Clean needles save lives. They may be illegal in some states.

Kim Botteicher doesn’t really consider herself a criminal.

Botteicher runs a flower shop and café on the ground floor of a former Catholic church in Bolivar, Pennsylvania.

In the basement of the former church, he also runs a non-profit organization whose goal is to assist people affected by the drug epidemic get back on their feet.

non-profit organization, LOVE Western Pennsylvania, is located in the rural Allegheny Mountains east of Pittsburgh. Westmoreland County, where her organization is based, has seen more or less 100 or more drug overdose deaths every year for the last few years, most of them involving fentanyl.

The plague of addiction has affected thousands of people in the region, and this is where Botteicher comes to the rescue.

It helps people find housing, jobs and health care, and works with families to run support groups and explain that substance apply disorder is a disease, not a moral failing.

But she also spoke publicly about what she achieved sterile syringes available people using drugs.

“When that person walks in the door,” she said, “if it’s covered in abscesses because they used dirty needles or shared needles — maybe they have the hepatitis C virus — we see that as, ‘OK, this is our first step.’

The research have shown public health benefits related to syringe exchange services. The Centers for Disease Control and Prevention says these programs reduce the risk of HIV infection and hepatitis C infections and that new users of programs are more likely to enter drug treatment and stop using drugs than those not participating in the programs.

This harm reduction strategy is supported by leading health groups such as American Medical Association, World Health ORganisationand International AIDS Society.

However, providing clean syringes could put Botteicher in legal jeopardy. Under Pennsylvania law, distribution of drug paraphernalia is a misdemeanor. The state definition includes hypodermic syringes, needles and other items used to inject prohibited drugs. According to a U.S. study, Pennsylvania is one of 12 states that do not implicitly or explicitly allow syringe services programs through statute or regulation. 2023 Analysis. Several of these states, with the exception of Pennsylvania, either have no state drug paraphernalia law or do not cover syringes.

People working on the front lines of the opioid epidemic, like Botteicher, say a reexamination of Pennsylvania’s law is long overdue.

The issue is also urgent: billions of dollars started to flow to Pennsylvania and other states from legal settlements with companies over their role in the opioid epidemic, and syringe services are among the eligible interventions that could be supported by this money.

The opioid agreements reached between pharmaceutical companies and distributors and the coalition of attorneys general included a list of: spending recommendations money. Expanding syringe services is cited as one of the main strategies.

But in Pennsylvania, where 5,158 people died from drug overdoses in 2022, state drug paraphernalia laws stand in the way.

Concerns about Botteicher’s cooperation with syringe services recently prompted Westmoreland County officials cancel the $150,000 allocation in the opioid settlement funds they had previously approved for her organization. County Commissioner Douglas Chew defended the decision, stating that the county “is highly risk averse.”

Botteicher said her organization planned to use the money to hire additional recovery specialists, not to purchase syringes. Supporters of syringe services point to the cancellation of subsidies as evidence of the need to change state law, especially considering the recommendations of the settlement documents.

“It’s just a huge inconsistency,” said Zoe Soslow, who leads Pennsylvania’s overdose prevention efforts for the public health organization Key strategies. “It causes a lot of confusion.”

Sterile syringes though can be purchased in pharmacies over the counter, handing out free drugs to make drug apply safer is widely considered illegal – or at least in a legal gray area – in most of the state. In two of Pennsylvania’s largest cities Philadelphia AND Pittsburghofficials used local health powers to provide legal protections for people operating syringe services programs.

Still, Philadelphia Mayor Cherelle Parker, who took office in January, has made clear she opposes using opioid settlement money or any city funds to pay for the distribution of spotless needles, The Philadelphia Inquirer reported. Parker’s stance signals a fundamental shift in the city’s approach to the opioid epidemic.

On the other side of the state, opioid settlement funds have had a major impact Prevention Point in Pittsburghharm reduction organization. Allegheny County said spent or contributed $325,000 in settlements at the end of last year to support the organization’s work on sterile syringes and other items to make drug apply safer.

“It was absolutely amazing not to have to raise every dollar for depleted supplies,” said Prevention Point executive director, Aaron Arnold. “It takes a lot of energy. It gets distracted from actually providing services when you constantly have to wonder, “Do we have enough money to even buy the materials we want to distribute?”

In parts of Pennsylvania that lack such legal protections, people sometimes run underground syringe programs.

According to him, Pennsylvania’s law prohibiting drug paraphernalia was never intended to apply to syringe services Scott Burrisdirector of Public Health Law Research Center at Temple University. But there have been no pending court cases in Pennsylvania on the issue, and the Legislature’s lack of action is having a chilling effect, he added.

Carla Sofronski, executive director of Pennsylvania Harm Reduction Networkstated that she was not aware of anyone who had faced criminal charges for providing syringe services in the state, but noted that a threat loomed over those who did so and that they were taking “a great risk.”

In 2016 The CDC identified three Pennsylvania counties — Cambria, Crawford and Luzerne — among 220 counties nationwide in an assessment of communities potentially at risk for the rapid spread of HIV and for new or continuing high rates of hepatitis C infection among people who inject drugs.

Kate Favata, a Luzerne County resident, said she started using heroin as a teenager and would not be alive today if it weren’t for the support and community she found through the Philadelphia Syringe Services Program.

“It just made me feel like I was in a safe space. And I don’t really know if it was a moment of coming to God or a moment of coming to Jesus,” she said. “I just wanted better.”

Favata is currently undergoing long-term rehabilitation and works for: medication-assisted treatment program.

At clinics in Cambria and Somerset counties Upland Health provides free or low-cost medical care. Despite the legal risks, the organization has operated a syringe program for several years while also screening patients for infectious diseases, distributing overdose reversal drugs and offering recovery opportunities.

Rosalie Danchenko, executive director of Highlands Health, said she hopes the opioid settlement money will ultimately support her organization.

“Why shouldn’t this asset be distributed to all organizations working with people affected by the opioid problem?” she asked.

In February, legislation legalizing syringe services in Pennsylvania was approved by committee and moved forward. The administration of Gov. Josh Shapiro, a Democrat, supports the legislation. But her future is uncertain in a full term, with Democrats holding a slim majority in the House and Republicans controlling the Senate.

One of the bills main sponsorscountry Representative. Jim Struzzi, has not always supported syringe services. But the western Pennsylvania Republican said that since his brother died of a drug overdose in 2014, he has a better understanding of the nature of addiction.

In committee votealmost all of Struzzi’s Republican colleagues opposed the bill. State Representative Paweł Schemel he stated that allowing “the very instrument of violence” crossed the line in his case and “would enable evil.”

After the vote, Struzzi said he wanted to build more bipartisan support. He noted that some of his skepticism about the programs lessened only after visiting Prevention Point Pittsburgh and seeing employees do more than just hand out syringes. These types of programs give people access to resources – overdose reversal drugs, wound care, addiction treatment – that can save lives and lead to recovery.

“A lot of these people are… desperate. They are alone. They are afraid. And through these programs, they go to someone who cares,” Struzzi said. “And that, I think, is a step in the right direction.”

Botteicher, who runs her nonprofit in western Pennsylvania, hopes lawmakers will take action.

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

This story was co-reported by, among others, WESA Public Radio AND PA reflector, An independent, nonpartisan, nonprofit investigative and public service newsroom that holds itself accountable and drives positive change in Pennsylvania.