Stuart Fisk: Syringe programs save lives

As Pennsylvania continues to grapple with covid-19, it is urgent that we do not lose sight of the overdose crisis that has ravaged our state in recent years.

Pennsylvania has the third highest rate of overdose deaths and the ninth highest rate of new HIV infections in the nation. In addition, the federal Centers for Disease Control and Prevention has declared Pennsylvania one of the states at risk for, or experiencing, increases in HIV and hepatitis C. Three counties in Pennsylvania (Luzerne, Cambria, Crawford) are known to be at imminent risk. Many others are suspected to also be at risk.

Pennsylvania has taken important steps to address this crisis, but we are missing a critical component in a comprehensive plan to save lives and reduce the spread of disease. Pennsylvania must expand syringe services programs to effectively address this crisis.

Syringe services programs are associated with a 50% reduction in HIV infections and provide community access to naloxone and overdose prevention education. In addition, syringe services programs are critical bridges to treatment for substance use disorders (SUDs) and other essential health services. Based on 30 years of research, the CDC found that individuals who participate in syringe service programs are five times more likely to enter SUD treatment than those who do not participate in such programs.

As a health care provider working in the fields of HIV/AIDS and addiction medicine for the past 30 years, I have seen the close connection between injection drug use, overdose and the spread of bloodborne diseases. Infections, such as HIV, HCV and numerous other pathogens, have caused significant mortality and morbidity to people who use drugs and tremendous economic cost to our communities and health systems. The cost of a single heart valve replacement in a person with a heart infection from injecting drugs with contaminated equipment can reach up to $500,000 in health care costs. Our hospitals are seeing many more of these cases in injection drug users in the past five years. Bone, spinal cord and other organ infections are equally common, debilitating and costly.

I have also worked with Prevention Point Pittsburgh (PPP), one of only two legal syringe services programs in Pennsylvania, since 1996 as a volunteer, naloxone prescriber and board member. In 2002 PPP was legally authorized through our local health department to provide life-saving preventative health services. In the past five years, PPP has assisted 1,065 individuals into SUD treatment, and distributed over 16,000 doses of naloxone, the life-saving opioid reversal drug to injection drug users and community members, resulting in 2303 overdose reversals. These services are not available to most people who use drugs in Pennsylvania.

Elected officials in Harrisburg are beginning to explore how to expand these life-saving programs. Co-sponsorship memos for legislation to expand syringes services programs has been introduced in the House and Senate by Reps. Ed Gainey, D-Allegheny, and James Struzzi, R-Indiana, and Sens. Patrick Browne, R-Lehigh, and Anthony Williams, D-Delaware, Philadelphia.

At the beginning of the covid-19 crisis the Wolf administration declared syringe services programs as life-sustaining programs authorized to continue operating during the pandemic.

We know that these programs save lives, reduce suffering from unnecessary infections and navigate people with substance use disorders to health services and recovery care. Now more than ever they should be legal and widespread across the commonwealth.

Stuart Fisk is director of the Center for Inclusion Health and principal investigator for the Ryan White Grant/Positive Health Clinic in Allegheny Health Network’s Department of Medicine.