Nebraska is a state so big that it takes at least six hours to drive across it from east to west. But its two million residents have zero syringe service programs (SSP), leaving people who inject drugs without access to safe equipment. Possession or distribution of syringes is criminalized as a misdemeanor under the state’s drug “paraphernalia” laws. But Nebraska’s lawmakers now seem set to change that, with a bill to authorize syringe services—if cities or counties allow them.
On January 26, the Nebraska legislature voted 37-2 to advance Bill 307. It would exempt pharmacies and public health agencies from “paraphernalia” laws if they distribute syringes for the purpose of preventing transmission of blood-borne diseases like HIV or hepatitis C.
The proposed legislation is sponsored by Senator Megan Hunt. Nebraska’s Unicameral legislature is officially nonpartisan but controlled by the right; however, the bill received support from both sides of the political aisle. It will need to pass three rounds of floor consideration in the single-chamber legislature before going to Governor Jim Pellen (R); the latest vote was the second of the three.
“There’s more support for these types of programs here than people might give credit for.”
Nebraska isn’t known for progressive drug policies. Residents have no legal access to cannabis, for example, even medical. In 2021, the state health department and pharmacy association did launch a statewide program to make it easier for people to find and receive free naloxone.
“There’s more support for these types of programs here than people might give credit for, if they’re looking from externally and seeing a state with very few harm reduction laws or a movement,” Patrick Habecker, research assistant professor in sociology at the University of Nebraska-Lincoln, told Filter. Dr. Habecker has studied injection drug use among vulnerable populations in urban and rural settings in Nebraska and Puerto Rico.
He explained that legally obtaining syringes for people who use drugs is currently almost impossible in Nebraska. A narrow exception in state law allows some pharmacists to sell syringes for non-medical use. But there are no SSP anywhere, publicly or privately run, and he’s not even aware of unlicensed distributors.
As for the current bill, “It’s a lot better than what we have now, which is absolutely nothing,” Habecker said. “It provides at least some path forward for a group to go and apply to the local health department and get a program running.”
“The weakness of this bill is the local oversight.”
If the state allows SSP, Habecker said he’d expect to see applications in Omaha and Lincoln. Most Nebraska residents live in these two metropolitan areas, while the rest of the state is mostly rural and sparsely populated. So major challenges would remain in ensuring syringe access for all residents. And while the bill would permit SSP, it wouldn’t require any counties or cities to host them.
“The weakness of this bill is the local oversight,” Habecker said. “Each local health jurisdiction will be able to say up or down whether they want to do this. As well, you need someone to step forward to do the program.”
One of his colleagues shares these concerns, and also pointed out that the bill would do little to legally protect the people who use syringes every day.
“What happens with the users?” Roberto Abadie, assistant professor of sociology at the University of Nebraska-Lincoln, asked Filter. “If you inject 10 times a day and every time you need a clean syringe, you will be in possession of 10 syringes. When you go through a syringe exchange you might have hundreds. How does this legislation protect people who actually inject drugs from the charges of drug paraphernalia?”
Similar harmful issues have arisen in states with legal SSP. New York, for instance, had permitted the programs for decades, yet syringes were still considered “paraphernalia” under criminal law. This created a situation where SSP participants, especially in suburban and rural areas outside of New York City, had to fear police harassment or arrest. In 2021, the state finally passed a law to decriminalize syringe possession.
“Syringe exchanges is an open window to bring people into other services.”
Nebraska’s bill would additionally do nothing to help fund SSP and the premises, staff and equipment they’d require.
“You say, ‘Okay, syringe exchanges are good,’ but then you don’t provide the funding,” Dr. Abadie said. “This legislation is very piecemeal and is not comprehensive, because it doesn’t look at the realities of injection on the ground and the fact that if you don’t have a mandate and resources … you don’t have it.”
Despite these serious limitations, the bill would represent a step forward for harm reduction in a state with very little of it, and might pave the way to further reforms.
“Syringe exchanges is an open window to bring people into other services,” Abadie said. “Once you start providing access to clean syringes, you [offer] wound care for ulcers, and from that care [you get] primary care referrals, mental health treatment, HIV prevention, hep C treatment, testing—that’s a lot of services and care provided once you establish contact with a population through a syringe exchange.”