SMART Policy Podcast
Podcast by the UT SMART Initiative. Host Jeremy Kourvelas speaks with experts from across the recovery ecosystem - representing healthcare, prevention, law enforcement and more - about local, state and federal drug policy to find out what is and isn't working to make this fight against addiction a little easier.
SMART Policy Podcast
Are More Syringe Service Programs Coming To Rural Tennessee?
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You're listening to the Smart Policy Podcast, a production of the University of Tennessee's Institute for Public Service. Syringe service programs, or SSPs, sometimes called needle exchanges, have been legal in Tennessee for several years now. Studies show that people that use SSPs are five times more likely to enter long-term recovery. But despite the success rate, only ten counties in Tennessee are currently listed as having permanent SSPs. Things like stigma, funding, NIMBYism, and more are barriers, of course. But a major reason for this lack of uptake is because of a law requiring that the SSP be at least 2,000 feet from a school or park.
SPEAKER_00It's a radius. So you take in and you drop that pin and it creates this pretty large circle around it where you could not operate one. And so when we looked at it and we started looking at where we could put one in a metro area, for example, that has a lot more schools, we found that 80% of the Knoxville community was off limits to operate a syringe service program.
SPEAKER_02My guest this month is Karen Pershing, Executive Director of Metro Drug Coalition. In the last legislative session, Karen played a significant role in pushing for a bill that reduced that requirement to 1,000 feet for nearly the entire state of Tennessee. That bill was signed by Governor Lee in May and should make opening SSPs in rural areas much easier. In this episode, we discuss the impact of the bill, what happened in the legislature, her behind-the-scenes role, how young people can get more involved in the policy-making process, and much more.
SPEAKER_00So hence the spread of HIV, because it is spread through, of course, it's a bloodborne pathogen, so it's spread through sexual contact as well as, you know, shearing needles and unclean syringes. So it's really important, you know, in order to protect the entire community and population to recognize when there's an outbreak among a certain portion of the population that it could rapidly spread and not stay within that small population that it may have started with. So Indiana faced this. It was a rural community. They were able to quickly put a bill in place in order to allow syringe service programs to happen in Indiana. So I think that was a good lesson for Tennessee, is that, you know, by not allowing these, we're setting ourselves up for potentially having HIV outbreaks within communities in Tennessee. So it was important at that time to kind of use that opportunity to kind of open the door to have conversations with policymakers and to educate them on the benefits of syringe service programs.
SPEAKER_02All right, so that brings us to 2023. Uh, what is Senate Bill 292? What does it do?
SPEAKER_00Well, Senate Bill 292 actually reduced the radius between a park and a school from 2,000 foot radius down to 1,000 feet. Um, when this bill was first passed, um it had that 2,000-foot radius requirement in it.
SPEAKER_02That's back in 2017?
SPEAKER_00Yes. And and so when we looked at it and we started looking at where could we put one in a metro area, for example, that has a lot more schools and has a lot more parks, um, we found that 80% of the Knoxville community was off limits to operate a syringe service program. So we went back to the General Assembly the very next year and were able to show them that in the metro areas in particular, uh, this was really prohibitive.
SPEAKER_02That makes so much sense. If you look at a heat map of overdose deaths, you see they're all concentrated in the population dense zones, which have schools and parks and churches as well. Yeah, that makes a lot of sense.
SPEAKER_00So, how can we compromise on that, right? And keep our kids safe. We all want to keep our kids safe. Um and uh and looking at, you know, one of the arguments I used was, you know, right now drug-free school zones in Tennessee are 500 feet. So, you know, even at a thousand feet, we're double the requirement of drug-free school zones. So um I again, I think education fear and pushback from the public, um, and there's still a lot of work to do with that, Jeremy. People who enter syringe service programs are not your drug dealers. Right, right. Those are the people who you want to be concerned about who are near your kids. A thousand percent. Um but people who are actively using drugs, uh, yes, it's not a pleasant uh situation, but at the same time, they're not trying to hurt anyone. Um and so again, you know, there's concerns about syringes, more syringes being, you know, uh dropped in the community and and being discarded, you know, here, there, and everywhere. And and one of the things syringe service programs really focus on is the fact that we try to get to the one-to-one exchange. So if we give you, for example, 17 syringes, when you come back the next week, we want you to bring 17 used syringes back with you. And so by providing that accountability piece with the participation in the program, it really helps keep our community safer and cleaner.
SPEAKER_02Okay, I was gonna say that probably reduces uh needles lying around.
SPEAKER_00Yeah, absolutely.
SPEAKER_02Okay. Now, and something that was said in the passage of the bill in in one of the committees really stuck out to me. A thousand feet is over three football fields. Yeah. That's a huge amount of space. You know, it's it that's definitely not likely to encounter a school or a school child, I should say.
SPEAKER_00And it's a radius. So it's not just a linear, you know, 1,000 feet. It's a radius. So you take it and you drop that pin and it creates this pretty large circle around it where you could not operate one. So um it's and I think that's where people misunderstand too, the radius versus a linear linear relationship there. But um so the Metro Aries, the next year again, back on that, we're able um to get the that reduced from 2,000 to 1,000 square feet.
SPEAKER_02And so that was in Memphis, Nashville, Chattanooga, and Knoxville. Yes.
SPEAKER_00Okay. Yes. And then um what was happening is some of our metropolitan-based syringe service programs operating through nonprofits began trying to create programs in the rural areas. And what they were running into is some of the same issues we ran into in the metro areas, which we really didn't anticipate. Um that 2,000-foot radius was pushing them out to the point where they weren't accessible to the population.
SPEAKER_02Okay, I think I remember uh Senator Briggs, who was the sponsor, saying uh they'd be out in a cow pasture in the middle of nowhere.
SPEAKER_00Exactly. So um going back this year and getting that reduced, I thought we might have a battle with some of our more rural legislators. Um, but uh we really it went pretty smoothly. There were a few legislators I was asked by the uh sponsor, you know, to reach out to because she felt like, you know, they may vote against it and said, you know, hey, I need you to contact these legislators. And um, so I was able to do that pretty easily. And of course, you never know how they're gonna vote until the voting happens. Um, but a bill sponsor is usually pretty good at knowing where their colleagues are before it comes to vote. And so um you kind of let them guide you if they're willing to sponsor your bill. Um, and then again, you do your work for them on behalf of them to try to encourage and try to educate members that may still not understand the benefits to Syringev.
SPEAKER_02Unfortunately, since we had already had them operating for a few years, we had hard Tennessee data too. So I bet that made it a little bit easier.
SPEAKER_00Yeah, that always helps. You know, once they once they've seen them and they can see the benefit, uh, the Department of Health is who approves these programs in the state and their requirements through the Department of Health in terms of reporting. So again, aggregating that data that we've collected so far in Tennessee and be able to use that data to actually show the benefits of the programs and the impact they're having on our communities where they exist now is definitely a step forward for Tennessee.
SPEAKER_02And and the votes at the breakdown, not just in the committee, but then in the full Senate, and then when the bill was brought to the House, it it passed by pretty clear majorities, uh, which was really nice to see for something that uh can have so much controversy around it. Um there were just a handful of holdouts uh in in all of those situations. So why do you think it was so successful?
SPEAKER_00Again, I think the the biggest thing is education. And I think with a lot of these situations related to substance use, um it creates educational opportunities to really get the public, but also get our our legislators to really understand the disease of addiction, um, the services that are provided that are evidence-based, you know, they're not something we just pulled a rabbit out of our hat and said, let's do that. And just seeing that, again, it's all of our problem, um, and it's affecting all of our communities. And so in order to see a reduction in the problem, we have to be willing to step up and say and meet people where they are.
SPEAKER_02And I suppose it helps that the bill sponsor is a medical physician. I I bet that added some credibility to it.
SPEAKER_00Yes. Uh Senator Briggs, uh, since he's been in the General Assembly, has been a real champion around these issues as a health care provider. You know, he's seen uh he's a cardiovascular surgeon. So, of course, he's seen uh cases of endocarditis, which are infections around the lining of the heart muscle, um, where you in many cases have to have valve replacement. Um, and he's had to do many of those procedures in young people, much younger than he was used to seeing, because of intravenous drug use and getting infections in their body from using, you know, unclean uh syringes and materials that they used to inject. He became aware very, very early uh when he became a senator and actually called me uh when he was on his way to Nashville one day and wanted me to send him every piece of data I had on this issue because he said, Karen, you're not gonna believe what I saw over the weekend. And again, it's that situation, right, where he was still working in the hospital and that weekend he had several cases where he had to do emergency surgery on a young person because of their IV drug use. And so I'm very grateful for him because he's he's sponsored several bills, not just this one, uh, that were key bills to help us with this substance use epidemic we're having in Tennessee.
SPEAKER_02That's an extremely valuable relationship, I think, for this state. Uh I I I wanna I want to talk about that a little bit. You you're you know the executive director of Metro Drug Coalition, a long-standing titan, I think, in this field. Uh I think that's without question. Do you have any advice for young people hoping to get into this policy-making sphere uh from your side of things? Uh that that relationship with the legislator, I'm sure you met them through your work, for example. I it's probably hard not to. There's always some sort of uh lunch and learn or or opportunities to meet these people if you're working in the space. But what what is it like forming and maintaining those relationships?
SPEAKER_00Well, it's really been something that I have enjoyed. Um, I really didn't think I would. I think the biggest thing it is about relationships. It's relationship building. It's not only asking them for things, but also being available when they have questions, being able to present facts, being able to give them research that backs up those facts, because again, the more information they have when they're advocating for something, that they can say, here's a piece of of data or here's a piece of research that shows this will have XYZ type impact if we if we do something like this in Tennessee. Um so I really try to make sure I delineate when I'm communicating with them that it's either my opinion based on the work that I do, or it is something that I have some evidence for. And then I'll follow up and send them the evidence so that they have it.
SPEAKER_02Do you have any advice for uh young people entering the field of prevention, treatment, recovery who are hoping to have an influence on policy? Um how should they get better involved?
SPEAKER_00Well, I think the biggest thing is um to get working in the field, um at an entry-level position, whatever they can get into, right? Um but to start there and then look for opportunities once you get within an organization to grow and develop in that area. But also let, you know, when you're interviewing for positions like this too, make sure that whoever you're interviewing with understands where the direction you'd like to go in your career. So if you specifically are in the prevention field and want to work on policy issues, you know, being able to say on the front end to whoever's hiring you that, hey, I have a real particular interest in that. If they know that, you know, if I know I have an employee who wants to dig into policy, then I'm gonna let them, you know, I'll mentor them, I'll let them help me do some of the research, you know, on a bill, I'll let them go to the day on the hill, let them go to meet with legislators so that again they they get a feel for what it's like um to do this type of work and feel like they're part of it. And then eventually, hopefully, they can grow into, you know, doing their own advocacy work and policy work. So that's the the most fun part of my job, to be honest with you, is bringing in um younger people who are eager to learn and watching them grow and develop while I'm working with them. So um again, just having those conversations on what your desires are and where your passion is is extremely important on the front end when you're looking for employment.
SPEAKER_02Right. So speak of about your goals and and and passions. And uh you should be rewarded if you're in if you're in a good place. And I imagine MDC is one of the most perfect places to work uh for that kind of thing.
SPEAKER_00Well, we're not perfect, Jeremy. Uh this work is hard. Um, and that's what people need to understand. Whenever you're working in a field where there's a lot of stigma, um, where there's a lot of not my kid, right? My kid wouldn't do this, or uh it's not gonna happen to me. Um people tend to like not want to invite you to think, you know what I mean, because it's uh what uh what you figure out about people is what we fear the most is what we stay away from the most. And so you know, you you see it or I've seen it over and over again, and it's like that's a a place of fear, and once you can get people past that fearfulness uh in order to engage with them and educate them, then you can decrease stigma and you can you can spread positive information, right? Even though it can be a hard subject. And so to be able to show people that recovery is possible and it's happening every day, and there's actually more people in long-term recovery in this country than active users, and so people can get there.
SPEAKER_02Oh wow, yeah, that's an amazing statistic.
SPEAKER_00It is well, and here's the thing, right? Back we have younger generations now that are what we call recovering out loud, right? They're not anonymous, they don't care if everybody knows their story. In fact, they feel like by being open and sharing their story that they can help others who are struggling. And so it's a beautiful thing to kind of see them jumping out there and being willing to share really hard stuff and situations that they've lived through, but also being able to at the same time say, and here I wouldn't be where I am now if it wasn't for recovery. And so that gives people hope, right? Yeah. If they recovered and they went through that, well, then I can recover too. Um, so recovery stories are extremely powerful in this space.
SPEAKER_02And the younger generation, so I'm I'm glad I'm glad you've brought them up and talked about their passions because that that's what I've seen. I mean, one, we have hard data uh at the national level that overall drug use is actually down. Um there's a lot more, you know, you hear about the sober curious movement and things like that. Uh uh of course, vaping's still a problem, but we can talk about that another time. Uh but uh in terms of the really intoxicating substances, overall use is down, and like you said, they're open about being in recovery if they are. Um I've been talking a lot with the collegiate recovery folks about uh building those on-campus communities, how there's clearly a change in the air. Um are you seeing that in the people who are applying to work uh for MDC or or uh out and about in the space that you encounter?
SPEAKER_00Yeah, I mean, we're I'm definitely seeing a shift in people's perspective on this. Um, especially um, of course, you know, I'm getting older. So uh younger employees that are coming on board um have a different perspective than I think my generation did on this issue and kind of understand it a little bit more and are less stigmatic than say my generation was. And so it's good to see that because I think again there's a movement that even alcohol use is down in uh well in certain populations. But uh just pushing back on the some of the cultural norms even around alcohol use, and that you know, you can't have a party, you can't have a good time, you can't you can't go to any kind of social event where there's not alcohol and expect to have a good time. Right. Um and so I think just breaking down some of those um decades of thinking that you know alcohol has to be a central um part of any kind of celebration. Or event I think is is happening. It's slow, but I'm seeing it more and more. And of course at MDC, you know, we have events and we have you know special events where we don't serve alcohol. But there's still somewhat of an expectation that uh you should have alcohol at your especially fundraising events. But as part of our mission, we have to kind of walk the walk. Um and so it kind of speaks has us speaking out of both sides of our mouths if we're uh saying one thing and then doing something else.
SPEAKER_02Absolutely. Okay, well this was this was a really fun ride. I I have to ask, do you have any particularly interesting stories, not just about this bill, but any other policy-making uh situation where there was just some sort of interesting story or unexpected twist in how the procedure went and like something you didn't expect about the the state legislature or what have you?
SPEAKER_00Yeah, well, um uh the biggest thing that comes up when you're working on a bill, and it came up with this bill as well, um, is you have people who are full-time lobbyists um who are representing uh you know other entities, organizations, um, who will present opportunities to amend your bill. Um and that came up again with the syringe service bill, this this go-around, where um we had a lobbyist who proposed an amendment that essentially, based on the way the amendment was written, would have invalidated really what we were trying to do. No, the whole thing. It was gonna, yeah, really ruin the whole thing. Um, but you know, I'm not a legal person, I'm not an attorney, I don't have that kind of background, but I've learned through this process to really read bills extremely carefully and language carefully. So just saying a may or a might or a shall or a will or comma. Yeah, I mean, a little nuance in the bill can totally change the impact that that piece of legislation it could potentially have. So essentially, this um this lobbyist brought forth an amendment. It got sent to me, you know. Will you approve this or are you okay with this? And I went, no, I'm not. Um, it's basically going to invalidate everything we're trying to do, and it'll just keep us at status quo. So I was told by this lobbyist that it would have been unconstitutional. So it was just one area in the state that wanted to be excluded from the 2,000-foot rule. And I was told that it was unconstitutional to name one entity in the amendment. And I said, Well, it was interesting because we did that for the metro areas, you know, uh the year after it passed. So were we unconstitutional then? And I said, I'm not a constitutional scholar, I'm just asking a question. So next thing I know, I get an amendment just amending out that one community that wanted to be excluded. And I was like, okay. So so you have to, in a polite way and in an appropriate way, kind of challenge people sometimes in order to really get where you intend to go on a bill. And again, I'm not a lobbyist, you know, I do advocacy work, and so I can't be in Nashville every day. They're in session. Oh, yeah, you're busy. So I'm I'm here running a nonprofit, and I go when I need to and when I can get to Nashville. Um, but otherwise I'm working from home pretty much and you know, making calls when I need to and checking on things. But um, lobbyists have an advantage because their full-time job is being there watching all these bills, representing their clients, and uh being able to pop into a legislator's office at any given moment. Huge advantage. It's a huge advantage. So just kind of understanding that, and it pretty much happens, it's happened every bill I've worked on. But it's also, you know, passing a bill and making smart politic policy decisions are really about compromise. And so it's about working with those other stakeholders. And when we worked on pain clinic legislation, you know, is there a way we can all compromise and come together but create meaningful change in the state around what we're seeing right now? And so we were able to do that. Was it hard? It was very hard. There was there were a lot of um very tense conversations um during the passing of the pain clinic legislation in 2015. But eventually we were able, you know, to all compromise and come together. So that's what's frustrating about looking at the political environment we're in right now, is there tends to be this real um uh disconnect or inability to really look at sometimes what's best because we're so polarized, you know, Republican, Democrat. Here's my stand on this, here's my stand on, and I'm not gonna budge, right? And in order to really serve the people that you're representing, you have to be willing to come together on these important issues. And I hope that this country, uh, state, even local politics, you know, will kind of be able to move less, be less polarized and move towards the ability to really work closely together and compromise in order to better create, you know, healthier communities. Because we all want that, right? If you can come up with a goal that everybody agrees on, right, regardless of your political affiliation, and say we all want this, this is our vision. So how can we collectively get there? And I think that's the key going forward to creating lasting change in our state and in our nation.
SPEAKER_02I share that hope very much as well. And I I suppose in this space we couldn't have a better goal than fewer dead Tennesseans.
SPEAKER_00Absolutely. Um it's a missed opportunity every person we lose.
SPEAKER_02I I completely agree. Uh, because it is a preventable, treatable condition.
SPEAKER_00100% preventable.
SPEAKER_02And I guess my takeaway from what you just said then is a good bill that passes is better than a perfect bill that fails.
SPEAKER_00Absolutely. Oh, gotcha.
SPEAKER_02Yeah. And and I agree. I think there's a hunger for people to work together again. I I I'm with you. I'm not seeing it so much, say, on social media, but when I talk to people face to face, it's there every time.
SPEAKER_00Yeah, I think so too. I think we've created with 24-7 news channels now, plus social media outlets, what gets attention is is the and and those those platforms create more polarization. They incentivize it, yeah. Exactly, because nobody's gonna follow those things or watch the news as much unless, you know, people are shooting, you know. Yeah, I mean, anger at each other and and hatred. And and I think the American public is getting very weary of this. I think so, too. And um a lot of us have discovered the more we're off social media, the better our mental health is.
SPEAKER_02So true. Yes, so true. The more I unplug, the less I uh the less I feel bad. Um Karen, this was this was a really wonderful conversation. Um, is there anything else you'd like to add?
SPEAKER_00I can't think of anything, Jeremy. It's been great to be with you.
SPEAKER_02Thank you so much. Thank you. For more episodes on in depth discussions on Tennessee policies related to substance use disorder by a range of local experts. Please subscribe to us wherever you get podcasts and visit our website at smart.tennessee.edu. I'm Jeremy Corvellis. Thank you for listening and see you next month.