Idaho investigation: Before police raided syringe program beneficiary, state reported illegal harm reduction tools

An internal investigation by the Idaho Department of Health and Human Services shows that state funds were likely used to finance the purchase of harm reduction materials that are illegal in the state of Idaho.

This finding follows a raid on two Idaho Harm Reduction Project (IHRP) offices in southern Idaho in February regarding the suspected distribution of drug paraphernalia.

At the time, IHRP was a grantee of the state’s Needle Exchange Program, which operated a safe syringe program and, in its own words, was able to “promote capacity building for other SSPs” through a buprenorphine clinic with low barriers to access.

In response to the raids, the Idaho state legislature repealed the syringe and needle exchange law.

The term “harm reduction” describes a set of tools designed to reduce the immediate negative impacts of drug use, such as overdose deaths and the spread of blood-borne diseases, while providing access to resources and education for people with substance use disorders.

Harm reduction includes materials that enable people to use drugs more safely, such as needle exchange programs, access to the opioid counterdrug naloxone, and drug testing strips that allow users to check whether a substance they plan to use is laced with fentanyl.

Monica Young, human resources manager at Idaho Health and Welfare, prepared the report. Young wrote that Intermountain West Mitigation Conference In September, the IHRP acknowledged during a recorded roundtable discussion that the harm reduction materials it distributed were illegal.

Young also spoke with five other beneficiaries of the Safe Syringe Program.

“These organizations spoke of their partnership with other organizations in their communities and with law enforcement,” she wrote. “They indicated that they did not feel the same disdain for law enforcement as IHRP staff. In addition, the SSPs emphasized that they were confident that their operations were legal.”

Young noted in her report that the Syringe and Needle Exchange Act requires that an entity “may obtain supplies necessary to conduct a syringe and needle exchange program,” but does not provide a definition of authorized “supplies.”

She also noted “a clear disconnect between leadership (of the Division of Public Health, part of Idaho Health and Welfare) and the DPH program staff who run the syringe and needle exchange program.”

Young also described an “unprecedented” level of independence and decision-making by the safe syringe program staff, which she attributed to DPH leadership focusing on the statewide response to the pandemic rather than operational details of the syringe program, which was put in place after the passage of the Syringe and Needle Exchange Act in 2019.

According to Young’s report, syringe program staff understood the law’s purpose of preventing disease transmission and overdose deaths as an indication that other evidence-based harm reduction tools, such as fentanyl test strips and injection alternatives, were appropriate.

The legislature decided to legalize fentanyl test strips this spring after they were previously classified as drug paraphernalia. The new law comes into force on July 1st.

In the meantime, the management of the Department of Public Health has interpreted the law narrowly and only concerns the exchange of syringes and needles.

Young wrote that this discrepancy has led SSP staff to encourage the use of, and in some cases reimburse the purchase of, harm reduction materials, such as fentanyl test strips, injection alternative materials such as pipes and instruction manuals, and “cookers,” which are containers for mixing and heating powdered and solid drugs for injection.

Young also found that in one case, health department employees purchased cookers directly and paid through a Department of Health and Human Services contract with a local printing company to print documents such as “Fentanyl Testing Instructions.”

According to the Centers for Disease Control and Prevention, stoves are often distributed besides syringes in safe syringe programs to prevent the transmission of blood-borne diseases.

Alternatives to injection are considered harm-reducing because they reduce the spread of disease caused by intravenous drugs, reduce damage to veins, and improve opportunities to connect users to treatment resources.

In several cases, the report noted that needle exchange program staff were aware that some safe syringe programs, including the Idaho Harm Reduction Project, offered a variety of other harm reduction tools, but left this to the discretion of individual programs.

According to Young’s report, “DPH program staff did not realize how their communications could constitute support for the purchase and reimbursement of various unapproved harm reduction tools” until it was brought to their attention.

Meanwhile, DPH leadership was unaware that cookers, test strips, injection alternatives, and other resources were being used in the programs or reimbursed by DPH.

Young’s recommendations included determining which shipments would be considered permissible under the law and what funds could be used to purchase or reimburse the items.

Although the law was repealed this year, some MPs said they wanted to reinstate needle exchange with changes to avoid similar problems in the future.

The report also recommended that DPH leadership review its document approval policies and matrix to determine if clarifications, changes and staff training are needed, and provide additional training to staff as needed.

In addition, it is recommended to work towards ensuring appropriate in-kind practices, such as printing and conducting training to maintain the boundary between staff and clients.