Clean Needles Save Lives. In Some States, They Might Not Be Legal.
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Kim Botteicher hardly thinks of herself as a criminal.
On the main floor of a former Catholic church in Bolivar, Pennsylvania, Botteicher runs a flower shop and cafe.
In the former church’s basement, she also operates a nonprofit organization focused on helping people caught up in the drug epidemic get back on their feet.
The nonprofit, FAVOR ~ Western PA, sits in a rural pocket of the Allegheny Mountains east of Pittsburgh. Her organization’s home county of Westmoreland has seen roughly 100 or more drug overdose deaths each year for the past several years, the majority involving fentanyl.
Thousands more residents in the region have been touched by the scourge of addiction, which is where Botteicher comes in.
She helps people find housing, jobs, and health care, and works with families by running support groups and explaining that substance use disorder is a disease, not a moral failing.
But she has also talked publicly about how she has made sterile syringes available to people who use drugs.
“When that person comes in the door,” she said, “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, ‘OK, this is our first step.’”
Studies have identified public health benefits associated with syringe exchange services. The Centers for Disease Control and Prevention says these programs reduce HIV and hepatitis C infections, and that new users of the programs are more likely to enter drug treatment and more likely to stop using drugs than nonparticipants.
This harm-reduction strategy is supported by leading health groups, such as the American Medical Association, the World Health Organization, and the International AIDS Society.
But providing clean syringes could put Botteicher in legal danger. Under Pennsylvania law, it’s a misdemeanor to distribute drug paraphernalia. The state’s definition includes hypodermic syringes, needles, and other objects used for injecting banned drugs. Pennsylvania is one of 12 states that do not implicitly or explicitly authorize syringe services programs through statute or regulation, according to a 2023 analysis. A few of those states, but not Pennsylvania, either don’t have a state drug paraphernalia law or don’t include syringes in it.
Those working on the front lines of the opioid epidemic, like Botteicher, say a reexamination of Pennsylvania’s law is long overdue.
There’s an urgency to the issue as well: Billions of dollars have begun flowing into 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 that money.
The opioid settlements reached between drug companies and distributors and a coalition of state attorneys general included a list of recommendations for spending the money. Expanding syringe services is listed as one of the core strategies.
But in Pennsylvania, where 5,158 people died from a drug overdose in 2022, the state’s drug paraphernalia law stands in the way.
Concerns over Botteicher’s work with syringe services recently led Westmoreland County officials to cancel an allocation of $150,000 in opioid settlement funds they had previously approved for her organization. County Commissioner Douglas Chew defended the decision by saying the county “is very risk averse.”
Botteicher said her organization had planned to use the money to hire additional recovery specialists, not on syringes. Supporters of syringe services point to the cancellation of funding as evidence of the need to change state law, especially given the recommendations of settlement documents.
“It’s just a huge inconsistency,” said Zoe Soslow, who leads overdose prevention work in Pennsylvania for the public health organization Vital Strategies. “It’s causing a lot of confusion.”
Though sterile syringes can be purchased from pharmacies without a prescription, handing out free ones to make drug use safer is generally considered illegal — or at least in a legal gray area — in most of the state. In Pennsylvania’s two largest cities, Philadelphia and Pittsburgh, officials have used local health powers to provide legal protection to people who operate syringe services programs.
Even so, in Philadelphia, Mayor Cherelle Parker, who took office in January, has made it clear she opposes using opioid settlement money, or any city funds, to pay for the distribution of clean needles, The Philadelphia Inquirer has reported. Parker’s position signals a major shift in that city’s approach to the opioid epidemic.
On the other side of the state, opioid settlement funds have had a big effect for Prevention Point Pittsburgh, a harm reduction organization. Allegheny County reported spending or committing $325,000 in settlement money as of the end of last year to support the organization’s work with sterile syringes and other supplies for safer drug use.
“It was absolutely incredible to not have to fundraise every single dollar for the supplies that go out,” said Prevention Point’s executive 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 parts of Pennsylvania that lack these legal protections, people sometimes operate underground syringe programs.
The Pennsylvania law banning drug paraphernalia was never intended to apply to syringe services, according to Scott Burris, director of the Center for Public Health Law Research at Temple University. But there have not been court cases in Pennsylvania to clarify the issue, and the failure of the legislature to act creates a chilling effect, he said.
Carla Sofronski, executive director of the Pennsylvania Harm Reduction Network, said she was not aware of anyone having faced criminal charges for operating syringe services in the state, but she noted the threat hangs over people who do and that they are taking a “great risk.”
In 2016, the CDC flagged three Pennsylvania counties — Cambria, Crawford, and Luzerne — among 220 counties nationwide in an assessment of communities potentially vulnerable to the rapid spread of HIV and to new or continuing high rates of hepatitis C infections among people who inject drugs.
Kate Favata, a resident of Luzerne County, said she started using heroin in her late teens and wouldn’t be alive today if it weren’t for the support and community she found at a syringe services 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 said. “I just wanted better.”
Favata is now in long-term recovery and works for a medication-assisted treatment program.
At clinics in Cambria and Somerset Counties, Highlands Health provides free or low-cost medical care. Despite the legal risk, the organization has operated a syringe program for several years, while also testing patients for infectious diseases, distributing overdose reversal medication, and offering recovery options.
Rosalie Danchanko, Highlands Health’s executive director, said she hopes opioid settlement money can eventually support her organization.
“Why shouldn’t that wealth be spread around for all organizations that are working with people affected by the opioid problem?” she asked.
In February, legislation to legalize syringe services in Pennsylvania was approved by a committee and has moved forward. The administration of Gov. Josh Shapiro, a Democrat, supports the legislation. But it faces an uncertain future in the full legislature, in which Democrats have a narrow majority in the House and Republicans control the Senate.
One of the bill’s lead sponsors, state Rep. Jim Struzzi, hasn’t always supported syringe services. But the Republican from western Pennsylvania said that since his brother died from a drug overdose in 2014, he has come to better understand the nature of addiction.
In the committee vote, nearly all of Struzzi’s Republican colleagues opposed the bill. State Rep. Paul Schemel said authorizing the “very instrumentality of abuse” crossed a line for him and “would be enabling an evil.”
After the vote, Struzzi said he wanted to build more bipartisan support. He noted that some of his own skepticism about the programs eased only after he visited Prevention Point Pittsburgh and saw how workers do more than just hand out syringes. These types of programs connect people to resources — overdose reversal medication, wound care, substance use treatment — that can save lives and lead to recovery.
“A lot of these people are … desperate. They’re alone. They’re afraid. And these programs bring them into someone who cares,” Struzzi said. “And that, to me, is a step in the right direction.”
At her nonprofit in western Pennsylvania, Botteicher is hoping lawmakers take action.
“If it’s something that’s going to help someone, then why is it illegal?” she said. “It just doesn’t make any sense to me.”
This story was co-reported by WESA Public Radio and Spotlight PA, an independent, nonpartisan, and nonprofit newsroom producing investigative and public-service journalism that holds power to account and drives positive change in Pennsylvania.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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It Didn’t Start with You – by Mark Wolynn
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There is a trend in psychology to “blame the parents” for “childhood trauma” that can result in problems later in life. Sometimes fairly, sometimes not. This book’s mostly not about that.
It does touch on our own childhood trauma, if applicable. But mostly, it’s about epigenetic trauma inheritance. In other words, not just trauma that’s passed on in terms of “the cycle of abuse”, but trauma that’s passed on in terms of “this generation experienced trauma x, developed trauma response y, encoded it epigenetically, and passed it on to their offspring”.
So, how does one heal from a trauma one never directly experienced, and just inherited the response to it? That’s what most of this book is about, after establishing how epigenetic trauma inheritance works.
The author, a therapist, provides practical advice for how to do the things that can be done to rewrite the epigenetic code we inherited. Better late than never!
Bottom line: it is well-established that trauma is inheritable. But unlike one’s eye color or the ability to smell asparagus metabolites in urine, we can rewrite epigenetic things, to a degree. This book explains how.
Click here to check out It Didn’t Start With You, and put things to rest!
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Missing Microbes – by Dr. Martin Blaser
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You probably know that antibiotic resistance is a problem, but you might not realize just what a many-headed beast antibiotic overuse is.
From growing antibiotic superbugs, to killing the friendly bacteria that normally keep pathogens down to harmless numbers (resulting in death of the host, as the pathogens multiply unopposed), to multiple levels of dangers in antibiotic overuse in the farming of animals, this book is scary enough that you might want to save it for Halloween.
But, Dr. Blaser does not argue against antibiotic use when it’s necessary; many people are alive because of antibiotics—he himself recovered from typhoid because of such.
The style of the book is narrative, but information-dense. It does not succumb to undue sensationalization, but it’s also far from being a dry textbook.
Bottom line: if you’d like to understand the real problems caused by antibiotics, and how we can combat that beyond merely “try not to take them unnecessarily”, this book is very worthy reading.
Click here to check out Missing Microbes, and learn more about yours!
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Self-Care That’s Not Just Self-Indulgence
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Self-Care That’s Not Just Self-Indulgence
Self-care is often seen as an excuse for self-indulgence. Worse, it’s often used as an excuse for self-indulgence—in ways that can end up making us feel worse.
It’s a bit like dietary “cheat days”. If your diet needs cheat days, your diet probably isn’t right for you!
How to recognize the difference between self-care and self-indulgence?
Statistically, the majority of our subscribers are parents (whose children are now mostly grown up, but still, the point is that parenting experience has been gleaned), and/or are or have been caregivers of some form or other.
When a small child is ill, we (hopefully!) look after them carefully:
- We don’t expect too much of them, but…
- …we do expect them to adhere to things consistent with their recovery.
Critically: an important part of self-care is that it actually should be care.
Let’s spell something out: neglect is not care!
How this works for physical and mental health
If you overdo it in physical exercise, it’s right and correct to take a break to recover, and during that time, do things that will hasten one’s recovery. For example:
Overdone It? How To Speed Up Recovery After Exercise
But it’s well-known that if you just do nothing, your condition will likely deteriorate. Also, “a break to recover” is going to be as short as is necessary to recover. Then you’ll ease back into exercise, but you will get back to it.
For mental health it’s just the same. If we for whatever reason need to take a step back, it’s right and correct to do take a break to recover, and during that time, do things that will hasten one’s recovery.
Sometimes, if for example it’s just a case of burnout, rest is the best medicine, and even rest can be an active process. See for example:
How To Rest More Efficiently (Yes, Really)
So the question to ask, when it comes to self-care vs self-indulgence, is:
“Is this activity helping me to get better?”
Some examples:
Probably not great self-care activities:
- Oversleeping (unless you were sleep-deprived, in which case, it’s better to get an earlier night than a later morning, if possible)
- Overeating (comfort-eating is a thing, but your actual problems will still be there)
- Mindless activities (mindless scrolling, TV-watching, game-playing, etc)
Probably better self-care activities:
- Enjoyable physical activity (whatever that may be for you)
- Preparing your favorite food, and then enjoying it mindfully
- Engaging in a personal project that might not be that important, but it’s fulfilling to you (hobbies etc can fall into this category)
- Scheduling some time, and committing some resources, to tackling whatever problem(s) you are facing that’s prompting you to need this self-care.
- Doing the tasks you want to hide away from, but making them fun.
What’s your go-to self-care? We love to hear from you, so feel free to hit “reply” to this email, or use the handy feedback form at the bottom!
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Synergistic Brain-Training
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Let The Games Begin (But It Matters What Kind)
Exercise is good for brain health; we’ve written about this before, for example:
How To Reduce Your Alzheimer’s Risk ← there are many advices here, but exercise, especially cardiovascular exercise in this case, is an important item on the list!
Today it’s Psychology Sunday though, and we’re going to talk about looking after brain health by means of brain-training, via games.
“Brain-training” gets a lot of hype and flak:
- Hype: do sudoku every day and soon you will have an IQ of 200 and still have a sharp wit at the age of 120
- Flak: brain-training is usually training only one kind of cognitive function, with limited transferability to the rest of life
The reality is somewhere between the two. Brain training really does improve not just outwardly measurable cognitive function, but also internally measurable improvements visible on brain scans, for example:
- Cognitive training modified age-related brain changes in older adults with subjective memory decline
- Functional brain changes associated with cognitive training in healthy older adults: A preliminary ALE meta-analysis
But what about the transferability?
Let us play
This is where game-based brain-training comes in. And, the more complex the game, the better the benefits, because there is more chance of applicability to life, e.g:
- Sudoku: very limited applicability
- Crosswords: language faculties
- Chess: spatial reasoning, critical path analysis, planning, memory, focus (also unlike the previous two, chess tends to be social for most people, and also involve a lot of reading, if one is keen)
- Computer games: wildly varied depending on the game. While an arcade-style “shoot-em-up” may do little for the brain, there is a lot of potential for a lot of much more relevant brain-training in other kinds of games: it could be planning, problem-solving, social dynamics, economics, things that mirror the day-to-day challenges of running a household, even, or a business.
- It’s not that the skills are useful, by the way. Playing “Stardew Valley” will not qualify you to run a real farm, nor will playing “Civilization” qualify you to run a country. But the brain functions used and trained? Those are important.
It becomes easily explicable, then, why these two research reviews with very similar titles got very different results:
- A Game a Day Keeps Cognitive Decline Away? A Systematic Review and Meta-Analysis of Commercially-Available Brain Training Programs in Healthy and Cognitively Impaired Older Adults
- Game-based brain training for improving cognitive function in community-dwelling older adults: A systematic review and meta-regression
The first review found that game-based brain-training had negligible actual use. The “games” they looked at? BrainGymmer, BrainHQ, CogMed, CogniFit, Dakim, Lumosity, and MyBrainTrainer. In other words, made-for-purpose brain-trainers, not actual computer games per se.
The second reviewfound that game-based training was very beneficial. The games they looked at? They didn’t name them, but based on the descriptions, they were actual multiplayer online turn-based computer games, not made-for-purpose brain-trainers.
To summarize the above in few words: multiplayer online turn-based computer games outperform made-for-purpose brain-trainers for cognitive improvement.
Bringing synergy
However, before you order that expensive gaming-chair for marathon gaming sessions (research suggests a tail-off in usefulness after about an hour of continuous gaming per session, by the way), be aware that cognitive training and (physical) exercise training combined, performed close in time to each other or simultaneously, perform better than the sum of either alone:
See also:
❝Simultaneous training was the most efficacious approach for cognition, followed by sequential combinations and cognitive training alone, and significantly better than physical exercise.
Our findings suggest that simultaneously and sequentially combined interventions are efficacious for promoting cognitive alongside physical health in older adults, and therefore should be preferred over implementation of single-domain training❞
~ Dr. Hanna Malmberg Gavelin et al.
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This Week In Brain News
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While reading this week’s health news, we’ve singled out three brain-related articles to feature here:
Bad breath now, bad brain later?
Researchers found links between oral microbiome populations, and changes in brain function with aging. The short version is indeed “bad breath now = bad brain later”, but more specifically:
- People who had large numbers of the bacteria groups Neisseria and Haemophilus had better memory, attention and ability to do complex tasks
- People who had higher levels of Porphyromonas had more memory problems later
- People with a lot of Prevotella tended to predict poorer brain health and was more common in people who carry the Alzheimer’s Disease risk gene, APOE4.
If you’ve never heard of half of those, don’t worry: mostly your oral microbiome can take care of itself, provide you consistently do the things that create a “good” oral microbiome. So, see our “related” link below:
Read in full: Mouth bacteria may hold insight into your future brain function
Related: Improve Your Oral Microbiome
Weeding out a major cause of cognitive decline
Cannabis may be great for relaxation, but regular use is not great for mental sharpness, and recent use (even if not regular, and even if currently sober) shows a similar dip in cognitive abilities, especially working memory. In other words, cannabis use for relaxation should be at most an occasional thing, rather than an everyday thing.
While the results of the study are probably not shocking, something that we found interesting was their classification system:
❝Heavy users are considered young adults who’ve used cannabis more than 1000 times over their lifetime. Whereas, using 10 to 999 times was considered a moderate user, and fewer than 10 times was considered a non-user.❞
Which—while being descriptive rather than prescriptive in nature—suggests that, to be on the healthy end of the bell curve, an occasional cannabis-user might want to consider “if you have 999 uses before you hit the “heavy user” category, project those 999 uses against your life expectancy, and moderate your use accordingly”. In other words, a person just now starting use, who expects to live another 40 years, would calculate: 999/40 = 24.9 uses per year, so call it 2 per month. A person who only expects to live another 20 years, would do the same math and arrive at 4 per month.
Disclaimer: the above is intended as an interesting reframe, and a way of looking at long-term cannabis use while being mindful of the risks. It is not intended as advice. This health-conscious writer personally has no intention of using at all, unless perhaps in some bad future scenario in which I have bad chronic pain, I might consider that pain relief effects may be worth the downsides. Or I might not; I hope not to be in the situation to find out!
Read in full: Largest study ever done on cannabis and brain function finds impact on working memory
Related: Cannabis Myths vs Reality
Mind-reading technology improves again
We’ve come quite a way from simple 1/0 reads, and basic cursor control! Now, researchers have created a brain decode that can translate a person’s thoughts into continuous text, without requiring the person to focus on words—in other words, it verbalizes the ideas directly. Most recently, the latest upgrade means that while previously, the device had to be trained on an individual brain for many hours, now the training/calibration process takes only an hour:
Read in full: Improved brain decoder holds promise for communication in people with aphasia
Related: Are Brain Chips Safe?
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Are You Making This Alcohol Mistake?
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The famous “small glass of red per day” is, as is quite well-established now in science, but not so much in popular culture, known to be not a good idea.
What most people don’t know
Rethinking “One Drink a Day”:
- Outdated beliefs and flawed studies:
- The idea that “one drink a day is healthy” stems from flawed associative studies that included…
- unhealthy former heavy drinkers in the zero-drinks category, and
- healthy older individuals who continued light drinking due to good health, not because alcohol contributed to it, in the drinkers category
- In other words, they looked at former alcoholics whose health was ruined by drinking and said “aha, non-drinkers have bad health”, and looked at the survivors of survivorship bias and said “aha, light drinking is the key to good health”. Which of course is terrible science propped up by terrible abuse of statistics propped up by shoddy methodology.
- The idea that “one drink a day is healthy” stems from flawed associative studies that included…
- New research findings:
- A 2022 UK Biobank Study showed that even one drink a day leads to brain shrinkage, neuron death, and cognitive decline.
- Another study on CVD disproved the notion that light drinking benefits heart health once confounding variables were removed.
- There are plenty more, and at 10almonds we’ve done a main feature about it, but for now, you get the idea.
Some other things you should know:
Ethanol and acetaldehyde damage neurons responsible for impulse control, judgment, motor coordination, and memory formation, leading to cognitive decline. The feeling of being drunk results from the suppression and damage of these neurons. But while the drunk feeling wears off, the damage to neurons does not.
Alcohol causes cumulative DNA damage in neurons, accelerates brain aging, and prevents the formation of new neurons, similar to a slow, gradual stroke.
Broader Health Impacts of Alcohol
We’ve said it before, and we’ll say it again: alcohol is bad for pretty much everything.
Here are some examples mentioned in the video:
- Neurodegenerative diseases: heavy drinking increases the risk of Alzheimer’s, particularly in those genetically predisposed.
- Sleep disruption: alcohol reduces deep, restful sleep and hampers the brain’s natural detox process overnight, contributing to morning grogginess.
- Inflammation and immune suppression: alcohol increases inflammation, exacerbates autoimmune diseases (like psoriasis and arthritis), and weakens immune function.
- Cancer risk: alcohol is classified as a Group 1 carcinogen by the International Agency for Research on Cancer, linked to various cancers, especially breast cancer. Even light drinking increases breast cancer risk.
- Hormonal imbalances: in women, alcohol heightens PMS symptoms, reduces fertility, and increases testosterone. In men, it lowers sperm quality and disrupts hormones.
For more on all of these and more, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- Can We Drink To Good Health? ← this is mostly about red wine and heart health
- How To Reduce Or Quit Alcohol ← this is about the more general reasons to quit, and how to do so
- What Happens To Your Body When You Stop Drinking Alcohol ← a realistic timeline of recovery
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- Outdated beliefs and flawed studies: