Testimony In Opposition to Pueblo, Colorado SSP Ban
Testimony from:
Stacey McKenna, Senior Fellow, Integrated Harm Reduction, R Street Institute
In OPPOSITION to banning syringe services programs
May 13, 2024
Assembly Committee on Public Safety
Chair Maestri and Honorable Members of the Council,
My name is Stacey McKenna. I am a long-time Colorado resident who has studied and written about illicit drug use and homelessness in the state prior for more than a decade. I am currently writing to this Council as senior fellow in Integrated Harm Reduction with the R Street Institute. R Street is a nonprofit, nonpartisan think tank focused on advancing free markets and limited but effective government in a variety of policy areas.
We recognize that even the best abstinence-oriented programming leaves many people behind, and believe that the government should not prevent people from accessing and using evidence-based tools that help protect their health.[1] Therefore, we support harm reduction, a practical approach that keeps people who use drugs—and the communities of which they are a part—safer, even if they are not currently ready to stop using.[2] This is why we are interested in Pueblo’s current efforts to ban syringe services programs (SSPs). These programs save lives, and keep communities healthier and safer.
Last year, more than 112,000 Americans died of a drug overdose, a tragedy to which neither Colorado nor Pueblo are immune—every week in 2021, a Pueblo County resident died of an overdose.[3] The crisis in Pueblo, as in much of the country, has been exacerbated by the social and economic stresses of the COVID-19 pandemic, as well as the influx of fentanyl.[4] As devastating as these losses have been, the situation would likely have been much worse without Pueblo’s SSPs.
It may seem counterintuitive, but SSPs are among the most important tools we have to combat overdose. Although originally developed to combat the spread of injections diseases like HIV and hepatitis C, as the U.S. drug supply has become more toxic, SSPs have evolved to focus more on overdose prevention.[5] Toward this end, they provide an essential service by educating participants about overdose prevention, and distributing tools such as fentanyl test strips and the opioid antidote, naloxone.[6] In 2023 alone, naloxone distributed by Pueblo’s Southern Colorado Harm Reduction Association was used to save at least 469 lives.[7] With fentanyl spreading through Pueblo’s drug supply in recent years, these overdose prevention tools provided by SSPs are more important than ever.[8]
In addition to saving lives in the short-term, SSPs make a difference in the long term. They do not enable drug use as some critics claim. In fact, they encourage recovery—participants are four to five times more likely to get into treatment and three times more likely to quit using drugs altogether.[9] Both of Pueblo’s SSPs are especially well equipped to provide wraparound health and social services as well as connections to substance use disorder and mental health treatment.[10] A ban on SSPs would remove these life-saving resources, leaving people who use drugs socially isolated and with fewer health and recovery resources.
Furthermore, in addition to directly serving and benefitting people who use drugs, Pueblo’s SSPs are good for the community as a whole. Therefore, even Puebloans who are not directly impacted by drug-related issues should be worried about the proposed ban on the programs.
Decades of research demonstrate that SSPs slash HIV and hepatitis C transmission, soft tissue infections and other health complications.[11] Not only does this save taxpayers upwards of $7 for every dollar spent (regardless of whether that funding came from the government), it reduces the chances of an outbreak spreading to the larger community.[12] Conversely, removing existing SSPs could lead to a rebound in infectious disease akin to what they have seen in West Virginia.[13]
In addition, despite the concerns of some Pueblo lawmakers and citizens that SSPs are driving an uptick in syringe litter in the city, they do the opposite.[14] SSPs are actually an exceptional resource for promoting proper syringe disposal. Yes, they distribute sterile equipment, but they also directly collect used syringes and coordinate community clean-up efforts, and research demonstrates that these actions effectively reduce syringe litter in surrounding areas.[15] In Pueblo, for example, the Southern Colorado Harm Reduction Association collected almost 60,000 used needles in 2023, needles that may have otherwise ended up in general trash cans or on the streets.[16] Residents’ concerns about syringe litter persisting despite the presence and efforts of the SSPs would be better addressed by expanding SSPs’ clean-up programs or providing additional sharps-disposal bins in public spaces.[17] In fact, Idaho’s syringe program was spearheaded by maintenance workers concerned about discarded syringes.
Banning SSPs in Pueblo would remove a life-saving resource and a recovery touchpoint from the community. It would also leave the community without organizations that serve the community broadly by preventing infectious diseases and keeping the streets cleaner. As such, R Street urges you to vote against this ban.
Respectfully submitted,
Stacey McKenna
Senior Fellow, Integrated Harm Reduction
R Street Institute
[email protected]
[1] Mazen Saleh and Chelsea Boyd, “R Street Integrated Harm Reduction Principles and Priorities,” R Street Explainer, Dec. 14, 2021. https://www.rstreet.org/research/r-street-integrated-harm-reduction-principles-and-priorities.
[2] “Harm Reduction,” Substance Abuse and Mental Health Administration, April 24, 2023. https://www.samhsa.gov/find-help/harm-reduction.
[3] Brian Mann et al, “In 2023 fentanyl overdoses ravaged the U.S. and fueled a new culture war fight,” NPR, Dec. 28, 2023. https://www.npr.org/2023/12/28/1220881380/overdose-fentanyl-drugs-addiction#:~:text=In 2023 the overdose death,for Disease Control and Prevention.&text=Biden administration officials say they have “flattened” the upward curve; “Provisional Drug Overdose Death Counts,” National Center for Health Statistics, Centers for Disease Control and Prevention, March 13, 2024. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm; “Substance Use in Pueblo County,” Data Brief, Pueblo Department of Public Health & Environment. https://county.pueblo.org/sites/default/files/2022-11/Data Brief 11.2022.pdf.
[4] ; “Substance Use in Pueblo County,” Pueblo Department of Public Health & Environment.
[5] Julie Latimer et al., “Risk of fentanyl overdose among clients of the Sydney Medically Supervised Injecting Centre,” International Journal of Drug Policy, 37, (November 2016), pp. 111-114. https://www.sciencedirect.com/science/article/abs/pii/S0955395916302699; Phillip O. Coffin et al., “Modeling of overdose and naloxone distribution in the setting of fentanyl compared to heroin,” Drug and Alcohol Dependence, 236, (July 1, 2022). https://www.sciencedirect.com/science/article/abs/pii/S0376871622002150; Charles Ingoglia, “This Drug Has Made the Overdose Crisis More Severe,” National Council for Mental Wellbeing, 2024. https://www.thenationalcouncil.org/this-drug-has-made-the-overdose-crisis-more-severe/#:~:text=Much of the information about,undetectable without drug testing equipment; David T. Zhu, “Public health impact and harm reduction implications of xylazine-involved overdoses: a narrative review,” Harm Reduction Journal, 20: 131, (Sept. 12, 2023). https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-023-00867-x; Jerome Adams and Mazen Saleh, “Clean syringes seem counterintuitive to fentanyl fight. But needle exchange saves lives,” USA Today, April 3, 2024. https://www.usatoday.com/story/opinion/2024/04/03/fentanyl-opioid-epidemic-syringe-services-harm-reduction/73169725007.
[6] Adams and Saleh. https://www.usatoday.com/story/opinion/2024/04/03/fentanyl-opioid-epidemic-syringe-services-harm-reduction/73169725007.
[7] Southern Colorado Harm Reduction Association, https://www.socoharmreduction.org.
[8] “Substance Use in Pueblo County,” Pueblo Department of Public Health & Environment.
[9] H. Hagan et al., “Reduced injection frequency and increased retention in drug treatment associated with syringe exchange participation in Seattle drug injectors,” Journal of Substance Abuse Treatment, 19: 3, (October 2000), pp. 247-252. https://pubmed.ncbi.nlm.nih.gov/11027894; “Syringe Services Programs (SSPs),” Centers for Disease Control and Prevention, Jan. 11, 2023. https://www.cdc.gov/ssp/syringe-services-programs-summary.html; Andrea Jakubowski et al., “Three decades of research in substance use disorder treatment for syringe services program participants: a scoping review of the literature,” Addiction Science & Clinical Practice, 18: 40, (June 10, 2023). https://ascpjournal.biomedcentral.com/articles/10.1186/s13722-023-00394-x.
[10] Visvajit Sriramrajan, “A Massive New Facility Bolsters Pueblo’s Fight Against the Opioid Epidemic,” 5280 Health 2024. https://www.5280.com/massive-new-facility-bolsters-pueblos-fight-against-opioid-epidemic; Colorado Health Network, Accessed May 10, 2024. https://coloradohealthnetwork.org; “Our Services,” Southern Colorado Harm Reduction Association, Accessed May 10, 2024. https://www.socoharmreduction.org/services.
[11] Cameron Bushling et al., “Syringe services programs in the Bluegrass: Evidence of population benefits using Kentucky Medicaid data,” The Journal of Rural Health, 38: 3, (Sept. 19, 2021), pp. 620-629. https://onlinelibrary.wiley.com/doi/abs/10.1111/jrh.12623;
[12] Trang Quynh Nguyen et al., “Syringe Exchange in the United States: A National Level Economic Evaluation of Hypothetical Increases in Investment,” AIDS Behavior, 18: 11, (November 2014), pp. 2144-2155. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4211599.
[13] Rebecca B. Hershow et al., “Notes from the Field: HIV Outbreak During the COVID-19 Pandemic Among Persons Who Inject Drugs – Kanawha County, West Virginia, 2019-2021,” Morbidity and Mortality Weekly Report, 71, (2022), pp. 66-68. https://www.cdc.gov/mmwr/volumes/71/wr/mm7102a4.htm; Xiao Zang, “The impact of syringe services program closure on the risk of rebound HIV outbreaks among people who inject drugs: A modeling study,” AIDS, 36: 6, (Feb. 24, 2022), pp. 881-888. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9081164.
[14] Barbara Fox, “Pueblo councilor pushing to eliminate syringe access programs, some say problem won’t be solved,” KRDO, April 3, 2024. https://krdo.com/news/2024/04/03/pueblo-councilor-pushing-to-eliminate-syringe-access-program-some-say-its-not-going-to-solve-the-problem; Rory Harbert, “City Council moves to ban syringe exchanges: affected programs, next steps,” Pueblo Star Journal, May 3, 2024. https://pueblostarjournal.org/news/2024/05/03/city-council-ban-syringe-exchanges-affected-programs-next-steps.
[15] Harry Levine et al., “Syringe Disposal Among People who Inject Drugs Before and After the Implementation of a Syringe Services Program,” Drug and Alcohol Dependence, 202, (Sept. 1, 2019), pp. 13-17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6854527.
[16] Josué Perez, “’Trying to make sure people survive’: Needle exchanges ponder future as Pueblo weighs ban,” The Pueblo Chieftain, May 10, 2024. https://www.chieftain.com/story/news/2024/05/10/will-pueblo-ban-needle-exchanges-city-council-to-decide-monday/73627075007; Southern Colorado Harm Reduction Association. https://www.socoharmreduction.org.
[17] Luc de Montigny et al., “Assessing a drop box programme: A spatial analysis of discarded needles,” International Journal of Drug Policy, 21: 3, (May 2010), pp. 208-214. https://www.sciencedirect.com/science/article/abs/pii/S0955395909001108.