\n\tEd Mahon, Spotlight PA and Sarah Boden, WESA<\/span><\/p>\n

Kim Botteicher hardly thinks of herself as a criminal.<\/p>\n

On the main floor of a former Catholic church in Bolivar, Pennsylvania, Botteicher runs a flower shop and cafe.<\/p>\n

In the former church\u2019s basement, she also operates a nonprofit organization focused on helping people caught up in the drug epidemic get back on their feet.<\/p>\n

The nonprofit, FAVOR ~ Western PA<\/a>, sits in a rural pocket of the Allegheny Mountains east of Pittsburgh. Her organization\u2019s home county of Westmoreland has seen roughly 100 or more<\/a> drug overdose deaths each year for the past several years, the majority involving fentanyl.<\/p>\n

Thousands more residents in the region have been touched by the scourge of addiction, which is where Botteicher comes in.<\/p>\n

She helps people find housing, jobs, and health care, and works with families by running support groups and explaining that substance use disorder is a disease, not a moral failing.<\/p>\n

But she has also talked publicly about how she has made sterile syringes available<\/a> to people who use drugs.<\/p>\n

\u201cWhen that person comes in the door,\u201d she said, \u201cif they are covered with abscesses because they have been using needles that are dirty, or they\u2019ve been sharing needles \u2014 maybe they\u2019ve got hep C \u2014 we see that as, \u2018OK, this is our first step.\u2019\u201d<\/p>\n

Studies have identified<\/a> public health benefits<\/a> associated with syringe exchange services. The Centers for Disease Control and Prevention says these programs reduce HIV and hepatitis C<\/a> infections, and that new users of the programs are more likely to enter drug treatment and more likely to stop using drugs than nonparticipants.<\/p>\n

This harm-reduction strategy is supported by leading health groups, such as the American Medical Association<\/a>, the World Health Organization<\/a>, and the International AIDS Society<\/a>.<\/p>\n

But providing clean syringes could put Botteicher in legal danger. Under Pennsylvania law, it\u2019s a misdemeanor to distribute drug paraphernalia. The state\u2019s definition<\/a> includes hypodermic syringes, needles, and other objects used for injecting banned drugs. Pennsylvania is one of 12 states that do not implicitly or explicitly authorize syringe services programs through statute or regulation, according to a 2023 analysis<\/a>. A few of those states, but not Pennsylvania, either don\u2019t have a state drug paraphernalia law or don\u2019t include syringes in it.<\/p>\n

Those working on the front lines of the opioid epidemic, like Botteicher, say a reexamination of Pennsylvania\u2019s law is long overdue.<\/p>\n

There\u2019s an urgency to the issue as well: Billions of dollars have begun flowing<\/a> into Pennsylvania and other states from legal settlements with companies over their role in the opioid epidemic, and syringe services are among the eligible interventions that could be supported by that money.<\/p>\n

The opioid settlements reached between drug companies and distributors and a coalition of state attorneys general included a list of recommendations for spending<\/a> the money. Expanding syringe services is listed as one of the core strategies.<\/p>\n

But in Pennsylvania, where 5,158 people died from a drug overdose in 2022, the state\u2019s drug paraphernalia law stands in the way.<\/p>\n

Concerns over Botteicher\u2019s work with syringe services recently led Westmoreland County officials to cancel an allocation of $150,000<\/a> in opioid settlement funds they had previously approved for her organization. County Commissioner Douglas Chew defended the decision by saying the county \u201cis very risk averse.\u201d<\/p>\n

Botteicher said her organization had planned to use the money to hire additional recovery specialists, not on syringes. Supporters of syringe services point to the cancellation of funding as evidence of the need to change state law, especially given the recommendations of settlement documents.<\/p>\n

\u201cIt\u2019s just a huge inconsistency,\u201d said Zoe Soslow, who leads overdose prevention work in Pennsylvania for the public health organization Vital Strategies<\/a>. \u201cIt\u2019s causing a lot of confusion.\u201d<\/p>\n

Though sterile syringes can be purchased from pharmacies<\/a> without a prescription, handing out free ones to make drug use safer is generally considered illegal \u2014 or at least in a legal gray area \u2014 in most of the state. In Pennsylvania\u2019s two largest cities, Philadelphia<\/a> and Pittsburgh<\/a>, officials have used local health powers to provide legal protection to people who operate syringe services programs.<\/p>\n

Even so, in Philadelphia, Mayor Cherelle Parker, who took office in January, has made it clear<\/a> she opposes using opioid settlement money, or any city funds, to pay for the distribution of clean needles, The Philadelphia Inquirer has reported. Parker\u2019s position signals a major shift<\/a> in that city\u2019s approach to the opioid epidemic.<\/p>\n

On the other side of the state, opioid settlement funds have had a big effect for Prevention Point Pittsburgh<\/a>, a harm reduction organization. Allegheny County reported<\/a> spending or committing $325,000 in settlement money as of the end of last year to support the organization\u2019s work with sterile syringes and other supplies for safer drug use.<\/p>\n

\u201cIt was absolutely incredible to not have to fundraise every single dollar for the supplies that go out,\u201d said Prevention Point\u2019s executive director, Aaron Arnold<\/a>. \u201cIt takes a lot of energy. It pulls away from actual delivery of services when you\u2019re constantly having to find out, \u2018Do we have enough money to even purchase the supplies that we want to distribute?\u2019\u201d<\/p>\n

In parts of Pennsylvania that lack these legal protections, people sometimes operate underground syringe programs.<\/p>\n

The Pennsylvania law banning drug paraphernalia was never intended to apply to syringe services, according to Scott Burris<\/a>, director of the Center for Public Health Law Research<\/a> at Temple University. But there have not been court cases in Pennsylvania to clarify the issue, and the failure of the legislature to act creates a chilling effect, he said.<\/p>\n

Carla Sofronski, executive director of the Pennsylvania Harm Reduction Network<\/a>, said she was not aware of anyone having faced criminal charges for operating syringe services in the state, but she noted the threat hangs over people who do and that they are taking a \u201cgreat risk.\u201d<\/p>\n

In 2016, the CDC flagged three Pennsylvania counties<\/a> \u2014 Cambria, Crawford, and Luzerne \u2014 among 220 counties nationwide in an assessment of communities potentially vulnerable to the rapid spread of HIV and to new or continuing high rates of hepatitis C infections among people who inject drugs.<\/p>\n

Kate Favata, a resident of Luzerne County, said she started using heroin in her late teens and wouldn\u2019t be alive today if it weren\u2019t for the support and community she found at a syringe services program in Philadelphia.<\/p>\n

\u201cIt kind of just made me feel like I was in a safe space. And I don\u2019t really know if there was like a come-to-God moment or come-to-Jesus moment,\u201d she said. \u201cI just wanted better.\u201d<\/p>\n

Favata is now in long-term recovery and works for a medication-assisted treatment<\/a> program.<\/p>\n

At clinics in Cambria and Somerset Counties, Highlands Health<\/a> provides free or low-cost medical care. Despite the legal risk, the organization has operated a syringe program for several years, while also testing patients for infectious diseases, distributing overdose reversal medication, and offering recovery options.<\/p>\n

Rosalie Danchanko, Highlands Health\u2019s executive director, said she hopes opioid settlement money can eventually support her organization.<\/p>\n

\u201cWhy shouldn\u2019t that wealth be spread around for all organizations that are working with people affected by the opioid problem?\u201d she asked.<\/p>\n

In February, legislation to legalize syringe services<\/a> in Pennsylvania was approved by a committee and has moved forward. The administration of Gov. Josh Shapiro, a Democrat, supports the legislation. But it faces an uncertain future in the full legislature, in which Democrats have a narrow majority in the House and Republicans control the Senate.<\/p>\n

One of the bill\u2019s lead sponsors<\/a>, state Rep. Jim Struzzi,<\/a> hasn\u2019t always supported syringe services. But the Republican from western Pennsylvania said that since his brother died from a drug overdose in 2014, he has come to better understand the nature of addiction.<\/p>\n

In the committee vote<\/a>, nearly all of Struzzi\u2019s Republican colleagues opposed the bill. State Rep. Paul Schemel<\/a> said authorizing the \u201cvery instrumentality of abuse\u201d crossed a line for him and \u201cwould be enabling an evil.\u201d<\/p>\n

After the vote, Struzzi said he wanted to build more bipartisan support. He noted that some of his own skepticism about the programs eased only after he visited Prevention Point Pittsburgh and saw how workers do more than just hand out syringes. These types of programs connect people to resources \u2014 overdose reversal medication, wound care, substance use treatment \u2014 that can save lives and lead to recovery.<\/p>\n

\u201cA lot of these people are \u2026 desperate. They\u2019re alone. They\u2019re afraid. And these programs bring them into someone who cares,\u201d Struzzi said. \u201cAnd that, to me, is a step in the right direction.\u201d<\/p>\n

At her nonprofit in western Pennsylvania, Botteicher is hoping lawmakers take action.<\/p>\n

\u201cIf it\u2019s something that\u2019s going to help someone, then why is it illegal?\u201d she said. \u201cIt just doesn\u2019t make any sense to me.\u201d<\/p>\n

This story was co-reported by <\/em>WESA Public Radio<\/em><\/a> and <\/em>Spotlight PA,<\/em><\/a> an independent, nonpartisan, and nonprofit newsroom producing investigative and public-service journalism that holds power to account and drives positive change in Pennsylvania.<\/em><\/p>\n

KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n

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This story can be republished for free (details<\/a>).<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"
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