10–​00 252
Appendix D. Press Release: Mayor Mark Farrell Announces Innovative Program to Fight Opioid Crisis on San Francisco Streets
City and County of San Francisco, Office of the Mayor 253
Appendix E. Executive Summary: Secure and Responsible Drug Disposal Act of 2010
Federal Register 255
About the Contributors 265
Index 269

“[A] useful compilation of reprinted short essays and government documents published from 2012 to 2019…. The editors, both public administration professors, present strong evidence for needle exchange and safe injection services to save lives from overdoses, provide vaccinations for hepatitis A and B, ensure testing and treatment for hepatitis C and HIV, and reduce financial burdens for treatment of infectious diseases and substance abuse.”—Choice