Kim Botteicher, founder and government director of FAVOR ~ Western PA, runs the nonprofit out of the basement of an previous church constructing in Bolivar, Pa. In addition to offering numerous habit and restoration help companies, she want to hand out clear syringes to assist forestall illness transmission. But doing that is not licensed beneath state regulation.

Nate Smallwood

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Nate Smallwood

Kim Botteicher, founder and government director of FAVOR ~ Western PA, runs the nonprofit out of the basement of an previous church constructing in Bolivar, Pa. In addition to offering numerous habit and restoration help companies, she want to hand out clear syringes to assist forestall illness transmission. But doing that is not licensed beneath state regulation.

Nate Smallwood

Kim Botteicher hardly thinks of herself as a prison.

On the primary flooring of a former Catholic church in Bolivar, Pennsylvania, Botteicher runs a flower store and cafe.

In the church’s basement, she additionally operates a nonprofit centered on serving to individuals caught up within the ongoing drug epidemic get again on their ft.

Botteicher based the nonprofit, FAVOR ~ Western PA, on this rural pocket of the Allegheny Mountains, east of Pittsburgh.

For every of the previous a number of years, the nonprofit’s dwelling county of Westmoreland has seen greater than 100 drug overdose deaths, the bulk involving fentanyl.

Thousands extra within the area have been touched by the scourge of habit, which is the place Botteicher is available in.

She helps individuals discover housing, jobs, and well being care, and works with households by working help teams and explaining that substance use dysfunction is a illness, not an ethical failing.

But she has additionally talked publicly about how she has made sterile syringes available to people who use drugs.

“When that person comes in the door,” she mentioned, “if they are covered with abscesses because they have been using needles that are dirty, or they’ve been sharing needles, maybe they’ve got Hep C, we see that as, ‘Okay, this is our first step.'”

The confirmed well being advantages of syringe exchanges

Many studies have recognized public health benefits related to syringe-exchange companies. The Centers for Disease Control and Prevention says these applications reduce HIV and hepatitis C infections, and that new customers of the applications usually tend to enter drug therapy and extra prone to cease utilizing medication.

Supplies for a clear syringe package are seen at FAVOR ~ Western PA, a nonprofit restoration heart in Bolivar, Pa., on Nov. 7, 2023.

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Supplies for a clear syringe package are seen at FAVOR ~ Western PA, a nonprofit restoration heart in Bolivar, Pa., on Nov. 7, 2023.

Nate Smallwood

This harm-reduction technique is supported by main well being teams, such because the American Medical Association, the World Health Organization, and the International AIDS Society.

But for Botteicher, offering clear syringes may put her in authorized hazard. Under Pennsylvania regulation, it is a misdemeanor crime to distribute drug paraphernalia. The state’s definition contains hypodermic syringes, needles, and different objects used for injecting banned medication.

Those engaged on the entrance strains of the epidemic, like Botteicher, say a re-examination of this regulation is lengthy overdue.

There’s an urgency to the problem as nicely: Billions of {dollars} have begun flowing into Pennsylvania and different states from authorized settlements with corporations concerned within the opioid epidemic, and syringe companies are among the many eligible interventions that may very well be supported by that cash.

Syringe companies in Pennsylvania: important and unauthorized

Included within the opioid settlements reached between drug corporations and distributors, and a coalition of state attorneys normal, have been recommended strategies for spending the cash, together with applications described as evidence-based. Expanding syringe companies is listed as one of many core methods.

An indication greets drivers arriving in Bolivar, Pennsylvania, in rural Westmoreland county. For the previous a number of years, the county has skilled greater than 100 drug overdose deaths a 12 months, the bulk involving fentanyl.

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An indication greets drivers arriving in Bolivar, Pennsylvania, in rural Westmoreland county. For the previous a number of years, the county has skilled greater than 100 drug overdose deaths a 12 months, the bulk involving fentanyl.

Nate Smallwood

But in Pennsylvania, the place 5,158 individuals died from a drug overdose in 2022, the state’s drug paraphernalia regulation stands in the way in which.

Concerns over Botteicher’s work with syringe companies just lately led Westmoreland County officers to cancel $150,000 in opioid settlement funds that they had beforehand authorized for her nonprofit. County Commissioner Douglas Chew defended the choice by saying the county “is very risk-averse.”

Botteicher had deliberate to make use of the cash to rent extra restoration specialists, not on syringes, she says. Supporters of syringe companies level to this incident as proof of the necessity to change state regulation, particularly given the suggestions of settlement paperwork.

“It’s just a huge inconsistency,” mentioned Zoe Soslow, who leads overdose prevention work in Pennsylvania for the general public well being group Vital Strategies. “It’s causing a lot of confusion.”

Pennsylvania is certainly one of 12 states that don’t implicitly or explicitly authorize syringe companies applications by way of statute or regulation, in accordance with a recent analysis.

Though sterile syringes might be purchased from pharmacies without a prescription, handing out free ones to make drug use safer is usually thought-about unlawful — or no less than in a grey space — in many of the state. (In Pennsylvania’s two largest cities, Philadelphia and Pittsburgh, officers have used native well being powers to offer authorized safety to individuals who function syringe companies applications.)

In Philadelphia, Mayor Cherelle L. Parker, who took workplace in January, has made it clear she opposes utilizing opioid settlement cash, or every other metropolis funds, to pay for the distribution of fresh needles, in accordance with reporting by The Philadelphia Inquirer. This transfer alerts a major shift in that metropolis’s strategy to the opioid epidemic.

Kim Botteicher organizes provides with coworker David Peightal within the church basement workplaces of FAVOR ~ Western PA in Bolivar, Pa. The nonprofit helps households combating habit discover housing, jobs, and different restoration helps.

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Kim Botteicher organizes provides with coworker David Peightal within the church basement workplaces of FAVOR ~ Western PA in Bolivar, Pa. The nonprofit helps households combating habit discover housing, jobs, and different restoration helps.

Nate Smallwood

But on the opposite facet of the state, opioid settlement funds have had a huge impact for Prevention Point Pittsburgh, which final 12 months obtained $325,000 in settlement funds from Allegheny County to help its syringe companies work.

“It was absolutely incredible to not have to fundraise every single dollar for the supplies that go out,” mentioned Prevention Point’s government director, Aaron Arnold. “It takes a lot of energy. It pulls away from actual delivery of services when you’re constantly having to find out, ‘Do we have enough money to even purchase the supplies that we want to distribute?'”

In elements of Pennsylvania that lack these authorized protections, individuals generally function underground syringe applications.

A road in Bolivar in Pennsylvania’s Westmoreland County, on Nov. 7, 2023. More than 5,000 Pennsylvanians died from a drug overdose in 2022 — 118 of these deaths have been in Westmoreland County.

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A road in Bolivar in Pennsylvania’s Westmoreland County, on Nov. 7, 2023. More than 5,000 Pennsylvanians died from a drug overdose in 2022 — 118 of these deaths have been in Westmoreland County.

Nate Smallwood

The Pennsylvania regulation banning drug paraphernalia was by no means supposed to use to syringe companies, argues Scott Burris, director of the Center for Public Health Law Research at Temple University. But there haven’t been court docket circumstances in Pennsylvania to make clear the problem, and the failure of the legislature to behave creates a “chilling effect,” he mentioned.

Carla Sofronski, government director of the Pennsylvania Harm Reduction Network, mentioned she’s not conscious of anybody ever going through prison fees for doing so within the state, however famous the menace hangs over them, and they’re taking a “great risk.”

Widespread want outdoors the largest cities

Three Pennsylvania counties — Cambria, Crawford, and Luzerne — have been flagged amongst 220 counties in a nationwide evaluation of communities probably susceptible to the fast unfold of HIV and new or persevering with excessive charges of hepatitis C infections amongst individuals who inject medication. The evaluation from the CDC was published in 2016.

Luzerne County resident Kate Favata mentioned she began utilizing heroin in her late teenagers and would not be alive in the present day if it weren’t for the help and neighborhood she discovered at a syringe companies program in Philadelphia.

“It kind of just made me feel like I was in a safe space. And I don’t really know if there was like a come-to-God moment or come-to-Jesus moment,” she mentioned. “But … I just wanted better.”

Favata is now in long-term restoration and works for a medication-assisted treatment program.

Kim Botteicher based FAVOR ~ Western PA, a restoration heart in in Bolivar, Pa. FAVOR stands for Faces and Voices of Recovery.

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Kim Botteicher based FAVOR ~ Western PA, a restoration heart in in Bolivar, Pa. FAVOR stands for Faces and Voices of Recovery.

Nate Smallwood

At a clinic in Cambria County, Highlands Health supplies free and charitable medical care. Despite the authorized danger, the group has operated a syringe program for a number of years, whereas additionally testing sufferers for infectious illnesses, distributing overdose-reversal remedy, and providing restoration choices.

Rosalie Danchanko, Highlands Health’s government director, mentioned she hopes opioid settlement cash can ultimately help her group.

“Why shouldn’t that wealth be spread around for all organizations that are working with people affected by the opioid problem?” she requested.

New efforts to vary state regulation

In February, laws to legalize syringe companies in Pennsylvania was authorized by a committee and has moved ahead. Democratic Gov. Josh Shapiro’s administration helps the laws. But it faces an unsure future within the full legislature, the place Democrats have a slim majority within the House, and Republicans management the Senate.

The invoice’s lead sponsor, state Rep. Jim Struzzi, hasn’t all the time supported syringe companies. But the Republican from western Pennsylvania says that since his brother died from a drug overdose in 2014, he is come to raised perceive the character of habit.

During the committee vote, most of Struzzi’s Republican colleagues opposed the invoice. State Rep. Paul Schemel mentioned authorizing the “very instrumentality of abuse” crossed a line for him and “would be enabling an evil.”

After the vote, Struzzi’s objective is to construct extra bipartisan help. He famous that a few of his personal skepticism concerning the applications solely eased after he visited Prevention Point Pittsburgh, and noticed how staff do extra than simply hand out syringes. These sorts of applications join individuals to assets — overdose reversal remedy, wound care, substance use therapy, and different companies— that may save lives and result in restoration.

“A lot of these people are … desperate, they’re alone, they’re afraid. And these programs bring them in to someone who cares,” Struzzi mentioned. “And that to me is a step in the right direction.”

Botteicher is hoping lawmakers take motion.

“If it’s something that’s going to help someone, then why is it illegal?” she mentioned. “It just doesn’t make any sense to me.”

This story was co-reported by WESA Public Radio and Spotlight PA, an unbiased, nonpartisan, and nonprofit newsroom producing investigative and public-service journalism that holds energy to account and drives constructive change in Pennsylvania.

It was produced as a part of NPR’s well being reporting partnership with KFF Health News.