Paraphernalia Laws, Criminalizing Possession and Distribution of Items Used to Consume Illicit Drugs, and Injection-Related Harm

Abstract

The United States remains in the grip of an unprecedented epidemic of drug-related harm. Infections of HIV, hepatitis C, and endocarditis related to lack of access to new syringes and subsequent syringe sharing among people who inject drugs have increased alongside a surge in opioid overdose deaths. Overwhelming evidence shows that using a new syringe with every injection prevents injection-related blood-borne disease transmission. Additionally, there is promising research suggesting that the distribution of fentanyl test strips to people who inject drugs changes individuals’ injection decisions, which enables safer drug use and reduces the risk of fatal overdose. However, laws prohibiting the possession of syringes and fentanyl test strips persist in nearly every state. The full and immediate repeal of state paraphernalia laws is both warranted and needed to reduce opioid overdose death and related harms. Such repeal would improve the health of people who inject drugs and those with whom they interact, reducing the spread of blood-borne disease and fatal overdose associated with infiltration of illicitly manufactured fentanyl into the illicit drug supply. It would also free up scarce public resources that could be redirected toward evidence-based approaches to reducing drug-related harm.

Harm Reduction, By Mail: the Next Step in Promoting the Health of People Who Use Drugs

“…However, laws and regulatory bodies place severe, non-evidence-based limitations on starting and operating SSPs, limiting their reach. In fact, fewer than 300 SSPs were known to exist nationwide as of 2018 and most PWUD remain without local access to harm reduction supplies [ 37 ]. Even for programs that are able to function above ground, police interference with clients and staff often impede optimal operation [ 38 – 40 ].…”

“…Funding should also be increased for local harm reduction programs to include mail-delivery services, such as through affiliates like NEXT. To overcome legal barriers, legislators should remove laws and policies that restrict rapid expansion of mail-delivery harm reduction, such as changing paraphernalia laws to completely exempt syringes, naloxone and other harm reduction supplies [ 37 ]. Failing that, they should clarify that any person or entity authorized to distribute harm reduction supplies can do so via mail and remove other barriers, such as geographic limitations on the areas an SSP can serve.…”

Characteristics and context of fentanyl test strip use among syringe service clients in southern Wisconsin

“…For example, FTS use is associated with using less, injecting more slowly, using a test dose, and not using alone [ 9 , 11 , 12 , 16 ]. FTS are also affordable and easily distributed where legal [ 17 , 18 ].…”

Syringe Services Programs’ Role in Ending the HIV Epidemic in the U.S.: Why We Cannot Do It Without Them

“…30−32 Despite this overwhelming evidence, coverage of SSPs remains limited in the U.S. 33,34 and many jurisdictions continue to have laws and policies that limit or disallow SSP services. 35,36 The coronavirus disease 2019 (COVID- 19) crisis has further exacerbated challenges in obtaining these lifesaving services, 37,38 compromising efforts to end HIV among PWID if not successfully addressed.…”