A proposal to loosen restrictions on Delaware’s syringe exchange programs cleared the state Senate's Health and Social Services committee this week.
Delaware first launched syringe exchange programs in 2005, when the strategy intended to stem the spread of Hepatitis C and HIV among intravenous drug users was still relatively contentious. Syringe exchange programs are now a well-established feature of state and local harm reduction campaigns nationwide, but Centers for Disease Control guidance on how they should operate has evolved in the past decade.
State Sen. Marie Pinkney’s bill would bring Delaware’s programs in line with the CDC’s current recommendation that programs provide syringes on an as-needed basis, rather than requiring a one-to-one swap – the current requirement in Delaware, meaning that a client who drops off ten used syringes can only receive one in return.
Pinkney says allowing drug users to pick up as many syringes as they need will lower the risk that they share or reuse needles, especially if the number of doses they use in a week increases or they are passing needles along to users who don’t participate in an exchange program.
“In other words, the higher the distribution rate, the lower the disease transmission rate through the avoidance of sharing used syringes," she said. "Needs-based distribution allows access to the number of syringes needed to ensure a new, sterile syringe is available for each injection.”
According to Delaware's Department of Health and Social Services, exchange programs distributed 34,659 syringes in January 2023 alone — a 40 percent increase over January 2022. The agency expects monthly distribution to reach 45,000 syringes by January 2024.
"One significant challenge is that clients ask for more syringes than we can exchange to stay within our current budget," said James Dowling, the HIV Prevention Program Administrator with the Delaware Division of Public Health. "As Xylazine-laced fentanyl becomes more common in Delaware, users are injecting twice as often and are left with infected wounds on their body because they only have used syringes."
Delaware’s Office of the Controller General estimates that shifting to an as-needed model would entail distributing as many as 1.3 million additional syringes annually at a cost of roughly $100,000.
During the committee hearing on Wednesday, state Sen. Eric Buckson suggested that the state should cap the number of syringes a client can receive to incentivize them to return to service providers more frequently, thereby increasing the likelihood they seek treatment.
In response, Brandywine Counseling and Community Services CEO Lynne Morrison — whose organization offers a syringe exchange program — contended that expanding syringe distribution could help build the relationships needed to help clients recover.
“People are 50 percent more likely to engage in treatment if they participate in a syringe exchange program than those who don’t," she said. "If we have someone who doesn’t have a syringe to return, they can come to us and talk to us when they wouldn’t have before.”
The discussion also offered an opportunity for Morrison to suggest other legislative actions that could increase participation in syringe exchange programs — namely a scaling-back of the state's penalties for possessing syringes. Delaware state law treats syringes as drug paraphernalia, the possession of which is a misdemeanor.
Morrison argued that adjusting the penalties for possessing syringes could also address widespread concerns about the health hazards posed by discarded used syringes.
"One of the main reasons people just discard them is because they fear being caught by law enforcement," she said. "If you're participating in a syringe exchange program and have your ID on you when you get stopped by a police officer, your syringes aren't considered paraphernalia. If you're not in an exchange program, that's not the case, and there's still some confusion among law enforcement. Participants in our program still get charged and we have to clean it up."
The proposed changes to Delaware's syringe exchange rules now head to the Senate Finance Committee.
