South Carolina, like many other states, is experiencing three co-occurring public health epidemics. The growing opioid crisis has significantly increased unsafe injection drug use, thereby increasing the prevalence of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) through the sharing of contaminated syringes and needles. These synergistic epidemics not only are occurring at the same time, but have biological interactions among them that, together, exacerbate the prognosis and burden of the diseases.

The scientific literature contains extensive evidence that Syringe Services Programs (SSPs) reduce the transmission of HIV and HCV by providing sterile injection equipment and by linking users to multiple treatment and riskreduction services.

The CDC and HHS encourage states to submit HIV and HCV incidence and prevalence data profiles to them for review to determine if the need exists for SSPs to be established in their state. Upon demonstration of need, states are permitted to use federal funding for SSP staff, operations and supplies (though federal funds cannot be used to purchase syringes and needles). The CDC and HHS offer recommendations in their review regarding determination and consultation to states in implementing SSPs.

In January 2019, the South Carolina Department of Health and Environmental Control (DHEC) received verification from the CDC that South Carolina is at high-risk for HIV and HCV outbreaks due to increased opioid use and unsafe drug injection activities in the state. This CDC response not only emphasizes the need that exists in South Carolina to fund SSPs, but also provides recommendations for implementing this effective public health intervention to address these co-occurring epidemics. However, South Carolina law currently prohibits SSPs (Article 7, Sections 44-53-391 and 44-53-930 South Carolina Code of Laws). Section 44-53-391 makes it unlawful to “manufacture, possess, sell, or deliver…paraphernalia,” including hypodermic needles and syringes. It is further unlawful to provide “instructions, oral or written, with the [paraphernalia] concerning its use” or any other “descriptive materials accompanying the [paraphernalia] which explain or depict its use.” Section 44-53-930 requires hypodermic needles and syringes to be sold only by “registered pharmacists or registered assistant pharmacists through a permitted pharmacy” or by “persons lawfully selling veterinary medicines.