On April 25, Dr. Oshea Johnson, a Centers for Disease Control and Prevention epidemic intelligence service officer based in Lexington, presented research he co-authored at a conference in Atlanta, as local NPR station WKMS reported. According to the report, Kentucky’s total number of SSP more than doubled between 2018 and 2022—increasing from 27 to 56. The number of individuals accessing services rose by 125 percent in that time period, exceeding 26,000 in 2022. Total recorded visits grew more rapidly still, rising from 22,350 to 108,200.

SSP were officially authorized in Kentucky in 2015, under a law signed by former Governor Steve Beshear (D). They offer a range of vital services beyond the provision of sterile syringes that remove people’s risk of blood-borne disease transmission. Distribution of the opioid overdose antidote naloxone, for example, increased by 1,456 percent at Kentucky SSP during the study period.

In that context, it’s notable that in 2023, the state published mortality data showing that overdose deaths declined in 2022, for the first time since 2018. The 2,135 lives lost in 2022 represented a decrease of over 5 percent on the prior year. Over 72 percent of deaths involved fentanyl.

But while the number of white Kentucky residents who died fell by 158 that year, recorded deaths among Black residents increased by 19, and those among members of “other” racial groups rose by 17.

“When you expand what is provided … then we start to have more individuals we can engage.”

Shreeta Waldon, executive director of the Kentucky Harm Reduction Coalition, told Filter that these differing trajectories demand more focus from elected officials, public health experts and the media. Kentucky is no outlier here, when years of national and state-level data have shown overdose deaths increasing among Black, Indigenous and Latino communities, while remaining stable or declining in white communities. Many contributing aspects of structural racism include disparities in access to opioid use disorder medications like buprenorphine and other health care; differing rates of poverty and other social factors; and disproportionate rates of arrest and incarceration, leading to increased overdose risk.

For communities of color, “Why is this happening, and what services do we need to provide?” Waldon asked.

One need, she continued, is for wider distribution of all safer use supplies, including those used for smoking drugs. With syringe provision, “You’re dealing with one community of users,” she said. “What we’re saying is, when you expand what is provided at these mobile sites and expand ‘harm reduction’ or ‘safer use supplies’—let’s not just call it ‘syringe services’—then we start to have more individuals we can engage.”

More people, in total, are now accessing testing for blood-borne diseases at Kentucky SSP. HIV tests rose by 446 percent during the study period, and hepatitis C tests by 53 percent.

That’s critical when CDC data show that both total numbers and rates of acute hepatitis C infection in Kentucky increased overall between 2017 and 2021, rising from 83 to 198 new cases. New HIV cases, meanwhile, based on data shared by AIDSVu, were on a steep decline through the 2000s, but have fluctuated dramatically in more recent years, with a number of sharp spikes. In 2021, Kentucky saw 390 new cases—the highest number in over a decade.

These numbers speak to the importance of expanding harm reduction services to prevent transmissions, detect new cases and get more people treated.

But Kentucky still limits lifesaving services. The state “does not support supervised consumption or overdose prevention [sites],” Waldon said, and “we do not provide safer use supplies like stems and materials used for smoking or inhaling substances.” Harm reductionists who want to provide those services are forced to do so underground. New York City, which in late 2021 opened the nation’s first sanctioned safe consumption sites, has seen over 1,000 overdoses averted as a result.

“We don’t want people to miss those [other] opportunities; that’s what I feel gets missed when we promote just SSP.”

Waldon said the Kentucky Harm Reduction Coalition is working with local partners to see what legislation for harm reduction expansion they could lobby the Kentucky General Assembly and governor to approve. In 2023, harm reduction advocates backed a successful effort to decriminalize fentanyl test strips in the state.

But within the current reality and its limitations, Waldon urges harm reduction providers to change their messaging to bring more people through the door—so they can also benefit from referrals to treatment, wound care, counseling, support with housing or job training, and more.

“We don’t want people to miss those opportunities; that’s what I feel gets missed when we promote just SSP,” she said. “It’s about reminding people: If we stop saying, ‘We offer just syringe services,’ [and say] ‘We offer harm reduction services,’ then it will help bring people to the table who would otherwise not come, because they feel like it doesn’t apply to them because they’re not using syringes.”

Photograph by Intropin (Mark Oniffrey) via Wikimedia Commons/Creative Commons 4.0

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“We are thrilled that a friend of the harm reduction community will serve as acting director of the White House Office of National Drug Control Policy,” AIDS United tweeted after the announcement. 

LaBelle has been particularly interested in increasing access to medication for opioid use disorder (MOUD) for people in detention centers. She’s praised a MOUD program in New York’s Albany County jail, and helped to develop a model law for access to MOUD in correctional settings. 

The administration hasn’t yet named a long-term “drug czar,” as the role is known, but that isn’t unusual. The position is usually filled after inauguration day, according to Grant Smith, deputy director of national affairs with the Drug Policy Alliance (DPA)*. Regardless, some advocates are excited by the prospect of pushing the yet-to-be-named drug czar to embrace harm reduction—and have already laid out the agenda items that they’d like to see the new administration pursue.

DPA was one of 212 organizations to sign a recent letter—addressed to Rahul Gupta, the Biden transition team’s ONDCP team lead—calling for sweeping changes to federal drug policy. 

“I think all of us hope that [not yet picking a permanent drug czar] signals that they are vetting a director based off of what over 200 organizations, as well as many people who were not in that letter, like experts, are saying where we need to move at this moment,” said Jasmine Budnella, a drug policy campaign coordinator with VOCAL-NY, another organization behind the letter. 

After sending the letter, which Smith described as a “roadmap for this new administration for its first 100 days, as well as looking long-term,” the writers asked the Biden administration if they could meet with the new ONDCP director once the decision is made. Budnella said the administration agreed to stay in contact.

Here’s a snapshot of the demands that harm reductionists are making of the Biden administration, both for the first 100 days and beyond. 

Funding for Syringe Service Programs

The harm reduction community’s “most immediate request” to the Biden administration is the ask to increase federal funding to syringe service programs (SSP) in the next COVID relief package, according to Smith. 

“We’re in a real dire situation where many providers of harm reduction services are struggling to remain afloat,” Smith told Filter.  Some New York harm reductionists, faced with a statewide shortage of syringes and other supplies, are fronting the bill themselves. Harm reductionists in other states, like Minnesota, are also facing shortages . 

Funding SSPs is an especially critical public health issue when many harm reductionists are uniquely able to foster relationships of trust with people who use drugs—and thereby help them reduce the spread of COVID. 

Rollbacks of Restrictive Federal Regulations

Harm reductionists are also demanding curtailment of federal restrictions on the distribution of methadone and buprenorphine, and on the operation of safe consumption sites (SCS).

“We’re continually getting to a point where we’re butting up against federal policies that prevent us from being able to move in a significant way to achieve ending the overdose crisis and the drug war,” Budnella, who runs VOCAL-NY’s city and statewide campaigns, told Filter.

As the pandemic hit in spring 2020, the federal government relaxeed regulations on methadone and buprenorphine. Under the new and currently temporary accommodations, patients are no longer required to meet in-person with providers before being prescribed buprenorphine, and certain patients who were not previously permitted to do so can now take home more than 14 days’ worth of methadone.  

The letter calls for those accommodations to be made permanent. But the issue is also that they “didn’t fully trickle down” when they were introduced, said Budnella.

Federal policy has also compounded state-level obstructions against opening SCS in New York, Budnella said. New York harm reductionists have not only had to fight against Gov. Andrew Cuomo’s reluctance to open the sites, but also had to keep in mind the Department of Justice’s lawsuit against the opening of Safehouse in Philadelphia. The letter’s signatories call for the Biden administration not to prosecute organizations or people who operate SCS, and for Biden’s DOJ to withdraw the litigation challenging Safehouse.

Ending the DEA’s Fentanyl Analogue Ban

The letter’s authors call for the federal government to allow the class-wide Drug Enforcement Administration ban on all fentanyl analogues to expire. The ban currently classifies all fentanyl-related substances as Schedule I drugs, which then allows prosecutors to seek fentanyl-related mandatory minimum sentences. The ban is scheduled to expire on May 6, 2021. 

That expiration date was the result of a compromise brokered in January 2020 between the federal government—which wanted a permanent ban on fentanyl analogues—and drug policy reform advocates. 

The Biden administration’s opportunity to let the ban expire “will be a first major test of this administration to honor its pledge not to exacerbate mass incarceration, not to perpetuate mandatory minimums,” Smith said. “Any effort by this administration to apply pressure on Congress to extend this [ban] again will be a betrayal of those pledges.”  

* DPA previously provided a restricted grant to The Influence Foundation, which operates Filter, to support a Drug War Journalism Diversity Fellowship.

Photo via US National Archives/Public Domain

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