Image Credit: Kaytee Riek on Flickr (https://www.flickr.com/photos/riekhavoc/6858612128)
Opioid addiction is one of the most devastating plagues of our time. There is a tremendous amount of stigma that the victims of addiction are burdened with, and many politicians paint the issue as a moral failing rather than a widespread health crisis (our country’s draconian drug laws don’t help either). This is not something that will work itself out by simply telling users to stop and incarcerating them when they are caught. State governments need to do their part to help people affected, and right now we do not have a system in place to do so. While there are several steps needed to eventually end the epidemic, there is one particular tactic that I want to focus on, because it is often misunderstood and attacked unjustly.
The tactic that I am referring to is the adoption of syringe services programs (SSPs), aka needle exchange programs (NEPs). These programs primarily exist to prevent the transmission of HIV and other diseases by providing free, sterile needles and syringes as well as allowing used ones to be disposed of properly. According to the CDC, most of these programs also provide safety education, items for preventing transmission, such as condoms, and referral to substance abuse treatment services. The benefits of these programs are immediately apparent. They not only are effective at stopping the spread of disease in its tracks, but they also allow intravenous drug users to come out of the shadows and into a compassionate setting, where they can be pointed in the right direction to receive help to quit the drugs altogether.
It is understandable, however, that there is much skepticism of and opposition to these programs. Many government officials believe that since the programs provide drug users the means to continue, that they are inadvertently promoting drug use. For example, the Chicago Tribune reported the opinions of two officials in the state of Indiana, where the governor has signed legislation allowing needle exchanges to be established by local governments. The article quoted a sheriff who questioned whether the programs would be able to end the crisis, considering how they enable drug users to persist, and a prosecutor who said that “he has seen exchange kits that include needles, cooking devices, tourniquets and other materials used for drug use, which ‘sends the wrong message’ when the goal is for people to get off drugs.”
These arguments are fatally flawed, however. The first argument, that the exchanges will only perpetuate the crisis, overlooks the fact the addicts will continue to be addicted regardless of whether the NEPs exist or not. We can either allow these people, who are already suffering, to become infected with HIV, or we can ensure that we do not. In fact, increasing the acceptance of these services would help to curtail the AIDS crisis too, effectively fighting two public health crises with one program.
The second argument, that the programs encourage drug use, ignores the statistics available that compare cities with and without the programs. As the UCSF Center for AIDS Prevention Studies shows, “A study of 81 cities around the world compared HIV infection rates among IDUs [intravenous drug users] in cities that had NEPs with cities that did not have NEPs. In the 52 cities without NEPs, HIV infection rates increased by 5.9% per year on average. In the 29 cities with NEPs, HIV infection rates decreased by 5.8% per year. The study concluded that NEPs appear to lead to lower levels of HIV infection among IDUs. If that data is not convincing enough, they also present a 5 year study of San Francisco, which found that “from December 1986 through June 1992, injection frequency among IDUs in the community decreased from 1.9 injections per day to 0.7, and the percentage of new initiates into injection drug use decreased from 3% to 1%.”
So, clearly, NEPs do not encourage increased drug use among users, and they do not enlist non-users to begin using either. With the question of their efficiency being settled, the only remaining concern would be that of the cost of these programs. With many state budgets being crunched already, and a federal ban preventing more than limited help from Washington, there may be hesitancy to promote government spending on the services.
However, it has also been proven that NEPs are far from financially crippling. As the same UCSF page explains, “The median annual budget for running a program was $169,000 in 1992. Mathematical models based on those data predict that needle exchanges could prevent HIV infections among clients, their sex partners, and offspring at a cost of about $9,400 per infection averted. This is far below the $195,188 lifetime cost of treating an HIV-infected person [in 1997]. A national program of NEPs would have saved up to 10,000 lives by 1995.” Adjusted for inflation and multiplied by the 3,144 US counties and equivalents, that $169,000 would, in 2017, be $936,490,200.96, certainly not an insignificant amount of money. But compared to the lifetime treatment cost of the 1.1 million people living with HIV in the US, a whopping $330,291,973,000, the fiscally responsible choice is obvious. Without a doubt, the best way for states and counties to take their first steps toward eliminating opioid addiction is to endorse and fund these programs. And to those that already have, I commend them.