Harm reduction advocates in Pennsylvania are once again seeking to legalize syringe exchanges across the state in response to the region’s growing opioid and hepatitis C virus (HCV) epidemics, The Incline reports.

So far, proponents of the initiatives say two past attempts at legalizing the distribution of clean needles for drug users have failed in the Pennsylvania state legislature. But now, thanks to some creative legal positioning and renewed grassroots efforts , advocates are hoping this time will be different. 

Currently, syringe exchanges are technically illegal in Pennsylvania, nonetheless, they operate in a small number of municipalities across the state, including Allegheny County and Philadelphia. Last year, advocacy group Prevention Point Pittsburgh said it distributed more than 376,000 clean syringes to injection drug users in the region. But harm reduction workers say the demand for clean needles is on the rise and that these shadow initiatives are serving only a small proportion of those in need. 

Advocates say there are two ways that Pennsylvania could allow syringe exchanges to operate statewide. First, state legislators could pass a bill—though with a conservative Republican stronghold in both chambers, this path seems unlikely. Second, Gov. Tom Wolf and Secretary of Health Karen Murphy could declare a public health emergency and decriminalize the possession of syringes with a prescription.

In fact, a recent letter sent by the Syringe Access Network of Pennsylvania (SANPA) and signed by nearly 70 people, including members of the Pittsburgh City Council and local doctors is asking Wolf and Murphy to do just that. Although last year, the Centers for Disease Control and Prevention lifted a federal funding ban for syringe exchanges across 14 states, including Pennsylvania, local health workers cannot use that money because of the prohibition. The SANPA letter argues that federal health authorities consider several Pennsylvania counties to be at risk for an HIV and hepatitis C outbreak because of injection drug use.

As of last Friday, advocates said they have not heard back from Governor Wolf about the letter’s request for a meeting. In the meantime, Pittsburgh state Rep. Ed Gainey has introduced yet another bill to decriminalize syringe exchanges. The law currently has bipartisan support from Allegheny County’s delegation, but lawmakers aren’t sure whether it will get a committee hearing or a vote.