Ten years ago, running a syringe exchange was a risky venture in Colorado.
At the time, it was illegal to give out clean paraphernalia to people using heroin and other injected drugs. There were only two known facilities where users could exchange dirty syringes for safer new supplies. In Boulder, the DA agreed to turn a blind eye to the health department’s program, while in Denver a private group ran their operations completely underground.
That changed in 2010, when state lawmakers legalized needle exchanges, saying they could reduce the spread of infectious diseases. Today, there are 14 of the facilities operating along the Front Range and in Grand Junction, with a growing medical consensus that they’re effective in reducing overdoses, outbreaks, and even substance use.
However, the law puts the power to authorize exchanges in the hands of local boards of health, and the idea remains politically polarizing in many areas. For example, local authorities in El Paso County have repeatedly shut down efforts to open a syringe exchange in Colorado Springs.
“You look at Pueblo, you look at Denver, and their opioid crisis is the worst in the state,” said Longinos Gonzalez, an El Paso county commissioner and health board member, referring to cities with syringe exchanges.
Gonzalez believes that county elected officials and their appointees should get the ultimate decision over exchanges in their communities. But to some lawmakers, the health boards have become a roadblock to spreading what they see as a proven idea.
“Some of these communities need access, and we need to go around these boards of health,” said Lisa Raville, executive director of the Harm Reduction Action Center, which runs the syringe exchange near the Capitol in Denver.
That debate is likely to play out in the legislature this year. A new bill would partially remove officials like Gonzalez from the equation, potentially making it easier to open an exchange in El Paso and other places.
Programs “would still be overseen by the state,” said state Sen. Brittany Pettersen, a Democrat and sponsor of the measure. “There’s a very high standard of what is expected of a center that would like to provide naloxone training and clean syringes But this makes sure that we’re clarifying that they actually don’t have to have that local approval.”
In El Paso, the health board that has rejected syringe exchange proposals is a mix of health workers, elected officials and others. They’re all ultimately appointed by the county’s elected leaders.
The new bill, HB20-1065, would no longer require a sign-off from a health board to set up a program — meaning fewer public votes and arguments about each proposed exchange. The bill is part of a larger package of “harm reduction” proposals, including a clause that would make it easier to sell syringes at pharmacies.
“My concern is that this is taking away the local control of the local government,” Gonzalez said. “Gov. Polis had specifically stated last year and again this year that he’s supportive of local control — and this would absolutely be taking away local control.”
If HB20-1065 passes, county governments would still have some authority over needle exchanges. Nonprofits would have to get approval from the county health agency before opening. And, ultimately, those agencies do report to the boards of health.
“I don’t think you’re going to see a huge difference between where the public health director might be falling on this issue … versus their employer, the county commissioners,” said Gini Pingenot, legal director for Colorado Counties Inc.
Still advocates hope that career employees will be more receptive than elected officials and others.
“I want this in front of public health officials and people whose job it is to serve the entire public,” Raville said.
Additionally, the bill would allow hospitals to operate syringe exchanges without any county involvement. That could allow doctors to give a patient a pack of clean syringes after treating an overdose or an infection.
Indeed, the idea of syringe exchanges has broad support among medical professionals. The Centers for Disease Control has declared that syringe programs are associated with a 50 percent reduction in the spread of HIV and hepatitis C.
The programs can also provide training and supplies to prevent overdoses; and because they offer referrals to drug treatment, their clients are three times more likely to stop using drugs, the CDC reported.
“Syringe exchange is an evidence-based practice that decreases harm,” said Dr. Bernard Birnbaum, a health board member in Larimer County and the associate director for family residency at Poudre Valley Hospital, who also works in addiction treatment.
“I think it is really antiquated to have a board of health, which is usually made up of community members as much as health professionals, making a determination about whether or not it’s a good, evidence-based project. It’s really clear that it’s a national recommendation.”
Often, he said, the opposition is driven by ideas about personal responsibility. Syringe exchanges are seen as facilitating an illegal activity.
Gonzalez, the county commissioner, is concerned that syringe exchanges could attract higher crime rates to an area, he said. The CDC reports that studies have found stable crime rates. But Gonzalez said that the research he’s seen is inconclusive and not applicable to Colorado, offering a critique of studies published in the American Journal of Public Health and the Journal of Acquired Immune Deficiency Syndromes.
“I have done the research, and the research doesn’t come back supporting their arguments. The data that they’ve generally used is 20 years old, and does not use local Colorado comparative data,” he said.
His concerns included the studies’ use of statistical significance calculations to discount some indicators of higher crime near exchanges, and the existence of other studies that found mixed results.
Gonzalez is asking that Pettersen and other sponsors amend their bill to preserve local control. In contrast, the Colorado Association of Local Public Health Officials is supportive of the bill, saying that syringe access programs will still be adequately monitored.
The question of the counties is only one small part of a larger package of bills aimed at harm reduction. Other proposed bills would, among other changes:
- Require insurers to provide coverage for substance use disorders and for overdose reversal drugs
- Clarify that pharmacists can sell clean syringes
- Increase funding for treatment, research and support