Advocates propose state legislation to legalize syringe exchange programs

As she walked into a coffeehouse last week in downtown Cape Girardeau, Kristi Booth’s shirt said it all.

“I carry Narcan!” the shirt read in big white letters. “(and so can you.)”

Narcan is a brand name for naloxone, a medication that counters the effects of opioid overdose, something Booth has seen up close and personal. She’s a person in recovery from substance use disorder who has spent the last several years advocating for education, awareness and change to the way Missourians understand drug addictions.

Some of that change begins at the state level.

Syringe exchange programs

Legislation proposed last week in the Missouri House of Representatives and Senate, if passed, would legalize syringe exchange programs (SEPs) in Missouri. The bills are being introduced in both chambers to help increase their likelihood of passing and are being carried by Rep. Holly Rehder of Sikeston and Sen. Bill White of Joplin.

“Hopefully, between the two of us, one of our bills will get to be debated soon on the senate floor,” Rehder said by phone Thursday. “And then that way, both houses will have heard the full debate and understand the fear that we have in this state.”

SEPs are community-based programs that provide access to sterile needles and syringes, facilitate safe disposal of used syringes and provide resources to other services. According to the Centers for Disease Control and Prevention, such programs typically include referrals for substance use disorder treatment programs, screening, care and possible treatment for HIV and viral hepatitis, vaccinations, screening for sexually transmitted diseases, abscess and wound care, naloxone education and distribution, and education about overdose prevention.

The goal of an SEP, therefore, is not simply to hand out clean needles to intravenous (IV) drug users but to help connect them to potentially life-saving resources.

Asked why the public might not be eager for the implementation of such programs, Missouri Network for Opiate Reform and Recovery co-founder and executive director Chad Sabora said, “Because there’s stigma; they think we’re enabling drug use.”

For that very reason, Rehder said she was initially unsure about the programs until conducting some research of her own.

“It kinda made me cringe at first ... I don’t ever want to be seen as enabling,” she said. “All of the research says that they do not enable, that they only lower the spread of HIV and hepatitis C.”

And, Sabora said, there is little evidence to support claims to the contrary.

“Nobody is going to start shooting heroin because a needle exchange program popped up in their neighborhood,” Sabora said. “ ... No matter what, all people [who] inject drugs will reuse needles ... which can cause a myriad of health problems that could end up costing the state tens of thousands of dollars in medical care for the uninsured, and all of this could be prevented by these programs.”

Do they work?

The CDC reports roughly 30 years of research has shown comprehensive syringe services programs are “safe, effective, and cost-saving, and do not increase illegal drug use or crime, and play an important role in reducing the transmission of viral hepatitis, HIV and other infections.”

Research shows new users of syringe services programs are five times more likely to enter drug treatment, according to the CDC, and about three times more likely to stop using drugs than those who do not use the programs.

Part of the reason for that, Redher said she believes, is because it connects people who inject drugs with medical professionals who can provide resources for treatment.

“They’re also giving them pamphlets and education when they come to get that needle,” Rehder said. “So, when they get to point in their addiction that they want help, and everybody does, then they have that medical professional in their lives.”

Sabora runs one of two existing SEPs in Missouri, based in St. Louis and Kansas City, which operate in a “legal gray zone,” Sabora said.

“The local authorities have kind of looked the other way for all these years because the results are so outstanding,” Rehder said of the existing programs.

Implementing SEPs may even mean less risk to law enforcement officers. While Sgt. Joey Hann said needle stick injuries have not been specifically reported by officers at the Cape Girardeau Police Department, cdc.gov states as many as one in three law enforcement officers may be stuck by a used needle during his or her career.

Sabora, who runs the St. Louis SEP, also helped author the SEP bills appearing before Missouri legislators this year.

“I put about 40 to 50 people a month into treatment, myself, [who] just came in to get a clean needle,” Sabora said. “We can reduce the spread of hepatitis C and HIV in the communities [and] help get dirty needles off the streets. It’s nothing but benefits.”

Most of the funding for SEPs comes from private foundations, Sabora said, noting the bills before the House and Senate do not include a fiscal note.

“We would not ask the state for a dime,” he said. “ ... and yet, it could save the state upwards of $20- to- $30 million a year if we can reduce the spread of hepatitis C.”

There are 13 Missouri counties on the CDC’s watchlist for counties and jurisdictions determined to be experiencing or at-risk for significant increases of viral hepatitis infection or HIV outbreak due to injection drug use — Bates, Cedar, St. Francois, Hickory, Wayne, Ozark, Wright, Iron, Madison, Reynolds, Ripley, Crawford and Washington, according to the CDC.

“This bill passing, by no means, means that every county is going to have a syringe access program,” Rehder said. “It only allows those health professionals to jump in and activate one if that’s necessary.”

If local authorities or health departments see the makings of a potential outbreak, Redher said the SEP legislation would help give those jurisdictions the authority to distribute clean needles and help combat the spread of disease without “red tape” from the state.

“They need to be able to be the ones to make that call and get that going right away,” she said. “I think that should be up to those people on the ground in the medical profession actually fighting the outbreak.”

To those who fear SEPs would mainly serve to enable drug use, the Republican representative offered this: “When I looked into the statistics of these programs and how they’ve been so successful in the past in getting folks through treatment ... and how they’ve been so vitally important in the midst of an outbreak, the numbers, the actual statistics and results and outcomes from these other states is what changed my mind.”

Harm reduction and local action

Booth’s sobriety date is Nov. 23, 2013.

Since then, she has worked with the Missouri Recovery Network as a peer ambassador, led a Friends of Recovery group at Southeast Missouri State University, organized the annual Recovery Walk in Cape Girardeau, worked in support services at Gibson Recovery Center and been involved with the Missouri Coalition of Recovery Support Providers. She also serves as an overnight volunteer with the People’s Shelter in Cape Girardeau.

As opposed to an abstinence-based approach to treating substance use disorder, she leans toward the harm-reduction model, which strives to meet people wherever they are in their journeys with substance use disorder.

According to the Harm Reduction Coalition at www.harmreduction.org, there is no specific “formula” for implementing harm reduction, as the needs of the individual and the community will differ from one circumstance to the next.

But there are a few principles central to the harm-reduction practice, including: accepting drug use is “part of our world” and working to minimize its harmful effects; understanding drug use is complex and encompasses a continuum of behaviors; establishing quality of individual and community life and well-being — not necessarily cessation of drug use — as successful interventions and policies; giving agency to drug users by inviting them to have a “real voice” in programs designed to serve them; and not attempting to minimize or ignore real and tragic harm and danger associated with drug use.

“It’s just accepting that drug use is going to happen,” Booth explained. “So how do we help those people live as healthy as they can and not harm themselves and the people around them or the public at large?”

In an attempt to raise public awareness and understanding, Booth said she has started offering weekly harm reduction meetings.

“It’s a way to understand substance use disorder,” she said. But it’s also a way to approach the topic with guests of the People’s Shelter, many of whom Booth said are experiencing substance use disorder and “trying to dull the pain of being homeless.”

“I wanted a way to connect with them and maybe get them to start looking at how their behavior affects the world around them,” she said. “ ... Any positive movement [or action] is recovery. So if you can get a person just to be conscious about their substance use, to me, that’s a step toward recovery.”

But the meetings are not strictly for those dealing with substance use disorder. They are an open invitation to the community as an educational resource.

“The only thing we ask is that [people] have respect, love and compassion,” she said.

The harm reduction meetings are at 6:30 p.m. every Friday in the sanctuary at St. James AME Church, 516 North St. in Cape Girardeau.

“It’s my passion to be that go-between for the community of substance use disorder and the community at large,” Booth said. “Up until now, I’ve empowered the recovery community. I want to empower the whole substance use disorder community, and that includes people that aren’t in typical recovery.”