State Laws Governing Syringe Services Programs and Participant Syringe Possession, 2014-2019.

OBJECTIVE: Law is an important factor in the diffusion of syringe services programs (SSPs). This study measures the current status of, and 5-year change in, state laws governing SSP operations and possession of syringes by participants. METHODS: Legal researchers developed a cross-sectional data set measuring key features of state laws and regulations governing the possession and distribution of syringes across the 50 US states and the District of Columbia in effect on August 1, 2019. We compared these data with previously collected data on laws as of August 1, 2014. RESULTS: Thirty-nine states (including the District of Columbia) had laws in effect on August 1, 2019, that removed legal impediments to, explicitly authorized, and/or regulated SSPs. Thirty-three states had 1 or more laws consistent with legal possession of syringes by SSP participants under at least some circumstances. Changes from 2014 to 2019 included an increase of 14 states explicitly authorizing SSPs by law and an increase of 12 states with at least 1 provision reducing legal barriers to SSPs. Since 2014, the number of states explicitly authorizing SSPs nearly doubled, and the new states included many rural, southern, or midwestern states that had been identified as having poor access to SSPs, as well as states at high risk for HIV and hepatitis C virus outbreaks. Substantial legal barriers to SSP operation and participant syringe possession remained in >20% of US states. CONCLUSION: Legal barriers to effective operation of SSPs have declined but continue to hinder the prevention and reduction of drug-related harm.

Two steps forward, one step back: current harm reduction policy and politics in the United States.

Harm reduction policies and attitudes in the United States have advanced substantially in recent years but still lag behind more advanced jurisdictions in Europe and elsewhere. The Obama administration, particularly in its last years, embraced some harm reduction policies that had been rejected by previous administrations but shied away from more cutting edge interventions like supervised consumption sites and heroin-assisted treatment. The Trump administration will undermine some of the progress made to date but significant state and local control over drug policies in the US, as well as growing Republican support for pragmatic drug policies, motivated in part by the opioid crisis, ensures continuing progress for harm reduction.

Injecting drugs in tight spaces: HIV, cocaine and collinearity in the Downtown Eastside, Vancouver, Canada.

This commentary revisits the political turmoil and scientific controversy over epidemiological study findings linking high HIV seroincidence to syringe exchange attendance in Vancouver in the mid-1990s. The association was mobilized polemically by US politicians and hard-line drug warriors to attack needle exchange policies and funding. In turn, program restrictions limiting access to syringes at the Vancouver exchange may have interfaced with a complex conjunction of historical, geographic, political economic and cultural forces and physiological vulnerabilities to create an extraordinary HIV risk environment: (1) ghettoization of services for indigent populations in a rapidly gentrifying, post-industrial city; (2) rural-urban migration of vulnerable populations subject to historical colonization and current patterns of racism; and (3) the flooding of North America with inexpensive powder cocaine and heroin, and the popularity of crack. In fact, we will never know with certainty the precise cause for the extreme seroincidence rates in Vancouver in the early to mid-1990s. The tendency for modern social epidemiology to decontextualize research subjects and assign excessive importance to discrete, "magic bullet" variables resulted in a counterproductive scientific and political debate in the late 1990s that has obfuscated potentially useful practical lessons for organizing the logistics of harm reduction services - especially syringe exchange - to better serve the needs of vulnerable populations and to mitigate the effects of political-economically imposed HIV risk environments. We would benefit from humbly acknowledging the limits of public health science and learn to recognize the unintended consequences of well-intentioned interventions rather than sweep embarrassing histories under the rug.

Guerra contra las Drogas o Guerra contra la Salud? Los retos para la salud pública de la política de Drogas de Puerto Rico / War on Drugs or War against Health? The pitfalls for public health of Puerto Rican drug policy

Puerto Rico has followed the United States in adopting drug policy sustained on a criminal justice model that limits the opportunities to address problematic drug use through public health interventions. Demand for illegal drugs is controlled by criminalizing drug use and applying jail sentences for drug offenses. These strategies marginalize drug users and reduce opportunities to minimize health risks applying public health measures. Production and sale of illegal drugs is criminalized with the intent of dissuading drug use, with adverse unintended health effects that impact both drug users and non-drug users in the community. The present work reviews the assumptions of the punitive prohibitionist model and its outcomes that present themselves as public health challenges in Puerto Rico. It also presents those principles that should sustain pragmatic drug policy to address problematic drug use from a health and social perspective.

If you thought this year was difficult, wait until next year.

AIDS: Despite a budgetary surplus for the year 2000, budget constraints for next year's funding of AIDS programs will be even greater. In 2000, voters will elect a new President, one-third of the Senate, and all of the House of Representatives. Such election conditions will greatly politicize the funding process. Daniel Zingale of AIDS Action is pressing the White House Office of Management and Budget for an increase of at least 25 percent in prevention funding. The current budget calls for $695.3 million for CDC prevention programs, an increase of 5.7 percent from 1999. Zingale says that increasing pressure to meet the costs of federally-funded HIV treatment programs justifies making prevention "a necessity." Additional highlights from the fiscal 2000 budget are provided.^ieng

Senate follows House in banning funds for needle swaps.

AIDS: The U.S. Senate has approved anti-drug legislation which permanently bans Federal funding for needle-exchange programs. Senator Paul Coverdell of Georgia added the anti-drug legislation to a tobacco bill that is very important to many politicians. During the Senate approval process of this tobacco bill, needle exchange programs were hardly mentioned. If the combined bill reaches the President, it is believed that he will sign it because of the Administration's interest in tobacco legislation. If, however, the tobacco bill is not approved, the funding ban may be attached to other, less controversial legislation.^ieng

Thorny issues confront California lawmakers in 1998.

AIDS: When the California Legislature reconvenes in January 1998 it will consider bills that were not resolved during the 1997 session. Senate Bill 705 makes it a felony for a person to intentionally infect another person with HIV through sexual activity. The current version of S.B. 705 only punishes those who intend to expose others to HIV through unprotected anal or vaginal intercourse. Senate Bill 885 would waive California's ban on nonprescription use of syringes and create a government-sanctioned needle exchange pilot program in Los Angeles, San Francisco, Long Beach, and San Jose through January 2000. It is unlikely that Governor Wilson will approve this bill. Senate Bill 1110 requires school districts to notify parents or guardians before pupils receive HIV prevention or human sexuality instruction. Senate Bill 535 establishes a $1 million State research program at the University of California to determine the efficacy of the medical use of marijuana for AIDS wasting syndrome, glaucoma, and cancer. Assembly Bill 1055 would require all contractors operating Medi-Cal managed care plans to provide all HIV medications that have been approved by the U.S. Food and Drug Administration.^ieng