According to the CDC, 3 Pennsylvania counties are most at risk for HIV and Hepatitis C outbreaks (out of 220 of the most at risk United States counties) as a result of the opioid epidemic.
These vulnerable counties, among the top 5 percent of counties in the nation, include Luzerne County (38th), Cambria County (131st), and Crawford County (188th).
The link between opioids and viral outbreaks comes from misusing injectable pain relievers, such as oxymorphone (also known as Opana). In the words of the National Institute on Drug Abuse, “people who inject drugs frequently share their needles and other injection equipment, enabling viruses such as HIV and hepatitis C (HCV) to spread between people.”
The non-profit amfAR (The Foundation for AIDS Research) reported that 85 percent of Pennsylvanians with opioid addiction were not receiving treatment in 2014. As of 2019, more than 159,000 of Pennsylvania Medicaid recipients are receiving medication-assisted treatment, or MAT.
Currently, the rate of Pennsylvania opioid overdose deaths is higher than the national average.
In 2019, approximately 25 per 100,000 people died of opioid overdose in Pennsylvania, according to the Kaiser Family Foundation (KFF), a health non-profit. The national rate in 2019 was 15.5 per 100,000 people.
From 2015 to 2018, OverdoseFreePA reported that overdoses from fentanyl increased sharply from 26.59 percent of all overdose deaths in Pennsylvania to 69.92 percent. Within the same timespan, overdose deaths by cocaine, fentanyl-related substances (FRSs), and non-prescription synthetic opioids (NPSOs) also increased (23.66 to 32.60 percent for cocaine, 3.72 to 22.62 for FRSs & NPSOs). Also within that same timeframe, overdose deaths by heroin, benzodiazepines, and prescription opioids decreased.
The majority of these deaths, as shown by KFF data in 2019, occurred in ages 25-34 at 28 percent (859 deaths), followed by ages 35-44 at 27 percent (811 deaths) and ages 45-54 at 21 percent (627 deaths). National percentages are lower at 27, 25, and 20 percent within each respective age category.
According to amfAR, “several policies can mitigate the impact of increased opioid use.” These measures include “the operation of syringe exchange programs, good samaritan laws that provide legal protections to bystanders who call for help in the event of an overdose, and state Medicaid coverage of methadone for the treatment of opioid use disorder.”
Governor Tom Wolf expanded Medicaid in 2015, giving more Pennsylvanians access to healthcare and MAT, including “people living on low incomes, people who had been diagnosed with substance use disorder, and others,” as reported by OpenData PA.
As of 2022, there are 7 official syringe exchange programs in Pennsylvania (out of 414 in the US) that provide access to sterile needles and syringes, facilitate safe disposal of used syringes, and screenings, care, and treatment for HIV and Hepatitis C.
Philadelphia County and Allegheny County lead the state at 3 programs and 1 program, respectively. Both counties reported having the highest concentrations of individuals in the state with drug use disorders in 2019, and the highest number of accidental or undetermined overdose deaths in the state from 2012 to present, according to OpenData PA.
In the 3 most vulnerable counties for HIV and Hepatitis C outbreaks, Luzerne, Cambria, and Crawford County, none have syringe exchange programs established.
Though syringe exchange programs have been deemed a “life-saving” service by the Department of Health, they are technically illegal statewide, with the exceptions of Philadelphia and Pittsburgh due to local ordinances. Bills to legalize these programs have been introduced in the Pennsylvania legislature, but none have passed.
An estimated 20 community-run syringe programs operate statewide, a number of which provide services outside of state law.
“We take running syringe service sites as seriously as hospitals take running emergency departments,” said Arnold of Prevention Point Pittsburgh, the only legal syringe exchange program outside of Philadelphia. “Hopefully people will start seeing us as a critical part of the health care infrastructure — pandemic or no pandemic.”