Will Stone/KJZZ

Needle exchanges remain illegal in Arizona, despite support from public health groups.

After months of work, Arizona health officials issued an ambitious plan for the state's opioid epidemic — everything from limiting the first fill of painkillers to establishing a hotline for physicians. But one thing that’s not part of the hundred page plan? Needle exchanges. Some who work in Arizona’s treatment industry are upset their advice was ignored.

Nick Stavros spends a lot of time thinking about how to get people who are addicted into treatment, which is why needle exchanges make sense to him.

“That is such an opportunity for engaging people. Going to the syringe access programs and saying hey let’s talk about treatment,” Stavros said.

Stavros runs Arizona’s largest opioid treatment program, Community Medical Services, which has about 2,000 patients across the state. He points to research showing syringe exchanges not only reduce infectious diseases like HIV and Hepatitis C, but that people who use them are five times more likely to eventually seek treatment.

“Drugs are illegal, people should not use drugs,” Stavros said. “But if they are using drugs, how do we get them to stop using drugs? I consider myself a pretty pragmatic person.”

At least two people die every day in Arizona from opioid-related overdoses, according to data from 2016.

The rising death toll led Gov. Doug Ducey in June to declare the opioid epidemic a public health emergency. As part of that effort, state health officials brought together experts from the treatment industry to come up with recommendations.

Stavros was one of them.

“We talked pretty extensively about syringe access programs and so I think there was a lot of agreement in the group on that,” he said.

In fact, legalizing syringe exchanges received more votes than any of the other proposals from the treatment subgroup that focused on how to assess and refer people, according to public records obtained by KJZZ. But when the state released its “Opioid Action Plan,” a roadmap for tackling the epidemic, Stavros was surprised to find that the hundred page report doesn’t mention syringe exchanges once.

“I understand the consternation, which is ‘well, you are just enabling people to use,’” Stavros said. “My take on this, and maybe it’s a little altruistic is, look we are all humans, we are all Americans, we want to do what's best for everybody."

Will Stone/KJZZ

A band of volunteers run Phoenix’s underground needle exchange, called Shot In The Dark.

Distributing needles for illegal drug use is a felony in Arizona. Because of legal concerns, Phoenix’s only syringe exchange program has operated under the radar and without public funding.

Some of the state’s top law enforcement officials like Maricopa County Attorney Bill Montgomery believe needle exchanges aren’t the answer to the opioid crisis.

“It’s a well-intentioned, misguided program. It sends the wrong message, too, and it’s not providing the treatment,” Montgomery told KJZZ recently.

Some conservative lawmakers like former Gov. Mike Pence only took the step as an emergency measure after Indiana experienced one of the worst documented outbreaks of HIV among intravenous drug users in recent U.S history.

“It is the sharing of needles that has caused this epidemic to take place. I am opposed to needle exchange as anti-drug policy. This is a public health emergency and as governor of the state of Indiana, I am going to put the lives of the people of Indiana first,” Pence said, according to a 2015 report from the Indianapolis NBC affiliate WTHR.

In North Carolina, Republican Gov. Pat McCrory signed a law last year legalizing syringe exchanges, saying, “it’s not the politically correct thing to do, at least on my side of the aisle, but it’s the right thing to do.”

But given the Arizona Department of Health Services’ silence on the issue, advocates like Angie Geren aren’t necessarily expecting that to happen here. Geren runs the local nonprofit Addiction Haven and was part of the same subgroup as Stavros.

“It’s super disappointing,” she said, “that they would ask us what our recommendations were for what we were seeing in the population we work with every single day and then they would allow politics to get in the way and take that out.”

So what does the report say instead?

The appendix at the end of the report contains charts displaying the recommendations of each expert group. The draft document said “legislation to allow syringe access programs to engage with the most vulnerable individuals to refer to care.” While the final report instead reads: “Utilize harm reduction strategies to engage with the most vulnerable individuals to refer to care.”

Geren and others, who attended the stakeholder meeting in late August when the recommendations were voted on, said there are several problems with this characterization: First, it doesn’t reflect what they said, and second, harm reduction is an umbrella term for an approach to addiction that seeks to minimize the negative effects of drug use, rather than just promote abstinence.

While a needle exchange is one example of this strategy, Geren said it’s one that requires concrete steps like new legislation.

“It’s not that we need to explore harm reduction services. We know the one service that works," she said. "We know the one service that can guarantee connection with people who are most vulnerable."

The Arizona Department of Health Services did not do an interview for this story, but in a statement said it had to consider more than a hundred recommendations and “while syringe exchange is an evidence-based, harm reduction strategy for preventing infectious diseases, it was not included as a recommendation because it does not directly reduce opioid related overdoses or deaths.”