The needle exchange program is a social service program which is aimed at allowing the drug syringe users to have free or cheap access to hypodermic needles. The idea underlying the program is to realize the concept of harm reduction i. e. to reduce the harm and to reduce the risk associated with the use of syringes. It is because the syringe users who use syringes for drug administration into their bodies can harm their bodies by re-using the same syringe or using the syringe which has been used by someone else.
Therefore, in order to eliminate the risk of HIV and AIDS associated with such usage of syringes, the needles exchange program is being launched in various countries across the globe. Another popular belief underlying the program is that it would be unreasonable to assume that individuals who are addicted to such drugs through needles can take healthy decisions. Moreover, the ones who get addicted to such drugs are often vulnerable to reusing the syringes because their addiction takes over their decision power of quitting the drug. Therefore, the program at least minimizes the health risks associated with syringe use and causes less harm which would otherwise follow from reusing the syringe.
The medical profession takes such an illness as chronic one just like asthma, hypertension and diabetes. Their focus is to treat the problem. This also eliminates the blame on part of drug addicts for causing health issues to their body. (Loconte, 1998) World Health Organization (WHO) conducted an in-depth study in 2004 whereby it was found that there was substantial evidence to believe that the needles exchange program has reduced the risk of HIV among drug administers. Similar findings had previously been observed by the American Medical Association in 2000 whereby they found out that the needles exchange program produced better results when combined with addiction counselling.
Therefore, the American Medical Association adopted a position supporting the needles exchange program. (Stancliff, et al. 2003; Jarlais, et al. 2009) The history of the program can be traced back to 1970s when it started informally to prevent the likelihood of diseases arising from reusing of the syringes. It is also believed that the idea took place in multiple locations simultaneously. However, the first initiative at governmental level was taken in The Netherlands due to an outbreak of Hepatitis B and the AIDS in the country.
Subsequently the program was being adopted in other countries as well so that such risks could be eliminated (Ritter & Cameron, 2006). There are a number of countries in which this program is taking place. This includes United States, United Kingdom, Canada, Australia, Czech Republic, Brazil, New Zealand, The Netherlands, Portugal, Norway, Spain, Ireland, Switzerland and Iran. However, in United States this program does not receive federal budgeting and although there was slight budget being offered in 2009 but it was again removed in 2010. (Davis & Beletsky, 2009)
It is being observed that the annual cost of HIV treatment in United States is $15,745 and the ones which are at advanced stage of the disease incur $40,678 annually towards their health care. The lifetime cost of the HIV patient’s health care is estimated to be at $303,000 to about $619,000 depending on the stage on which the problem was diagnosed and treatment began. However, on the other hand the cost per needle which reduces the risk of HIV from arising is only $0. 97 as compared to the cost on each dosage of Truvada the HIV medication is $36.
(KA Gebo, et al. 2009; Schakman, et al. 2006) In United Kingdom, the National Institute for Health & Care Excellence (NICE) proposed a recommendation regarding needle exchange program in 2014 as a result of increased number of people using syringes for drug and steroid administration. The same body had previously carried out a study program in 2009 in this regard whereby it did not suggest the use of needles for those aged below 18. However, the organization revised its proposal in 2014 and updated it to suggest needle exchange for anyone using it so that the increased number of health risks can be avoided.
This suggestion came following the organization’s study whereby it found that children aged 15 were using syringes for administering steroids into their bodies for developing muscles. (Charlie, 2014) There are arguments both for and against the effectiveness of the needles exchange program. These arguments are being discussed below: Franciscus (2013) observed that the prime advantage of the program is that it ensures the safe disposal of the needles and reduces the risk of reusing the needles and thus reduces the likelihood of health issues from arising.
However, Tilson (et al. 2007) argued that there is little evidence to suggest that the needles exchange program significantly reduced the likelihood of health risks from arising. They also argued that this program has backfired as people can get encouraged to use needles when they realize that they are being provided fresh needles. They stated that there should be a check on the number of syringes supplied to the user and the limit on such a number. In Australia the voice is being raised on the accountability factor with respect to such needles exchange programs.
In this regard the Federal Parliamentary inquiry was also conducted which proposed various suggestions and recommendations to enhance the accountability of the organizations running this program and to track the injuries caused by the needles. Besides, a person using the syringe whether fresh or otherwise, may not be aware of his body’s needs with respect to drugs and might inject himself with something lethal to his body by being unaware of it. People with diabetes are sensitive to a number of drugs and therefore they too may not be aware of the needs of their body (Latt, et al. 2009; McCoy, et al. 2001;McDonald, 2009).
Jarlais (2009) recommended that the main advantage of needles exchange program is that it can be provided in conjunction with the counselling and treatment. Therefore, those who feel in need of syringes would get encouraged towards the treatment and the counselling along with the safe provision of the needles. He suggested attaching social service care along with the program. McLean (2011) observed that in US alone the needles exchange program saves the HIV treatment cost of $178,000 and has reduced 30% cases of HIV due to needle usage all because fresh needles were being offered to the users.
It has also been argued that despite the fact that the needles exchange program helps preventing the spread of disease but on the other hand the user is unaware of the dosage he cannot administer into the body and therefore can administer increased amount of dosage through the needle regardless of its fresh or reused status (Aaron, 2012). Perkins (2000) argued that unless additional services or education is being provided with the program, informing the user about the safety protocols of how to inject and how much to inject, the program would be useless.
Keyl (et al.1998) observed that due to the fresh provision of needles, it can actually encourage the use of drugs in community and the number of people can get increased due to fresh provision of needles. Islam (2010) argued that it is the belief of one third of the Australian public is that needles exchange program is encouraging the drug use in the Australian community despite the fact that Australia is the prominent proponent of needles exchange program. In a 2010 study carried out by Norah Palmateer found out that there is little evidence to suggest that the needles exchange program reduced the spread of hepatitis C but the evidence of self-reporting of this behaviour has reduced significantly. However, she asked the governments not to close the programs but instead regulate it properly which focuses more on the treatment of the addicts.
(Amy, 2010) Wodak & Cooney (2004) reviewed eleven studies conducted on the effectiveness of needles exchange program and its effectiveness with regards to reducing the health risks. They found out that six studies found the needles exchange program effective regarding the risk avoidance and prevented HIV from arising, 3 were the ones which were found negative and only 2 were the ones which were inconclusive.
However, Kall (et al. 2007) disagreed with the Wodak & Cooney (2004) review and stated that the review contained three positive studies, three negative which were not in favour of needles exchange program and five were inconclusive in nature. The evidence forwarded by both studies was then reviewed by US Institute of Medicine in its session in Geneva (Tilson, et al. 2007). It was concluded in the session that there is little evidence to suggest the significant effectiveness of needles exchange program in reducing the HIV risks and that the evidence in this regard is inconclusive.
It was also observed that four studies which suggested the effectiveness of needles exchange program were the ones in which no conclusive causal link was established between the program and the spread of HIV. It was also stated that the study was general in nature and the sample of the study did not comprise the drug addict individuals. However, Tilson (2007) also pointed out that needles exchange program is still considered to be a prominent step in fight against spread of HIV through needles. The program has increased the effectiveness of measures that are intended to reduce the risk of diseases.
Therefore, he concluded that only a program which not only focuses on provision of fresh needles but also focuses on the provision of treatment can be effective in reducing the risks. However, it still need be solved that what would be the ingredients of the package. It has also been argued by a number of researchers that many of the needle exchange programs are focused only on providing fresh needles. They therefore contribute little if any towards the treatment of the problem and instead can be a source of encouraging the users to use fresh needles. It has also been observed that the organizations running these programs do not market or offer the treatment facilities in conjunction with the needles and instead are only focusing on the provision of the needles.
Therefore, it can be concluded that unless a complete package of needles exchange program is being offered i. e. which contains not only the fresh needles but with the condition of treatment and awareness programs, the program would be of little use. It is imperative that the governments encourage such programs but in conjunction with treatment. There should also be laws in place which regulate such programs so that no one can take advantage of the
program to encourage the users and that the users are in fact encouraged towards treatment through this program. References Amy (2010): “Do needle-exchange programs really work? ” Reuters Health Aaron (2012): “Why a Needle-Exchange Program is a Bad Idea” Charlie (2014): “NICE: Needle exchanges should supply safe equipment to under-18 steroid users”. The Independent Davis & Beletsky (2009): “Bundling occupational safety with harm reduction information as a feasible method for improving police receptiveness to syringe access programs: Evidence from three U. S. Cities”. Harm Reduction Journal 6: 16
Franciscus (2013): Needle Exchange – A Matter of Public Health So why is the government playing politics with this ticking time bomb? Islam (2010): “Needle Syringe Program-Based Primary HealthCare Centers: Advantages and Disadvantages”. Journal of Primary Care & Community Health 1 (2): 100 Jarlais, et al. (2009): “Doing harm reduction better: syringe exchange in the United States. “. Addiction 104 (9): 1441–6 KA Gebo, et al. (2009): “Contemporary Costs of HIV Health Care in the HAART Era”. Presentation for 13th International Workshop on HIV Observational Databases March 26– 28, 2009 Lisbon, Portugal, HIV Research Network
Keyl (et al. 1998): “Community support for needle exchange programs and pharmacy sale of syringes: A household survey in Baltimore, Maryland”. Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association. 18 Suppl 1: S82–S88 Kall (et al. 2007): “The Effectiveness of Needle Exchange Programmes for HIV Prevention – A Critical Review”. The Journal of Global Drug Policy and Practice 1 (3) Latt, et al. (2009): Addiction Medicine. Oxford University Press Loconte (1998): “Killing Them Softly”. Policy Review (Heritage Foundation): 14–22.
McCoy, et al. (2001): “Drug use and barriers to use of health care services”. Substance use & misuse 36 (6–7): 789–806 McDonald, (2009): “The evaluation of a trial of syringe vending machines in Canberra, Australia”. International Journal of Drug Policy 20 (4): 336–339 McLean (2011): “The biopolitics of needle exchange in the United States”. Critical public health 21 (1): 71–79 Perkins (2000): “False Compassion: Needles”. The Rockmart Journal Ritter & Cameron (2006): A Systematic Review of Harm Reduction, Drug Policy Modeling Project, Monograph 06, Turning Point Alcohol and Drug Center, University of Melbourne,
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