It’s been nearly a year since Pittsburgh got the green light from Allegheny County to launch a city-run syringe services program. But seven months after the facility was expected to open downtown, it’s not up and running in quite the way city officials originally intended.
Syringe services programs — sometimes referred to as syringe or needle exchanges — are a harm reduction method aimed at preventing people who inject drugs from getting infected by providing sterile equipment. Individuals who use these programs are roughly 50% less likely to contract HIV and Hepatitis C, according to data from the Centers for Disease Control and Prevention.
City leaders intend to use a Public Works building along Second Avenue to provide a place to obtain clean needles and other supplies, along with overdose reversal drugs and information about treatment. The public works site was selected for its proximity to a recently opened low-barrier homeless shelter and the Allegheny County Jail.
“There’s a pretty deep entanglement between substance use and homelessness,” said Lisa Frank, Pittsburgh’s Chief Operating and Administrative Officer. People recently released from incarceration are also 40 times more likely to die of an overdose than someone in the general population.
The city site isn’t available for drop-in visits yet, Frank told WESA. Instead, the facility operates on something akin to an appointment-only basis. Outreach workers with the Reaching Out On The Streets program — a joint venture between the city and Allegheny Health Network — are identifying people in need and escorting them to the site to collect supplies, Frank claimed.
The ROOTS team has worked with about 800 individuals in the last year who needed support, according to the city. But the drop-in program hasn’t launched yet, in part because staffers in other city departments work in the facility.
“You’ve got a lot of different people crossing paths who are not really all doing the same work,” Frank said.
The city will eventually move those workers to another location: 412 Boulevard of the Allies. But it’s not clear when that will happen. Renovation of the building, which the city co-owns with the Housing and Urban Redevelopment authorities, has been beset by delays and has already exceeded its original budget by $3.2 million.
Frank added that once the Public Works building is emptied out, it will also need to undergo renovation before it can open as a drop-in site.
In the future, Frank said the city could also explore authorizing so-called “secondary providers”: entities who distribute syringes on behalf of the city outside the Second Avenue site.
But for now, the city is not permitted to distribute supplies away from that location, according to the Allegheny County Health Department.
The region’s primary existing syringe services program, Prevention Point Pittsburgh, says that more outreach efforts can’t come soon enough.
The city facility was slated to operate on Mondays, a time not already served by Prevention Point. The nonprofit operates out of vans parked in East Liberty, Perry South, the Hill District, Overbrook and Homewood. But its executive director, Aaron Arnold, said that while the organization serves about 5,000 people annually, he’s eager to see more groups — such as medical providers, nonprofits or municipal agencies — step into the space.
“We don’t want to be the only provider,” he said. “We believe there should be many, many more.”
Lowering a 'pretty high barrier'
The Allegheny County Board of Health is considering revisions to the rules and regulations that govern syringe services. The board has said the changes are designed to “expand access to an important point of intervention in the overdose epidemic.”
Permitting secondary services is one of several changes up for consideration, according to a Health Department spokesperson.
Other changes would remove a requirement that program locations be more than 1,500 feet from schools, daycare facilities and drug treatment facilities. The board said easing that requirement could “encourage previously ineligible municipalities” to start programs.
The Board of Health is scheduled to vote on the changes Wednesday. The revisions would also need a thumbs-up from Allegheny County Council and Chief Executive Rich Fitzgerald.
Prevention Point Pittsburgh, which operated underground before Allegheny County sanctioned its efforts in 2001, has long advocated changes to make it easier to establish syringe services programs, and to protect those who use them.
“Policies that were put in place did establish a pretty high barrier,” said Arnold.
Backed by data, limited by public perception
Though groups like Prevention Point Pittsburgh, and its unrelated counterpart Prevention Point Philadelphia, have decades of public health data that supports syringe services programs, Arnold noted public perception can still be a challenge to overcome.
Community opposition to a proposed Prevention Point site in Pittsburgh’s Carrick neighborhood, for example, prevented it from opening in 2018. (The group relocated to a site along Saw Mill Run Boulevard.)
But Arnold argued that attitudes are changing, and said some residents have become more comfortable with sites opening in their neighborhoods.
“The length of history that we have in the region is a very big help. People didn’t see the sky fall in 1995,” when Prevention Point started as a needle exchange, he said.
Critics express discomfort with groups helping people inject drugs. But Arnold notes that clean supplies can help keep people who use drugs alive longer, and eventually get them into treatment.
But while treatment is important, it’s “not the first and only conversation that we have” when people are struggling with substance abuse, Arnold said. “The immediate need when somebody is dependent on a substance is just obtaining the substance, [and] not going through withdrawal.”
And providing materials to safely inject has become more relevant as drugs become increasingly potent, Arnold said.
Fentanyl, a powerful synthetic drug, has surpassed heroin as the dominant opioid in Pennsylvania. It’s strong — 50 times more potent than heroin and 100 times more potent than morphine. It’s also cheap: According to a 2022 report from then-Attorney General Josh Shapiro, doses of fentanyl are “selling for the price of a six-pack of beer.”
Arnold said fentanyl changed the game for harm reduction.
“It no longer became an issue of just getting people to treatment,” he said. “It became an issue of: how do we keep them alive long enough for anything different to happen?”
In addition to preventing overdose, these programs offer a path toward recovery. Individuals who use syringe services programs are five times more likely to enter treatment compared to those who don’t, according to the CDC.
Pittsburgh isn’t the only Pennsylvania city looking to syringe services programs as one way forward.
A report issued by the Philadelphia Health Department last June pledged to explore “strategies to expand access to syringe exchange and other harm reduction services.”
The Philadelphia Health Department did not respond to WESA’s multiple requests for an interview. But Prevention Point Philadelphia, the city’s primary syringe services provider, said it would welcome the help of a city-run program.
The group’s executive officer, José Benitez, argued it could “alleviate some of the pressure” his organization is feeling right now. “We’re serving a lot of people.”
Prevention Point Philadelphia served 36,000 people last year, according to Benitez.
A legal gray zone
Though Pennsylvania saw a slight downturn in fatal opioid overdoses early last year, experts have warned against assuming that will last. Pennsylvania has for years ranked among the states facing the worst of the opioid crisis, according to federal data.
But despite support from state and federal health officials, syringe services programs remain illegal in Pennsylvania. The state’s drug paraphernalia laws — which Arnold referred to as “antiquated” — broadly define what is considered illegal to possess and distribute.
“Anything from a plastic bag to a paperclip could be considered paraphernalia” if it can be used to take drugs, Arnold said. But, he added, “there has been a pretty established gray area over time where things were overlooked.”
Several syringe services providers operate in Pennsylvania in that gray area, under varying levels of visibility.
Both Pittsburgh and Philadelphia’s Prevention Point organizations started underground, but later became the state’s only two legal syringe services providers. The groups led separate successful efforts to legitimize their operations under local ordinances.
But leaders locally and in Harrisburg are calling for the state to legalize syringe services statewide.
At a press conference last June, Mayor Gainey was flanked by state and county health officials from then-Gov. Tom Wolf's administration. Gainey urged Harrisburg to pass legislation to legalize syringe services. That, he said, would make it easier for new programs to launch, protect those already operating, and allow state funding to support the services.
“We need our leaders in Harrisburg to do more to end this overdose crisis,” he said. “These programs save lives in our city and should be expanded across our commonwealth,”
Dr. Debra Bogen, who at the time was the director of the Allegheny County Health Department, stood beside Gainey. She described syringe services programs as part of an “evidence-based strategy” to confront the opioid crisis.
“Syringe service programs go a really long way to [reduce] the spread of bloodborne infection” and toward linking people to other needs like housing, food and counseling, she said.
Today, Bogen is Pennsylvania's Secretary of Health under the new administration of Gov. Josh Shapiro. While Shapiro has been wary about some harm reduction methods in the past, his administration expressed support for syringe services providers.
A statement from Pennsylvania’s Department of Drug and Alcohol Programs said the administration is in favor of legalizing syringe services statewide.
The department said it “supports local communities’ efforts to promote public health, combat addiction, and reduce crime, including the decision to operate safe syringe service[s] programs.
“When conducted safely, these programs are a proven harm reduction strategy that can save lives, improve health … and connect those suffering from addiction with critical resources and treatment,” the statement reads.
It added that such programs “also help break down the barriers associated with stigma many individuals with substance use disorder still face today and protect law enforcement and first responders by properly disposing of used syringes.”
As for the General Assembly, lawmakers decriminalized fentanyl test strips last year, a move lauded by harm-reduction groups as a positive step. Users can now use the strips to avoid unintentional fentanyl exposure.
But legislators have so far chosen not to take up bills to legalize syringe services programs.
The most recent effort was sponsored by Rep. Sara Innamorato, who represents portions of Allegheny County. Though Innamorato’s bill died in committee at the end of last year's legislative session, she is rounding up support for the measure with plans to re-introduce it.
Innamorato is also currently a candidate for Allegheny County Executive, a position with the authority to change how syringe programs are regulated locally.
Meanwhile, the city of Pittsburgh was awarded $1 million in federal funds last year to expand overdose support services. With that money now in hand, Frank said the city is considering how to expand its overdose response unit. One idea is to purchase a small fleet of vehicles “so they can respond immediately” to incidents, Frank said.
Arnold is hopeful that relaxed local laws and municipal interest in syringe services programs could indicate a larger shift away from the zero-tolerance policies of the past. In the meantime, he said groups like Prevention Point will continue to provide harm reduction resources regardless of the limits of the law.
“We have often pushed the boundary,” said Arnold. “If there’s something with a clear value that could improve the safety or the health of an individual using drugs… then we’ll go ahead and do that.”
