Pa. law blocks needles, care, compassion for people trapped in addiction
Allison Klunk’s son struggled against opioid addiction for 11 years before he died of an overdose at 29. His death made the York County resident want to help other people’s loved ones.
She went to a local organization, expecting a focus on recovery. As it turned out, the tiny nonprofit distributed clean needles to drug users.
“I was like no way, I can’t do this,” she says.
But Klunk remembered her son calling from jail, crying, after testing positive for hepatitis C, a disease commonly spread by shared needles. So she accepted the low-paying job and soon found herself parked near a food bank in York, a magnetic sign attached to her car to help drug users find her.
She gave them needles and syringes and urged them to return used ones. She also offered disease testing, personal hygiene supplies and naloxone, the overdose-reversal drug. People she came to know sometimes had sores or fevers or were otherwise sick from the drugs and the lifestyle. Klunk provided whatever aide she could, including offers to just sit in her car and rest.
And at every chance, she told them: “If you’re ever tired, if you’re ever sick of this, please know that I can get you into rehab and know I would love to.”
Klunk worked for a “syringe service.” Their work is called harm reduction – helping drug users stay as healthy as possible until, hopefully, they choose treatment.
Yet in Pennsylvania, unlike the vast majority of states, syringe services are illegal. That has far-ranging fallout, and may even have contributed to the stunning spate of nine Harrisburg-area overdose deaths in one weekend last September.
True, syringe services operate in Philadelphia and Pittsburgh, which have unique health-related powers. And others, much smaller in size and capabilities, fly under the radar elsewhere, including a small contingent that sets up three times a week in Harrisburg.
“There are a lot of underground harm reduction programs in Pennsylvania, because harm reductionists are not going to wait for the law to change to save lives,” says Carla Sofronski, co-founder of the Pennsylvania Harm Reduction Network.
But the fact such services are illegal has profound consequences: It cuts them off from most public funding, including tens of millions flowing into Pennsylvania from settlements with drug companies that fueled the opioid crisis. It minimizes their ability to prevent diseases including HIV and hepatitis. And it holds back the organizations that interact most closely with drug users, and which are ideally positioned to provide a broad range of help — from overdose-reversing naloxone to wound care to shepherding them into treatment.
Ken McGarvey, a former state public health official, believes the September overdoses proved it.
Local officials responded with a roundtable to warn of the dangers of unexpectedly potent drugs, and to stress the availability of test strips and naloxone from police and drug treatment providers.
But McGarvey and numerous others interviewed for this article saw it as much too little, too late. They argue that, for one, it’s unrealistic to expect illegal drug users to go to police or drug treatment providers for naloxone and test strips.
They contend the deaths highlight a serious problem: a severe shortage of groundlevel efforts to directly engage with drug users.
“There needs to be a street outreach program in these counties that understands where the people that are using drugs are, makes contact with them, gets the naloxone into their hands,” McGarvey says. “There are tools available, but we are just not using them.”
McGarvey, who is retired from the Pennsylvania Department of Health, became involved with syringe services during the early response to AIDS. As a member of the advisory board for the Cumberland-Perry Drug and Alcohol Commission, he remains focused on the harm reduction response to the opioid overdose crisis.
The U.S. has had little success in reversing the tide of fatal overdoses, which were expected to total about 112,000 in the United States last year — more than double the total in 2015 — and more than 5,100 in Pennsylvania.
Aside from curbing the flow of fentanyl and providing access to treatment, the response now centers on harm reduction, including “saturating” communities with life-saving naloxone. The administrations of both former President Donald Trump and President Joe Biden support expanding the availability of nalaxone.
Pennsylvania has bought and distributed well over a million free doses, with
much of it going to emergency responders, who in turn have reversed tens of thousands of overdoses. Much has also gone to county drug and alcohol departments, which are entrusted with community-level distribution.
McGarvey has long been troubled by what he sees as a failure on the part of most counties to get naloxone directly into the hands of drug users.
The state, he says, is “purchasing it, they are making it available. The problem is, the infrastructure to get it out on the street, into the hands of the people who need it, in a lot of these counties does not exist.”
In Dauphin County, officials declined to give in-depth answers to written questions about what they have done to get naloxone and newly legalized fentanyl and xylazine test strips directly to drug users.
In a written statement, the county said it gives naloxone to drug treatment providers, and plans to contract with two organizations “to do community outreach to those who have substance use disorder but are not accessing treatment.”
Dauphin plans to partner with Lebanon, Cumberland and Perry counties on a contract that will include naloxone distribution, according to Jack Carroll, who heads drug and alcohol treatment for Cumberland-Perry. Still, he doubts it will be easy to find a capable outreach organization.
“I think street-level outreach is a great idea. But it’s hard to do. There are not a lot of organizations that are set up to do that,” he says.
McGarvey believes syringe services such as the Lancaster Harm Reduction Project, which is also responsible for the effort in Harrisburg and the one Klunk worked for in York, are ideally suited.
“They’re a great agency. Their heart is in it. It’s just that they’re small, they don’t have the resources,” he says.
The organization has six part-time employees and two full-timers counting the director, Melinda Zipp. It has
a $350,000 annual budget, nearly all of it donated. With that, it sends teams three times per week to Harrisburg, York and Lancaster, with a fourth day spent restocking supplies.
Zipp says she has received overtures from counties regarding distribution of naloxone and test strips. But she worries, for one, that accepting the money will come with conditions that will interfere with distributing syringes.
“Our funding is constantly in jeopardy because of gray areas in the law,” she says.
That danger materialized early this year in Westmoreland County, where a syringe service was told it would receive $150,000 in opioid settlement money. It planned to use it to hire more staff to help people and families dealing with addiction and recovery. But after a news article about the effort to legalize syringe services featured the organization, county commissioners pulled the money, citing
legal concerns, according to Spotlight PA.
At the same time, Lakita Davis-Jones, Pennsylvania’s secretary of drug and alcohol programs, contends opioid settlement money can go to syringe services, as long as they put it toward their other services.
She says the Shapiro administration backs syringe services, which she calls “services that we rally behind and that we truly support.”
“Part of what [the Department of Drug and Alcohol Programs] and the Shapiro organization are trying to do is normalize the idea of harm reduction,” according to Davis-Jones.
To that end, her department plans to look more closely at how counties spend their streams of state and federal funds aimed at addiction and recovery.
“We’re going to ask additional questions, really trying to understand a little bit more about their perspectives on harm reduction,” she says. “We don’t want naloxone sitting in somebody’s cabinet and then expiring.”
There’s other hope on the horizon, although of a kind that can be exceedingly slow to arrive.
A bill advancing in the state House, still far from final approval, would legalize syringe services.
It’s cosponsored by state Rep. Jim Struzzi, a Republican from rural western Pennsylvania who once opposed syringe services, but changed his mind after visiting a program.
“It was not just someone handing out needles on the street corner. It was an actual organized program where they bring people in and they talked to them about recovery,” says Struzzi, who cites studies which found people who cross paths with syringe services are much more likely to enter treatment.
Still, syringe services are subject to new pushback. Some local officials in Philadelphia, for example, argue they intensify problems in already troubled neighborhoods, including used needles littering the ground and getting into the hands of children.
But others counter the majority of neighborhood residents support their presence, knowing they actively collect used needles and respond to emergencies such as overdoses, sparing local residents from having to intervene.
Allison Klunk, 54, is another who, like Struzzi, experienced a transformation after seeing harm reduction up close. At the very beginning, she felt like she was handing out loaded syringes. But her thoughts would return to her son.
“I would think maybe he would have appreciated some love and someone saying, ‘Look, I want you to stay as safe as you can’,” she says.