Syringe exchange programs are where injection drug users can bring their used needles and exchange them for new needles. This is a controversial issue with most Americans. On the one hand the opinion is that you are helping a drug user, on the other you are protecting the innocent who may be affected unknowingly. Syringe exchange programs will take a used syringe and exchange it so the drug user has a new sterile needle to continue using drugs. Injecting drugs is a main cause of the spreading of disease.
The idea is to save lives by letting drug users have new clean needles to inject drugs with so they do not feel the need to share needles. This could save the lives of the drug users and their families, as well as those that they have sexual intercourse with. The transmission of HIV among IDU’s would go down if users could exchange contaminated needles for sterilized equipment (Jacobson, 2006). Because injection drug users have a hard time finding new needles, they resort to injecting themselves with used needles, putting their health at risk.
Recently, programs like this have been established worldwide in an effort to prevent the spread of diseases, such as HIV. Until the 1970’s needles could be purchased without a prescription and without limits on quantities. Syringes were sold next to marijuana paraphernalia at “head shops” (stores selling materials utilized by drug users) in many cities across the country. From the 1970’s into 1980’s most states criminalized the possession or sale of syringes without a prescription.
As it became recognized that dirty needles were a main cause of HIV transmission, in the late 1980’s, syringe exchange programs began in some cities, like New Haven, Connecticut; Seattle, Washington; Portland, Oregon; San Francisco and New York City (Jacobson, 2006). According to Needle Exchange and Harm Reduction the New Haven, Connecticut program helped cut HIV and hepatitis transmissions by an estimated 33% in the first two years of operation.
At the time of the 1993 assessment, almost 20% of participants in the Connecticut program had begun drug treatment and hundreds of others, including many users who were not injectors, had come to the program for referrals to treatment. In 1997, the National Institutes of Health and the Institute of Medicine reported that needle exchange programs contributed to nearly 80% reduction in risky behaviors by injecting drug users and at least 30% reduction of HIV transmission (Needle Exchange and Harm Reduction, 2011). Since then syringe exchange programs have continued to provide a visible means of reducing HIV among injection drug users.
Because syringe exchange programs were illegal in a number of states, efforts went underway, supported by AIDS activists and public health officials, to legalize syringe exchange programs, decriminalize syringe sales, and to receive public funding for their operations (Jacobson, 2006). Injection drug users who regularly use drugs could potentially suffer the consequences of their abuse, most of which are harmful and some of which are deadly. The main purpose of syringe exchange is to stop needle sharing among injection drug users, to lower the number of people contracting and spreading HIV, and to lower death rates among injection drug users.
Studies have found that through offering an accessible alternative to needle sharing like supplying sterile syringes, HIV transmission within drug user communities can be brought under control (Needle Exchange and Harm Reduction, 2011). Jacobson states injection drug users share equipment because syringes/needles are difficult to obtain and even more difficult to sterilize. Sharing equipment for drug injection is a well-known route for the transmission of HIV and other diseases because of the infected blood left behind in needles (Jacobson, 2006).
Injection drug users should not share needles, syringes, cotton balls, or rinse water because of the high risk of transmitting diseases (Centers for Disease Control and Prevention, 2011). Tests have shown that bleach, hydrogen peroxide, and alcohol can kill HIV. These substances can be effective for cleaning a syringe and needle if the solution fills the syringe completely, but using disinfected syringes is still not nearly as safe as using new sterile equipment every time of injection (Jacobson, 2006). A study found that between 2008 and 2009, needle sharing increased 13% following the closure of a syringe exchange program in Canada.
In contrast needle sharing among those studied in Vancouver, which has a number of syringe exchange programs, remained at less than 11% (Needle Exchange and Harm Reduction, 2011). Because of the one for one rule, syringe exchange programs are taking contaminated needles and properly disposing of them in hazardous waste containers. Syringe exchange programs send syringes to collection sites with services that safely destroy needles/syringes (Needle Exchange and Harm Reduction, 2011). This helps get used needles out of public places like garbage dumps where they do not belong and out of homes away from children.
It also lowers the number of used needles being shared between injection drug users. Many injection drug users will use in parks and alleys and without SEP’s drug users are more likely to leave syringes in parks where children who find them can be in danger. Garbage collectors can also be at risk of getting pricked by a contaminated needle inside a trash bag while doing their jobs. Other people that may be affected can be anybody coming in contact with the bodily fluids of injection drug users, like medical professionals and sexual partners.
Syringe exchange programs are one of the main harm reduction measures that aim to lower the spread of blood-borne diseases among injection drug users (Needle Exchange and Harm Reduction, 2011). Syringe exchange programs can give IDU’s the opportunity to protect their selves in many ways. Syringe exchange programs provide access to not only sterile syringes but other equipment such as swabs and sterile water. Syringe exchange programs can also act as a gateway through which users learn about safe injection practices, equipment disposal, safer sex education, and referral to treatment.
An injection drug user might visit a syringe exchange just to get clean needles to inject drugs, but they may also access free condoms or talk to drug counselors about treatment plans. There is much stigma surrounding injection drug users, but syringe exchange programs provide support and information that can get users into much needed treatment (Needle Exchange and Harm Reduction, 2011). According to the Centers for Disease Control and Prevention, in December 2002, staff from Beth Israel Medical Center (BIMC).
In New York City and the North American Syringe Exchange Network (NASEN) mailed surveys about syringes exchanged and services provided to all 148 SEP’s known at the time. Results showed out of the 148 syringe exchange programs one hundred ten provided male condoms, 96 female condoms; 97 provided referrals for substance-abuse treatment; 91 offered voluntary counseling and testing for HIV, 54 for hepatitis C; 39 offered sexually transmitted disease (STD) screenings; 29 provided medical care; and 28 provided tuberculosis screening (Centers for Disease Control and Prevention, 2011).
Although proven to be very effective in many ways, syringe exchange programs are still illegal in 16 states and research indicates that drug users who live closer to these programs are substantially more likely to access sterile syringes from them (Friedman, 2011). Injection drug users in the 16 states where syringe exchange programs are illegal are more likely to share needles and spread HIV than in the 36 states that have syringe exchange programs to fight the rise of HIV. According to Needle Exchange and Harm Reduction many countries that report injection drug use and HIV among their populations do not have needle/syringe exchanges.
Globally, only 82 countries have syringe exchange programs. Some countries report having syringe exchange programs, but injecting drug users are still not accessing enough needles/syringes. For example, in Germany there are over 200 syringe exchange programs, but injection drug users receive only an average of two needles/syringes each, per year. It is recommended syringe exchanges programs provide 200 needle/syringes per injection drug user, per year to prevent HIV transmission and make an impact on the HIV epidemic.
Low numbers of syringe exchange programs and low distribution rates can be due to many reasons; for example, lack of resources and funding, public and political opposition to harm reduction, as well as laws that criminalize syringe exchange programs (Needle Exchange and Harm Reduction, 2011). Overall, Australia and Western European countries, with an average distribution of 213 needles/syringes per injection drug user, per year are the leaders in harm reduction, and have some of the highest distribution levels in the world (Needle Exchange and Harm Reduction, 2011).
Jacobson states that European nations who take advantage of syringe exchange programs have their programs funded by their government, so they have the means to supply more sterile syringes; unlike the United States who has always had their programs privately funded, limiting the amount of needles that could be supplied and the number of people that could be helped (Jacobson, 2006). According to Needle Exchange and Harm Reduction in Southern Australia there are over 50 syringe exchange programs that serve an estimated 1.
2 million people, they reported that there have been no new HIV infections among injecting drug users over the past three years. Studies have also shown that over the course of six years, HIV infection rates among injection drug users in Hawaii have declined from 5% to 1% (Needle Exchange and Harm Reduction, 2011). Currently, the syringe rate in the US is 22 per injection drug user, per year which is far below the recommended rate and one of the lowest in the world (Needle Exchange and Harm Reduction, 2011).
With only 22 needles/syringes per injection drug users, per year syringe exchange programs in the US have already made a huge impact on the HIV pandemic in the injection drug user communities. The goal is to have syringe exchange programs in every state for easy access, and at least 200 needles/syringes per injection drug user, per year going out to lower HIV rates even more. Needle Exchange and Harm Reduction says that according to an Australian government study, investment in needle exchange programs from 1991 to 2000 prevented 25,000 HIV infections and 21,000 hepatitis C infections.
A study examining the impact of needle exchanges in the following decade revealed they had prevented 32,000 more HIV infections and almost 100,000 more hepatitis C infections. Furthermore, it is believed that syringe exchanges led to healthcare cost savings of over $1 billon, with a five-fold return on every dollar spent (Needle Exchange and Harm Reduction, 2011). Injection drug users are considered to be a high risk group for Hepatitis and other sexual transmitted diseases as well (Centers for Disease Control and Prevention, 2011).
HIV can be transmitted by cross contamination of blood between injection drug users when sharing needles. It can also be passed to children during pregnancy, or during birth. HIV is also capable of being passed from unknowing infected mother to child though breast milk. Syringe exchange programs offer HIV/STD testing to assist injection drug users in being knowledgeable on if they are infected with a blood borne disease. This can help a pregnant women seek out special care for her unborn child if she finds that she is infected with HIV.
One of the most definitive studies of the effects of syringe exchange programs focused on 81 cities worldwide. It found that HIV infection rates increased every year by 5. 9% in the 52 cities without needle exchange programs, and decreased every year by 5. 8% in the 29 cities that did provide them (Needle Exchange and Harm Reduction, 2011). There is obviously a great deal of stigma surrounding syringe exchange programs. Until the flow of illegal drugs into the U. S. can be slowed or stopped, people will use them (Friedman, 2011).
Until then the United States should address the more serious issue at hand: the consequences of injection drug use, like the transmission of HIV and hepatitis in injection drug user communities. Approximately half of new HIV infections are caused by the sharing of contaminated needles (Centers for Disease Control and Prevention, 2011). Syringe exchange programs have proven that they substantially decrease the amount of injection drug users sharing needles/syringes and lower the transmission rate of blood borne diseases.
References USA. gov, (2011), Centers for Disease Control and Prevention. Jacobson, R. (2006). Illegal Drugs: America’s Anguish. Wylie, Texas: Information Plus England and Wales National Institute for Health and Clinical Excellence. (2011). Needle Exchange and Harm Reduction. Friedman, S. (2011)Spatial Access to Syringe Exchange Programs and Pharmacies Selling Over-the-Counter Syringes as Predictors of Drug Injectors’ Use of Sterile Syringes. American Journal of Public Health.