On Monday March 12, the leaders of six ASPPH member institutes in Pennsylvania issued a joint letter to Governor Tom Wolf, urging the governor to use powers provided under his emergency disaster proclamation for the opioid crisis to remove barriers to syringe service programs in the Commonwealth. The deans and leaders at University of Pittsburgh, Drexel University, Penn State University, Temple University, Thomas Jefferson University, and the University of Pennsylvania signed the letter. Syringe service programs are evidence-based practices to reduce the risk of disease transmission and are included as recommendations from the National Academy of Sciences as a response to the opioid crisis. Removal of the identified barriers could allow for increase funding to the state to expand these programs in the Commonwealth.
March 12, 2018
Honorable Tom Wolf Governor
Commonwealth of Pennsylvania 508 Main Capitol Building Harrisburg, PA 17120
Dear Governor Wolf,
As leaders of Pennsylvania schools and programs of public health, we commend you for your Declaration of a Public Health Emergency in the Commonwealth in regards to the opioid crisis. The declaration is an important step in addressing the epidemic by bypassing burdensome regulations and implementing effective interventions.
We write now to strongly support the use of this declaration to immediately expand Syringe Service Programs (which have also been referred to as syringe exchange programs, needle exchange programs, and needle-syringe programs) in Pennsylvania. Such programs are community-based programs that provide access to sterile needles and syringes free of cost and facilitate safe disposal of used needles and syringes.
We ask you to exercise your emergency powers to remove the clauses in Pennsylvania’s Controlled Substances, Drugs, Device, and Cosmetic Act referencing syringes as drug paraphernalia and their distribution as a prohibited act. These clauses effectively prohibit expansion of Syringe Service Programs despite overwhelming evidence of their effectiveness.
Hepatitis C, HIV, and other blood born infectious diseases are readily transmitted through contaminated syringes and needles. Four other states have already experienced large outbreaks of HIV among people who inject drugs. Experience from around the country suggests that removing syringes from the drug paraphernalia law is an expeditious and effective way to promote wider access to and use of sterile syringes and needles.
Pittsburgh and Philadelphia have operated successful Syringe Service Program models for over 20 years. However, other communities, especially hard-hit rural communities, are being left out of the benefits of such programs. Removing legal barriers to Syringe Service Programs and allowing for mechanisms of funding for them could provide immediate access to disease prevention tools, lifesaving naloxone, and a needed bridge to treatment.
Current state law prevents our communities from gaining access to federal funds already earmarked for this effort in Pennsylvania, as well as stand in the way of community efforts to respond to HIV, Hepatitis C, and overdose deaths through community-run Syringe Service Programs. Pennsylvania is one of 14 states granted a “Determination of Need” from the CDC to receive and redistribute federal funds for Syringe Service Programs, but these funds cannot be accessed due to the state’s prohibition.
For public health interventions, it is important to consider and implement evidence-based approaches. These approaches are the core of our field and form the basis for the curriculum and epidemic response in public health. This is never more important than amidst a public health emergency. The National Academies of Sciences recommendations for addressing the opioid
epidemic include removal of barriers to accessing naloxone and safe injection equipment, reduction of harms of opioid use, permitting the sale or distribution of syringes and exempting syringes from laws prohibiting sale/distribution of drug paraphernalia. Syringe Service Programs are endorsed by the preeminent public health authorities including the WHO, CDC, and AMA.
Exempting syringes and distribution of them from the Pennsylvania Controlled Substances, Drugs, and Cosmetic Act would allow these types of programs to expand to other parts of the state without creating a bureaucratic burden for state and local agencies, or obstacles to operation for existing programs. This solution would also be effective in increasing access to sterile syringes through pharmacies or other retail outlets for those individuals who might not have access to a formal Syringe Service Programs.
It is essential that we make the right policy changes now to ensure that both existing programs and future efforts are effective. The evidence is clear that such harm reduction strategies work, and decriminalization of syringes would allow these essential programs to publically operate and expand their services. We are all working together throughout the Commonwealth to address the opioid crisis and we ask for your immediate attention to resolve this issue. We look forward to working with you and your administration to implement effective public health strategies to save lives and increase the quality of life in Pennsylvania.
Donald S. Burke, MD, Dean, Graduate School of Public Health, University of Pittsburgh
Ana V. Diez Roux, MD, PhD, MPH, Dean, Dornsife School of Public Health, Drexel University
Vernon M. Chinchilli, Chair, Department of Public Health Sciences, College of Medicine, Pennsylvania State University
Laura A Siminoff, Dean, College of Public Health, Laura H Carnell Professor, Temple University
David B. Nash , Dean, Jefferson College of Population Health, Thomas Jefferson University
Jennifer Pinto Martin, Director MPH Program, University of Pennsylvania