New Outlook on Needle Exchange Programs
Nearly three decades after the federal government first banned funding for needle exchange programs, Congress has decided to change course. In December 2015, a congressional budget deal was approved and signed by President Obama to fund most core aspects of needle exchange programs.
Needle exchange programs (NEPs) traditionally offer clean needles to injecting drug users with an aim of reducing the amount of contaminated needles being shared and in turn, preventing the spread of infectious diseases. NEPs safely dispose used needles in exchange for clean needles. Programs also generally offer a variety of related services, including referrals to drug treatment and HIV counseling and testing. A number of studies have shown that NEPs dramatically lower the rate of Hepatitis C and HIV infection among substance users.
In the past, many advocated against NEPs, claiming they did little to help substance abusers. Some continue to believe that NEPs don’t effectively discourage substance abuse, and instead normalize and even promote drug addiction. However, the increase in heroin use in the U.S. – alongside increased risk of diseases like Hepatitis C and HIV often associated with intravenous drug abuse – has led politicians to reconsider their position.
What caused the federal government to change its mind?
Opioid addiction has been a serious problem in U.S. cities for over 50 years. In the last decade, it has been declared an epidemic because of the significant increases in heroin and prescription opioid overdose deaths and because of the spread to suburban and rural communities. Although effective treatments are often available in more populated areas, access to these medicines is more limited in poor, rural areas. Senate Majority Leader Mitch McConnell, who represents the mostly rural state of Kentucky, was the architect of the budget agreement that included support for NEPs. Kentucky is one of the places where the heroin epidemic has hit hardest: last year the state had over 1,000 overdose deaths.
The new legislation aims to address the intravenous drug problem, providing “flexibility so that certain counties in Kentucky [and the rest of the United States] may be able to access federal funds for their treatment and education efforts,” said Kentucky Senator Hal Rogers, who also worked on the bill. The funding will target communities deemed to be in dire need of NEPs, with the programs led by the U.S. Centers for Disease Control and Prevention.
Connecting NEPs with Medication Assisted Treatment
As a stand-alone service, needle exchange programs are unlikely to alter the number of people using opioids. In order to effectively change the opioid epidemic, NEPs must be paired with services like Medication Assisted Treatment (MAT). MAT includes buprenorphine, methadone, and naltrexone, which have been shown to dramatically reduce and manage opioid dependence. With NEPs that emphasize referral to MAT, opioid dependent individuals not only receive immediate treatment to prevent illnesses like HIV and Hepatitis C, but extended care to help them manage their substance problem.
A 2014 study conducted by The National Center on Addiction and Substance Abuse found that clean syringe exchanges which included mobile outreach and MAT, helped marginalized groups receive the assistance they needed to treat their opioid addiction. NEPs that incorporated MAT were more effective at getting individuals into treatment than NEPs alone.
While federal funding for NEPs should be welcomed, it’s too early to claim a victory with regard to decreasing the risks of infectious diseases or improving access to treatment. The initial ban on federal funding for NEPs was instituted in 1988, lifted in 2009, and then reinforced in 2011. Additionally, the federal government remains barred from funding the needle replacements themselves. State governments continue to be responsible for syringe replacements. Depending on state funding – and political culture – this can be problematic.
Politicians and experts do agree that additional work needs to be done. As a broader group of states and demographic groups are hit hard by addiction and its related diseases, there appears to be a greater consensus on how to tackle this urgent health issue.
Max Dorfman is a Science Writer at Center on Addiction