Senate Bill 0629, introduced October 30, would allow authorized entities to operate a “needle and hypodermic syringe access program for the purposes of distributing sterile needles or hypodermic syringes to individuals or providing additional services, items or equipment” to mitigate the spread of blood-borne disease like HIV and hepatitis C.Participants, staff and volunteers who carry syringes—whether used or new—would be exempt from criminalization under local ordinances that ban so-called paraphernalia. It’s nearly identical to a bill that passed unanimously through the House in December 2024 before stalling in the Senate Committee on Government Operations.

Michigan has no law explicitly authorizing SSP. State law bans equipment associated with “injecting” unregulated drugs, but doesn’t ban syringes or needles specifically. But some localities have passed ordinances that do, and also ban various other harm reduction supplies like fentanyl test strips, which was why local harm reduction groups had rallied around the similar legislation from the previous session.

“Due to inconsistent language in municipal ordinances, there is often confusion and variation in paraphernalia criminalization throughout the state, causing inequities and devastating interruptions to the lives of those affected, even in the absence of prosecution,” the Michigan Drug Users Health Alliance wrote to House representatives in December 2024, in a letter signed by over 100 organizations and advocates. “Provision of safer use supplies is positive for everyone in the community—not only in mitigating the spread of infectious disease, but also in lifting the stigma that isolates people who use drugs. When our laws are unclear, law enforcement officers often take action that further marginalizes people who are most at risk of infectious disease and overdose.”

In 2017, the state had just four authorized programs. In 2018, the Michigan Department of Health and Human Services published an SSP implementation guide and began funding an increasing number of programs, especially during the COVID-19 pandemic. As of June, the state has 37 programs operating at around 140 locations. Since late 2018, SSP in Michigan have linked at least 89 people to HIV care, and at least 367 to treatment for hep C.

The new bill is sponsored by Democratic senators Rosemary Bayer, Jeff Irwin and Sue Shink. A separate bill, SB0628, was also introduced October 30 by the same three senators, and would ensure that SSP are covered under the state’s Medicaid program. It defines SSP as “harm reduction programs that provide a wide range of services, including, but not limited to, the provision of new, unused hypodermic needles and syringes and other injection drug use supplies, such as cookers, tourniquets, alcohol wipes or sharps waste disposal containers, to individuals who inject drugs.”

The previous legislative session was the first time in decades that Michigan had a Democrat majority in both chambers, following a ballot initiative that took control of redistricting away from state legislators and put an independent, nonpartisan commission in charge. Democrats had not controlled the House since 2008. In the current session, the Republican Party holds the majority again.

Top image (cropped) of 2025 harm reduction agency directory via Michigan Department of Health and Human Services/Google Maps. Inset graphic via Michigan Department of Health and Human Services.

The post Michigan Will Again Try to Legalize Its Rising Number of Syringe Programs appeared first on Filter.

The California Department of Public Health had reinstated the program’s license in December 2024. HRC leadership told Filter that they resumed services earlier in 2025, but initially kept a lower profile as they assessed their funding and resources.

In 2020, Grant Park Neighborhood Association filed a lawsuit against HRC with the goal of shutting down syringe services. After HRC won that case, Grant Park filed an appeal and sued the health department, arguing that as a state-run program HRC’s use of volunteers to distribute syringes put it “in direct conflict” with the separate, county-run SSP.

The county SSP did not object to HRC’s operations. But a Superior Court judge in Sacramento agreed with Grant Park, and in late 2023 HRC’s license was revoked.

Other services like naloxone distribution and wound care were allowed to continue, as those don’t involve supplies criminalized as drug paraphernalia. But the deauthorization cost HRC their California Clearinghouse funding. This is a partnership between the CDPH and the Dave Purchase Project/NASEN that covers a substantial share of resources for HRC and many harm reduction providers.

“We saw a massive drop in the participants who we could stay in contact with.”

“We saw a massive drop in the participants who we could stay in contact with,” HRC Executive Director Anna Koplos-Villanueva told Filter. “That meant a lot less Narcan out in the community, lower engagement rate [with] wounds and abscesses that needed clinical support. We had to offer fewer rides to connections and referrals … losing that funding means we lost access and the ability to get people what they need in other aspects of their lives.”

HRC began working on the application for reauthorization immediately. Part of this process involved soliciting public comment and, based on feedback from law enforcement, developing new operational guidelines that ultimately included a ban on syringe distribution in public parks. HRC founder Denise Elerick told Filter that the organization hadn’t been doing syringe distribution in parks. But the police-driven fearmongering around so-called “syringe litter” made this a flashpoint in HRC’s fight for reauthorization anyway.

“The impacts of these programs might be proven or beneficial from a public health standpoint, but they don’t help from a public safety perspective,” Santa Cruz Police Chief Bernie Escalante claimed according to Santa Cruz Lookout. 

This is inaccurate. SSP are associated with reductions in the number of used syringes discarded in public, not increases, and needlestick injuries are neither as prevalent nor as dangerous as the public is often led to believe anyway.

“We’ve never met with our police chief. He’s never reached out to us directly to discuss any aspect of our operations or his concerns.”

While the health department was in discussions with the Santa Cruz Police Department, HRC was not privy to them. Elerick and Koplos-Villanueva told Filter that their organization made repeated efforts to contact the SCPD by phone and email, but never received a response. But while California police departments can consult with state health officials about SSP, they do not have the power to approve or deny their operations. So HRC was able to get reinstated, but the dynamic with SCPD brings some uncertainty about what may happen next.

“We’ve never met with our police chief. He’s never reached out to us directly to discuss any aspect of our operations or his concerns,” Koplos-Villanueva said. “The biggest issue of why [distribution in parks] is coming up with police departments is they are not as well aware of the science and research of harm reduction programs reducing syringe litter in the community.”

Similar campaigns against syringe distribution have targeted SSP in other California jurisdictions like Eureka and Chico. In April 2024, the city council of Santa Ana in Orange County voted unanimously to issue a resolution stating its “strenuous opposition” to a proposed SSP. In October 2021, Governor Gavin Newsom (D) signed a bill that protected SSP from bad-faith lawsuits that cited environmental impact, a tactic that was becoming increasingly popular. 

Image via Harm Reduction Coalition of Santa Cruz County

The post CA Syringe Program Resumes Services After Fight for Reauthorization appeared first on Filter.

A new study published in the Harm Reduction Journal provides compelling evidence that the growing excitement about vending machines is warranted. Reviewing three decades of research from 11 countries, the researchers found that vending machines tend to reach their intended audiences, reduce many of the risks associated with substance use, and garner community support.

Unlike tried-and-true harm reduction methods such as mobile outreach or staffed distribution centers, vending machines are available around the clock and don’t require face-to-face interaction. In fact, many machines are most heavily used outside of traditional business hours, particularly when other services are unavailable.

“It’s definitely a lot more accessible and can reach a different population than traditional public health programs or services,” lead study author Dr. Alice Zhang, of the Penn State College of Medicine, told Filter. “[It’s] another venue to try to get items out to the community.”

The review reports that research has consistently found vending machines to be in high demand across a broad range of settings, from universities and health care centers to prisons and commercial sex venues. Users cited convenience, increased anonymity and the ability to access supplies on their own schedule as key benefits.

“Some of the studies that have come out so far show some promising impact on reducing overdoses, on being able to diagnose HIV.”

Importantly, vending machines tend to be accepted by both their target users and the broader community. While some initial community concerns arose in several sites, especially when the proposed vending machine was slated to distribute syringes, those worries tended to diminish after the machines were implemented.

Though fewer studies directly assessed the impact of vending machines on issues like overdose risk or HIV transmissions, the research that did was promising.

“Some of the studies that have come out so far show some promising impact on reducing overdoses, on being able to diagnose … new HIV infections,” Zhang said. “So I think there’s a lot of promise in these vending machines.”

For example, four separate studies found that needle-sharing decreased after the installation of a syringe-dispensing vending machine. One German study even reported that sharing of needles inside a prison stopped entirely. Similarly, in two studies analyzing the effect of naloxone vending machines in the United States, county-level fatal overdose rates were substantially lower than predicted in the year following installation.

Across studies conducted in China, California and the United Kingdom, researchers also found positive impacts on HIV testing and diagnosis. One particularly compelling study found that a vending machine distributed more than five times as many HIV tests than community outreach staff working in the same area.

Still, Zhang cautioned that the evidence base for long-term impact remains limited.

“The impact is a little bit underrepresented in the research,” she said. “I think it’s sometimes hard to evaluate the impact just because there are so many factors related to our target outcomes.”

“I think there’s a huge gap in understanding what vending machines look like nowadays in the US.”

While the concept has gained traction globally, the US has only recently begun adopting harm reduction vending machines more widely. Research on vending machines in countries like France, Switzerland and Germany began in the late 1990s, while the bulk of US studies have been published over the past 10 years.

Regulatory hurdles, particularly surrounding syringe access and drug-checking tools, may be the reason for these differences. Zhang and her colleagues found that vending machines in the US often focused on naloxone distribution or HIV testing rather than syringe access—likely a reflection of differing policy environments.

To adapt successful international models to local contexts within the US, Zhang emphasized the need for more research.

“While I think a lot of the lessons that we’ve learned from those [international] vending machines could apply, I think there’s a huge gap in understanding what vending machines look like nowadays in the US,” she said.

Zhang’s motivation was to assess whether her team, alongside community partners, should consider implementing a vending machine in a nearby town.

For harm reduction organizations or public health departments considering implementing vending machines, this review provides strong evidence that they are feasible, impactful and accessible. In fact, Zhang’s own motivation for conducting the study was to assess whether her team, alongside community partners, should consider implementing a vending machine in the nearby town of Harrisburg, Pennsylvania. The answer, based on the findings, was a clear yes.

“It was certainly helpful to know that these vending machines are accepted by their target population, and that they are very feasible,” she said. “It’s kind of like proof of concept in some ways.”

She hopes that others exploring similar ideas in their communities will see this as an encouraging sign—even when facing “not in my backyard” sentiments.

“The climate might not necessarily be the best, but yeah, these vending machines can certainly make it on the ground and be in high demand,” Zhang concluded.

Image via United States Department of Veterans Affairs

The post Harm Reduction Vending Machines Work, Says 30 Years of Research appeared first on Filter.

Roseburg is the county seat and most populous city of Douglas County in southern Oregon, about 70 miles from Eugene. In a council hearing on May 12, the police chief claimed that several city employees have reported needlestick injuries incurred while removing tents and personal belongings from local parks.
Syringe distribution in the city is operated by HIV Alliance. Prevention Manager Dane Zahner noted at that same meeting that the language of the ordinance could possibly restrict groups like his from distributing injectable naloxone. He suggested mutually agreed-upon public outreach locations where syringe service programs could be authorized to continue distribution, and offered to “help provide some training for the officers” who had reported needlestick injuries. HIV Alliance has already suspended its operations in parks.

Roseburg has been escalating enforcement against people sleeping outside.

The council members debated possible scenarios if Zahner’s suggestions were adopted, with some calling for greater surveillance. They expressed particular interest in an account of an estimated 300 syringes found in one tent. Zahner explained that it’s a common harm reduction practice in unhoused communities for someone to collect syringes from those around them and return them to an SSP all at once. Ultimately the ordinance was advanced by a vote of 5-2, but still needs final approval.

Roseburg has been escalating enforcement against people sleeping outside. A recent agenda noted that Mayor Larry Rich, who has held that position since 1998, had questions about “whether individuals or groups of tents are considered an illegal camp” as well as the “reasoning for someone to have so many needles in their tent.”

In August 2024, the city voted unanimously for more crackdowns on encampments, with increasing fines and possible jail time for repeated citations. In January, Roseburg police targeted Deer Creek Park, where more than 100 people had been staying. In February, the department reported it had seized so many belongings that it had run out of space to store them.

Image via National Institute on Drug Abuse

The post Amid Encampment Sweeps, Oregon City May Ban Public Syringe Exchange appeared first on Filter.

Harm reduction was a different thing in the early ’90s; we didn’t even call it that yet. The closest you’d get to publicly acceptable harm reduction was maybe the “Friends Don’t Let Friends Drive Drunk” campaign. Even giving out free condoms to high-schoolers was controversial. Giving out free syringes to people who injected drugs was something the public hadn’t really heard of.

The Thurston County Syringe Services Program in Olympia opened as a pilot project in 1993, but that wasn’t the beginning of syringe distribution there. Ask anyone who was on the streets downtown in the early ’90s and they’ll tell you they got clean rigs from Olympia’s one-man syringe service program, Long Hair Dave.

Dave was a local legend, someone whose whole life was about bringing direct services to those of us on the streets. But the first time I met him, in 1992, I knew nothing about him and didn’t trust him at all. He was a pretty eccentric guy, to me at least—he had this big hat and long coat with buttons all over it; he rolled his own cigarettes—but the reason I was suspicious was that he was giving out syringes. We were standing on 4th Ave, right on the main drag, and he just handed my friend Tony a new syringe like it was nothing. 

The HIV and AIDS epidemic was in full swing, but you needed a documented medical condition to legally possess syringes. Dave brought them to us anyway. That first day we talked for a while, and he gave me his phone number and said if I needed syringes I could call him anytime.

He probably meant that as more of a figure of speech, but when I literally called him up in the middle of the night he didn’t complain. He usually gave out syringes one or two at a time, but pretty soon he started giving me more so he could get a decent night’s sleep. 

Long Hair Dave in downtown Olympia in 1993

Dave was good at meeting people where they were at. He used to come down to the train access tunnel where we slept, but he’d respect our space and not go inside. Just check on us from the entrance and hand us some condoms and bleach kits, and swap new needles for used ones. He lived the principles of harm reduction before concepts like that were written or talked about. He did the work because he believed in it.

If someone was thinking about trying to get into treatment, Dave was right there to talk to them about it. But he never told us we needed to get clean. He never told us what we needed, period. He listened, and then he tried to help as best he could.

That summer, Dave was the one who told me I had HIV. The health department outreach team who’d tested me couldn’t find me, but they knew Dave could. He sat down with me in his little office at the old Bread & Roses shelter and told me what was up. 

We talked a lot. He gave me a lot more information about how the virus is actually transmitted. That was when it really clicked for me why it was so important to not share needles. There’s a good chance I already had HIV by the time I met Dave, but while I’d mostly been using clean rigs since I met him I was still sharing sometimes. After that day I stopped, and I was able to do that because of Dave. He helped make sure I always had clean rigs, as well as a supply of condoms.

I came and saw him quite a bit over the next few weeks. Even though we all assumed I was going to die pretty soon, he didn’t just talk to me about not spreading the virus to others; he also shared information about living with HIV. I wouldn’t be alive today if it weren’t for Dave. I can say that and really mean it.

I’ve been in prison since 1995. Dave wrote me a couple of times, even sent books—he founded the Olympia chapter of Books to Prisoners—but I can’t really speak to any part of his life or work that’s more recent than that. What I can tell you is that over my years in prison I’ve met more than one person who remembers Dave, and everyone always has a story about how he helped them when they were in trouble, or went out of his way to connect them to services they needed.

He didn’t approach life like a popularity contest. He didn’t care about getting credit for the work he did. He just did what was needed for the people who needed it.

Image (cropped) via Long Hair David/YouTube

The post Remembering Long Hair Dave, Early Champion of Sterile Syringe Outreach appeared first on Filter.

Texas doesn’t authorize SSP state-wide, and for the past several years only Bexar County has permitted locally funded pilots to operate. That authorization became part of state law on April 1, but still applies only to Bexar County. The proposed bill would expand it to six others, effectively legalizing harm reduction services for those residents.

“While we will continue to advocate for the authorization of SSP in Texas, we do not anticipate that this legislation will necessarily pass during this session,” Maggie Luna, executive director of the Texas Harm Reduction Alliance (THRA), told Filter. “This has been a long struggle.”

The bill proposes a “one-to-one” restriction on any SSP opening in the protected counties, meaning participants wouldn’t be able to receive new syringes without bringing in an equal or greater number of used syringes. Public health experts including the Centers for Disease Control and Prevention have established that the most effective model for reducing blood-borne disease transmission is to give people however many syringes they need. 

“Having a one-to-one basis is a great start, it’s something,” Luna said. “People will still end up re-using the same ones over and over.”

“Asking [people] to scrounge up some change to get one or two syringes, I don’t know if it would be worth it.”

The bill would also allow SSP to charge participants a fee for each syringe, capped at 150 percent of what the program paid for them. This would be highly unusual; SSP are designed for low-income communities, and traditionally everything they offer is free. The price cap would likely be under $1, which would be a lot cheaper than buying syringes elsewhere, but people who use syringes for intravenous drug injection very rarely access them that way.

“In what world does that help people who don’t have access?” Luna said. “The people we serve, we’re helping them find food, showers and clothes. Asking them to scrounge up some change to get one or two syringes, I don’t know if it would be worth it.”

Luna testified in support of the bill on April 14, but felt that many lawmakers were dismissive of the need for harm reduction services. She shared the story of training her teenage daughter to use Narcan, and how that allowed her daughter to reverse an overdose at her school.

“She had Narcan—nobody else did,” Luna said. “Since she was educated she knew how to spot an overdose and use it, now that child has another chance to live.”

Narcan isn’t criminalized in Texas. But syringes are, under drug paraphernalia statutes that also ban fentanyl test strips. THRA is therefore not authorized to distribute them, but that would change if the bill is enacted—one of the counties authorized for SSP would be Travis County, where THRA is based.

Luna said that if the bill did pass, THRA would consider becoming a licensed pilot program—but would proceed cautiously, while still supporting any other programs that chose authorization.”Our services are free, and it’s important to us that we always maintain free services,” she said. “While authorization is important, sometimes it does have it’s drawbacks, as I’m sure many programs can attest to.”

Image via Centers for Disease Control and Prevention

The post Texas Bill Could Expand Sterile Syringe Access—for a Fee appeared first on Filter.

A great recommendation, but it was hard. It took a long time, sometimes ruined your plunger and required me to carry a bunch of other stuff to do it.

In 1992, after I’d tested positive for HIV, a program in Olympia, Washington, helped me do more to prevent HIV transmission to others. It gave me access to sterile equipment.

Bleaching was difficult. Just using a new rig, on the other hand, was not only a more failsafe method—it was easy.

I began to use new rigs for myself and carry them for everyone else, too. It was easy to do this. We all preferred using new rigs. No extra paraphernalia, and it didn’t get in the way of using. This choice was made easy for me, and I helped make it easy for others.

Harm reduction is most effective when adoption of a resource or practice is easy, convenient and even enjoyable.

Harm reduction needs to meet people “where they’re at.” It needs to give people the things they need to take control of their health and wellbeing and reduce risks in their life. And it does this most effectively when adoption of a resource or practice is easy, convenient and even enjoyable—and at the very least, not unpleasant and hostile.

That’s why overdose prevention centers, for instance, emphasize being welcoming spaces. Places where you can not only use a drug safely, pick up necessary supplies or obtain valuable referrals, but also stop for a chat, share a meal, create art or otherwise build community.

Similarly, at syringe service programs every effort is taken to make the environment comfortable. Pop-up SSP are located as much as possible in safe places where patrons will feel at ease, not surveilled, in areas they already frequent. At brick-and-mortar SSP the decor, the whole setting and the ethos are ideally designed to help people feel welcome, safe and good about the choices they are making.

This “pleasure” principle extends to all harm reduction—tobacco harm reduction included.

There’s substantial evidence that vapes, pouches and other safer nicotine products are effective in helping people who want to quit smoking. Two big factors in why they work are that they are easy to use and enjoyable.

If a fruity-flavored vape gives people pleasure, meaning they’d never want to return to smoking, why wouldn’t we prioritize making the preferred option available?

A large majority of adults who quit smoking with vapes prefer flavors other than tobacco—mostly fruity ones. People like sweet, fruity flavors in lots of contexts. But many who formerly smoked also say they don’t want to be constantly reminded of combustible tobacco when they vape.

Disposable vapes, meanwhile, are often demonized but represent the most low-barrier vaping option. You just pick them up and inhale, and this ease of use can be critical for someone who smokes, has never tried vaping and has no idea what a mod is.

If a harm reduction resource is both much safer than the alternative and more satisfying, pleasant or convenient to use, that’s ideal. If a fruity-flavored vape gives people pleasure, meaning they would never want to return to smoking—while for some, a tobacco-flavored vape isn’t more enjoyable than a cigarette—why wouldn’t we prioritize making the preferred option available? More lives can be saved that way.

Youth use, and the notion that flavors entice youth, is always the reason given for restrictions and bans, of course. It’s cited in a current effort to ban flavored nicotine products where I live, in Washington State.

But unlike the cigarettes they can replace—for all ages—vapes and pouches aren’t killing people. It’s curious how with certain risky products that come in a wide range of flavors—alcohol, sugary drinks—lawmakers in contrast see age restrictions or parental discretion as adequate, mostly taking the view that outright bans would be draconian.

People lose their ability to think rationally when it comes to children.

The youth thing reminds me of the 1990s, when there was a big push to get condoms in schools. Teachers brought people in to talk to classes, and I did that work for a while. The goal was to teach about risks from sex, and about proper condom use to help prevent HIV transmissions and pregnancy.

Many people back then objected, arguing that this was a sort of tacit encouragement for underage people to go have sex. The point, of course, was that many were having sex already, or soon would, and they deserved to know how to protect themselves.

Some kids will use nicotine. If we accept that reality, we should surely teach that while you don’t have to use it, if you do, some options are much safer than others. But people lose their ability to think rationally when it comes to children.

Again, supporting safer choices that people are making is important. When people don’t feel good about what they’re doing, they generally go back to what they know, even if they don’t feel good about that.

Sometimes people just need a bit of help in managing their lives. For years, everyone told me I needed to do fewer drugs. Sometimes I would. Tapering the amount of meth I used. Saving money, restoring balance in my life. Sometimes I would swap one substance for another. I would always rely on cannabis to help manage my other substances.

I was able to make adjustments because I enjoyed what I was doing. Because I felt good about my choices. Ultimately, when I was ready, I quit drugs.

It was hard. But It was also notable that sometimes something as simple as how I used a substance helped. Stopping injecting and maybe parachuting or snorting for a while could have a huge effect on how much I used.

The through-line here is that all of these management tools were things I liked. They still gave me the pleasure I needed. I was able to make adjustments because I enjoyed what I was doing. Because I felt good about the choices I was making. Ultimately, when I was ready, I quit using drugs.

In Sweden, where uptake of snus, a safer, non-combustible tobacco product, has led the country to the brink of “smoke-free” status, snus is sold in appetizing flavors at outlets that resemble chocolate shops.

If we offer people vapes—but only some vapes that many find less palatable or convenient, with a message that these shouldn’t be used for pleasure—that sabotages harm reduction potential.

Consider how we offer another resource to reduce drug-related harms in the United States. Methadone is available, but only in cold, carceral clinics where surveillance and punishment are the norms. This self-defeating setup dampens access to a lifesaving drug. It leads some people who use opioids to conclude, understandably, that they’d rather take their chances with the high-risk street supply.

In the effort to reduce smoking-related disease and death, which way will we go? 

Photograph (cropped) by Jacqueline Munguía via Unsplash

The post When Harm Reduction Is Easy and Enjoyable, It’s More Effective appeared first on Filter.

Researchers recently put this to the test. They sent secret shoppers to all 125 community pharmacies in Austin, Texas, to buy OTC naloxone and non-prescription syringes. Their study, published in JAMA Network Open in February, illustrated how access to harm reduction tools in pharmacies remains severely limited.

The alarming findings included that each of the two items was available at just over half of the pharmacies, and only 20 percent of stores provided both.

The main barrier to accessing OTC naloxone was that stores simply did not carry it. Only 55 percent of stores had a location for naloxone on their shelves. And even among those stores, one in three were sold out. Additionally, under 10 percent of pharmacies sold generic naloxone, which tends to be less expensive than brand-name options like Narcan.

Almost all the pharmacists asked the shoppers follow-up questions about why they wanted the syringes, and many refused to sell them without a prescription.

Stigma appears to have been a major barrier for purchases of non-prescription syringes. The secret shoppers successfully bought these items at 58 percent of the stores, but pharmacy technicians played an active role in blocking access. Almost all the pharmacists asked the shoppers follow-up questions about why they wanted the syringes, and many refused to sell them without a prescription, even though Texas state law does not require a prescription to purchase syringes.

“We had heard anecdotal reports that pharmacists … were unwilling to sell syringes to people without either asking a bunch of follow up questions or having a prescription on file,” lead study author Dr. Lindsey Loera, of the University of Texas at Austin College of Pharmacy, told Filter. “The findings of our study confirmed those anecdotal reports.”

While surveys or interviews of pharmacists may capture what they claim they would do, this in-person secret shopper experiment (also called an “audit study”) revealed their actual, everyday behavior.

“If you go do a phone call and say, ‘Hey, do you sell non-prescription syringes to people who walk in?’ it’s easy for a person to say yes or no,” Loera explained. “When you go in person and do a secret shopper audit … you’re getting the true measurement.”

To maintain consistency across visits, the shoppers went through several rounds of training, including a harm reduction workshop facilitated by the Texas Drug User Health Union. They also stuck to a strict script, asking only for a bag of 10 syringes and responding, “I need to protect myself against HIV and HCV [hepatitis C]” to pharmacists’ questions.

“We took a standardized approach to navigating the conversations,” Loera said.

Even with this rigorous protocol, the shoppers’ identities may have afforded them some privileges. All five secret shoppers were young pharmacy students, and four of them were white women. Based on this study, we don’t know if shoppers from more marginalized backgrounds would have experienced even greater difficulties in obtaining harm reduction supplies. But it would not be surprising if such a finding were later demonstrated.

“It would be great if we could replicate this study utilizing people with lived experience as the auditors,” Loera said, referencing a similar study conducted in Arizona in 2022 with a more diverse group of secret shoppers—which found even bleaker results.

“The findings from this were obviously not great, but I want pharmacists to read this and feel motivated to help this patient population.”

The new findings reflect ongoing tensions between drugstores and harm reduction as OTC naloxone has been rolled out nationwide. While the FDA approved the first OTC naloxone product in March 2023, its initial approval applied exclusively to Narcan, an expensive brand-name naloxone product.

In the following months, the FDA continued to approve additional generic and name-brand options. By September 2023, naloxone had hit the shelves of major pharmacy chains across the United States. Some stores, such as Walgreens, even created their own white-label products.

Despite these major steps forward, this study and related research demonstrate the persistent effects of stigma even after legal restrictions have been loosened. As a pharmacist herself, Loera hopes that these results will remind her peers that providing compassionate care to all customers should be central to their work.

“The findings from this were obviously not great, but I want pharmacists to read this and feel motivated to help this patient population,” she said. “My hope would be that people are willing and able to deliver compassionate care.”

Rather than villainizing pharmacists, Loera emphasized the importance of education in bridging gaps in care for people who use drugs. She highlighted the need for pharmacy personnel to seek out training and resources to better serve this population.

“Most of us pursued our education to help other people. And so I think sometimes just remembering the why—like, why did we pursue our degree? Why did we go into clinical practice?” Loera emphasized. “Remembering why we’re doing our work can sometimes help put into perspective why it’s important to not only engage and provide health care, but to do so in an empathetic and loving way.”

Photograph by Harrison Keely via Wikimedia Commons/Creative Commons 4.0

The post Secret Shoppers Struggle to Buy Naloxone, Syringes at Texas Pharmacies appeared first on Filter.

Some 5,000 people were being served by TB HIV CARE at two harm reduction sites in eastern South Africa—depending on them for access to resources including sterile syringes and medications for opioid use disorder (MOUD).

“I owe my HIV-negative status to their efforts.”

Barend Beukes, 42, who lives in the city of Tshwane in Gauteng province, has relied on groups like TB HIV Care, and others funded by US aid programs, for years. “I owe my HIV-negative status to their efforts,” he told Filter.

He got his first dose of methadone right before the COVID lockdowns. “It has progressively been changing my life ever since. Programs like opioid support therapy have allowed me the semblance of a normal life.”

The two sites include one in Tshwane, which has been serving about 4,000 people, and another in the Ehlanzeni district of Mpumalanga province, serving around 1,000.

“Both sites are now closed, leaving these clients without access to critical harm reduction services,” Klaas Mtshweni,a national leader with the SANAC Civil Society Forum PWUD Sub-sector, told Filter.

People have been directed to public health facilities instead, but most of them don’t offer MOUD. And the shutdown was so abrupt, Mtshweni’s not sure if TB HIV Care had the chance to connect people with the few programs that do.

“The closure of these programs has left a significant gap in harm reduction services, putting the health and safety of people who use drugs at risk,” he said. “Without access to [syringes and MOUD], there is an increased likelihood of HIV and hepatitis C transmission, overdose deaths and other drug-related harms.”

The US spends less than 1 percent of the federal budget on international humanitarian aid. Nonetheless, on January 20 President Donald Trump ordered a 90-day work stoppage to audit how the money is used.

“We spent the weekend feeding USAID into the wood chipper,” billionaire Elon Musk gloated.

Secretary of State Marco Rubio issued a memo exempting “lifesaving” humanitarian efforts, but aid groups quickly found that their stop-work orders were not being reversed. The Trump administration’s attacks on the largest foreign aid agency, USAID—which has been funding TB HIV Care through PEPFAR (President’s Emergency Plan for AIDS Relief)—sharply escalated: Top staffers were fired and the website knocked offline. Almost all USAID staff, including thousands based overseas, are being placed on administrative leave from February 7.

On February 3, Trump seemed to confirm rumors that the agency will be dismantled and what few programs remain will be folded into the State Department. Shutting down USAID, “should have been done a long time ago” he told reporters. On the same day, Rubio announced that he was now the administrator of USAID.

“We spent the weekend feeding USAID into the wood chipper,” billionaire Elon Musk gloated. “Could’ve gone to some great parties. Did that instead.”

Musk’s weekend plans have been presented as a matter of fiscal responsibility, but the administration has made no pretense of hiding its ideological agenda, raging against “DEI” and trans care. Harm reduction, including US-funded international programs, could similarly be categorized, derisively, as “woke.” Trump’s nominee for health secretary, Robert Kennedy Jr., favors 12-step programs and coerced treatment.

Aid groups are frantic, and whatever happens from here, great damage has immediately been done.

“Things have already been disrupted,” Shaun Shelly, executive director of Harm Reduction International, told Filter. “The momentum has been compromised, and it will take a lot to overcome the inertia and restore the services.”

“Many people traumatized and criminalized by the American-led war on drugs, who found employment as peers, have lost their only income and their medical services.”

Shelly, who is South African, is also a co-founder of SANPUD (South African Network of People Who Use Drugs), and previously served as human rights and policy lead for TB HIV Care.

“The reality is that many people who have been traumatized and criminalized by the American-led and -sponsored war on drugs, who found employment as peers in harm reduction programs, have lost their only income and their medical services without notice,” he said.

“Experience and research have shown that disrupted services lead to people dropping out of programs, stopping treatment, and often they end up back on the streets, vulnerable, drug-dependent and retraumatized.”

The shuttering of harm reduction programs also betrays hard-earned trust. “The situation undermines years of progress in building engagement with people who use drugs, who often face stigma and discrimination in public health care settings,” Mtshweni said.

“The broader impact of the stop-work orders on harm reduction efforts in South Africa is deeply concerning,” he added. “It not only disrupts essential services but also sends a discouraging message about the prioritization of harm reduction in public health policy.”

Beukes considers himself lucky to have had past access to harm reduction services, unlike many who now won’t.

“The harsh reality of President Trump’s freeze is that people will never have the opportunity to live a better quality of life,” he said. “The cold hard truth is that for every one of me there are around five others who are not aware of their HIV status, and who desperately need projects that’re funded to ensure dreaded diseases like HIV, TB and hepatitis are under control.”

Photograph by US Navy via Picryl/Public Domain

Correction, February 12: A previous version of this article wrongly attributed some TB HIV CARE services (and prospective layoffs) to SANPUD, which advocates for people who use drugs in South Africa. This is not the case, and we apologize for the error.

The post People Who Use Drugs Among Victims of Trump’s Assault on USAID appeared first on Filter.

An ordinance passed in 1997 caps the number of SSP at just three, in a city where the population has grown to well over 700,000. They’re also barred from operating within 1,000 feet of any school or daycare center, though the current SSP have some exemptions. Denver’s three SSP are run by the Harm Reduction Action Center, Colorado Health Network and Lifepoint by Vivent Health (a mobile program).

Back in October, as Filter reported, the City Council held discussions about repealing the law. Ahead of the second and final vote on January 13, the Council took a preliminary vote on January 6, when eight out of 12 members voted to give initial approval to the proposal, which is sponsored by Councilmembers Serena Gonzales-Gutierrez, Sarah Parady and Stacie Gilmore.

“When I learned that Denver is alone among large American cities in restricting where syringe access programs can operate in relation to schools, I was honestly surprised,” Councilmember Parady told Filter by email. “A school-based distance restriction is really irrational for these programs, which do not have any controlled substances on site and are very strictly regulated by the public health department. And in Denver’s real estate market, since they also have a pretty narrow zoning classification, the restriction has made it impossible for our most successful program to relocate when their lease ends.”

The final vote was 8-5—one vote short of the threshold to prevent Mayor Johnston from vetoing it.

“I don’t believe that if this bill passes—and it’s signed by our mayor—that anything is going to change in your life,” Councilmember Paul Kashmann said, explaining his vote in favor. “Unless one of your relatives who’s on the edge happens to get a clean needle and stays alive long enough to get into treatment.”

The final vote was 8-5—one vote short of the threshold to prevent Mayor Johnston from vetoing it. In 2024, Johnston exercised his veto power to kill a “freezing sweeps” bill, which would have limited city officials’ power to clear encampments of unhoused people. He also vetoed an effort by the Council to fund a universal basic income program, which would also have supported people experiencing homelessness, arguing instead that Denver’s “rapid rehousing model” was more effective.

Lisa Raville, executive director of the Harm Reduction Action Center, told Filter ahead of the vote that she and her organization had met with most of the councilmembers to share evidence and testimony in support of repealing the restrictions.

“We are a great neighbor, and we’re very collaborative with the city,” Raville said. “Most of City Council already knows and works with us. Oftentimes if they have a tricky area with high drug trafficking or encampments, instead of calling law enforcement they’ll reach out to us, and have our street outreach team go out and engage with resources, referrals, supplies and naloxone. Most of them have known us as a collaborative partner.”

Some councilmembers who opposed the idea of lifting the restrictions countered with another proposal to allow hospitals and urgent care centers to distribute syringes. Raville said she would welcome having more places where people could access syringes, but believes dedicated harm reduction programs are the best option.

“People who use drugs and health care providers have had a tumultuous relationship for years,” she said, “and for us in Denver there’s been a deeply entrenched rumor that folks are going to be warrant-checked at the emergency department. We’ve passed legislation earlier to reduce that. Harm reduction programs are by people who use drugs for people who use drugs. People feel more confident the quality of services they will get will be stigma- and judgement-free.”

Raville explained that the mayor’s signature on the new Council measure is vital to the survival of her program.

As Filter previously reported, the Harm Reduction Action Center’s downtown program is facing an existential crisis: Its current location is likely being sold by the landlord, and they need to find a new home. The clock is ticking, because the program received a grant from the Denver Opioid Abatement Council to purchase a new location, but the current city law restricts the options available. The grant expires if it isn’t spent by the end of 2025.

Raville explained that the mayor’s signature on the new Council measure is vital to the survival of her program; it would mean more flexibility in finding a new location, and more amenable property owners.

“If we lose this exchange site, I worry that we will see an immediate uptick in overdose deaths, infectious disease transmission, and needle waste in parks and city garbage bins,” Councilmember Parady said. “Syringe access programs are one of the most effective gateways to treatment and recovery for people experiencing opioid addiction—they literally triple someone’s likelihood of entering into recovery.”

Asked whether the Council measure would in practical terms simply allow the three existing SSP operators to expand or bring in new harm reduction programs to Denver, Raville said both are possible—but stressed that funding could be a major barrier to new programs, amid a political backlash to SSP in Colorado and nationwide.

Photograph of Harm Reduction Action Center courtesy of Harm Reduction Action Center 

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