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Using Syringe Exchange Programs to Stop the Spread of Disease Among IV Drug Users

By Hugh C. McBride

Most of the time and money that has been invested in the ongoing war on drugs has been directed toward separating drug abusers from the objects of their addiction. But some experts are advocating approaches that support the “safer” use of illegal drugs – particularly those that are often abused via intravenous injection.

One of the most widespread manifestations of this harm-reduction philosophy involves syringe exchange programs – efforts that, supporters argue, meet a crucial public health need without promoting or increasing the prevalence of illegal drug use.

Fighting the Spread of HIV & Hepatitis

The primary health risk associated with injection drug use – aside from the complications caused by the drug itself, of course – is the transmission of blood-borne pathogens via the sharing of needles. Health experts are most concerned about the spread of HIV and hepatitis among injection drug users.

The Centers for Disease Control and Prevention estimates that injection drug use is responsible for more than one-third of all AIDS cases in the United States. The CDC says the practice both “directly and indirectly” facilitates the spread of HIV and AIDS, noting that the unsafe sharing of needles not only puts users at risk, but also exposes their sexual partners and their children.

Syringe exchange programs attempt to mitigate this risk by providing free sterile syringes to injection drug users, as well as collecting and safely disposing of their used needles. Some programs also offer alcohol pads, condoms, and HIV testing and counseling.

According to the PBS program “Frontline: The Age of AIDS,” researchers have documented the effectiveness of syringe exchange programs, and studies also indicate that the programs do not prompt increases in use:

Seven federally funded studies during the 1990s, conducted by the Government Accountability Office (GAO), the CDC and the National Academy of Sciences among others, all reached similar conclusions that [syringe exchange programs] work in reducing HIV's spread among IV drug users, their partners and children, and that they do not encourage increased drug use.

The AIDS Action organization concurs with these findings, and also notes that the programs can offer a significant financial incentive:

Mathematical models predict that [syringe exchange programs] prevent HIV infections among injecting drug users, their partners, and family members at a cost of approximately $9,400 per avoided HIV infection. Considering the lifetime cost of treating a person living with HIV/AIDS is approximately $200,000, this represents a 95.3 percent savings per life.

Wide Approval, Continued Opposition

nformal and underground syringe-exchange efforts have been around since the early 1970s, but the effort became much more widespread – and, in many countries, formalized and subsidized – as the AIDS pandemic began to advance a decade later.

Early efforts in Europe included distribution systems set up by a Scottish pharmacist and a Dutch users-advocacy group. Though the World Health Organization reports that both of these initiatives were initially deemed illegal by local authorities, governments throughout Europe eventually began to approve such programs to help halt the spread of HIV.

A 2004 WHO-sponsored study on the effectiveness of sterile syringe exchange programs noted that “providing access to and encouraging utilization of sterile needles and syringes for [injection drug users] is now generally considered to be a fundamental component of any comprehensive and effective HIV-prevention programme.”

The following were among the conclusions cited in the WHO study:

  • There is compelling evidence that increasing the availability and utilization of sterile injecting equipment by [injection drug users] reduces HIV infection substantially.
  • There is no convincing evidence of any major, unintended negative consequences.
  • Needle syringe programmes are cost-effective.

The study’s authors added that exchange programs also offer “additional and worthwhile benefits apart from reducing HIV infection,” such as increasing the recruitment of injection drug users into rehabilitation programs and primary health care facilities.

Estimates of the number of syringe exchange programs in the United States vary from 185 to 250, with programs being run by private outreach organizations, health clinics and hospitals, and, in some cases, public health agencies. Although several cities, counties, and states have approved and provided funding for exchange programs, the U.S. government does not allow any federal money to be spent on the effort.

The U.S. moratorium has been in effect since 1988. In March 2007, Dr. Peter Havens of the Medical College of Wisconsin told the Associated Press that American legislators have been slow to approve and subsidize syringe exchange programs because of fears they would be seen as tacitly approving of the drug use itself. “Funding for needle-exchange programs in the United States has always been difficult because the governmental bodies have never wanted to support what they see as a morally slippery intervention,” Havens said.

The Global Health Council, an independent nonprofit organization focused on world health issues, is much blunter in its evaluation of the U.S. government’s position. The GHC describes the continued federal ban on funding the programs as “a striking failure to resolve political and ideological differences despite nearly two decades of experience and a clear scientific and medical consensus in favor of these programs.”

In U.S., the Debate Continues

Though the U.S. government’s moratorium on federal funding for syringe exchange programs has been in effect for almost two decades, opponents of this policy have not been without their successes. For example, in 2007 an appropriations bill that included legislation lifting the ban on Washington, D.C.’s, city sponsorship of exchange programs was passed into law, allowing the district government of the nation’s capital to use tax dollars to support syringe exchange programs.

This decision was applauded as an important step in the fight against HIV and AIDS, as Washington, D.C., has the nation’s highest rate of new AIDS cases.

On February 7, 2008, the National Urban League, the NAACP, and several other organizations announced their participation in a campaign to convince the federal government to lift its funding ban. Coinciding with the observance of National Black HIV/AIDS Awareness Day, the announcement also called attention to the fact that though black citizens account for only 13 percent of the U.S. population, they comprise almost half of all new AIDS cases.

Rep. Barbara Lee of California, one of the leading voices in the fight to overturn the federal ban, told MSNBC that syringe exchange programs provide the dual benefit of protecting against the spread of disease while also aiding in the fight against addiction itself.

 “These programs are the way you really reach these drug users and help them end their addiction,” Lee said.

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Viewed in some circles as the less-threatening "little brother" of the dangerous and highly addictive crystal meth, amphetamine remains a significant threat to the adolescents and adults who use the drug in misguided attempts to fight off fatigue, enhance concentration, or gain a competitive edge in an athletic event.

 

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