By Joel Sjerven For the St. Louis American
Dec 30, 2019
A needle exchange program offers sterile needles to people who inject drugs. This harm reduction intervention has been effective at decreasing risk and improving the quality of life for those affected. Needle exchange is a low-cost intervention which saves $100-$1000 per case of HIV avoided, according to a 2018 study of such programs in Central Appalachian.
Needle exchange programs have proven to be particularly effective at reducing HIV and hepatitis C transmission, according to a 1997 study published in The Lancet.
Alderwoman Cara Spencer introduced a bill on November 8 to legalize such programs in St. Louis.
“For such a long time, actions towards individuals that inject drugs have been punitive,” Dr. Fredrick Echols, director of the St. Louis Department of Health, told St. Louis Public Radio. “This will be one of the first times I think in the history of St. Louis we’re actually reaching out to them provide some of the support they need.”
Spencer told St. Louis Public Radio that the program also “creates that point of intervention where those service providers can introduce those folks to other services available to them that could address their addiction.”
As Spencer points out, needle exchange programs are often used as points of contact to build relationships and offer education and other services. Services offered include other harm-reduction interventions, medical care, social services, referral to drug treatment, HIV and hepatitis testing, medication assisted treatment, condoms, and vaccinations. People who access needle exchange programs are five times as likely to engage in treatment, according to a 2019 study published in the Journal of Psychosocial Nursing and Mental Health Services, while no evidence supports the idea that substance use disorder is reduced by mandated detention.
Needle exchange programs are inexpensive, ranging between $23 to $71 per person annually. The range depends on where the program is offered and how the needles are exchanged. Examples include pharmacies, vending machine, or mobile outreach vehicle. There are also several methods for collecting used syringes, including drive-up drop boxes, pharmacists, and mobile outreach teams. When there are not programs to collect used needles, they are often found in rivers, abandoned houses, and public parks.
Impact on disease transmission
In the United States 26,000 cases of AIDS resulted directly or indirectly from injection drug use in 1995, making up 35 percent of all new cases that year. In West Virginia injecting drug users accounted for 10 percent of HIV transmission cases. In 2018 West Virginia found that 25-40 percent of acute hepatitis C cases listed injection drugs as a potential source of infection.
Needle exchange programs have been effective at stemming these transmissions. In Australia needle exchange reduced the HIV rate by 74 percent over 10 years, saving as much as $5.5 for each dollar invested. Tacoma, Washington had an over 60 percent reduction in risk of hepatitis contraction associated with the implementation of a NEP.
Cities with needle exchange programs reduced HIV rates by 5.8 percent, while those without increased by 5.9 percent, accounting for an 11 percent average difference between cities that have these programs and those that don’t.
As many as 19 percent of people who inject drugs have been diagnosed with HIV. A leading causing of transmission is sharing a needle with another person who has been infected. In Baltimore, 56 percent of needles were found to have been used by multiple people. A Canadian study found that in Edmonton 37.8 percent of needles had been shared, and 88.7 percent of new needles had been received from a needle exchange program.
Worldwide it is estimated that 90 percent of people who inject drugs don’t have access to needle exchanges. In the United States, the West had the best access for rural people, with 30 percent, compared to the South having the least at 7 percent. Urban locations showed the opposite results with 86 percent of people in the South having access, compared to 51 percent in the West.
Needle exchange programs are recognized as one of the most cost-effective interventions for public health. The cost effectiveness of preventing transmission of HIV and hepatitis C has routinely been found to be lower than treating the disease after transmission.
A 2014 study found that each dollar invested in needle exchange programs saved at least $6 in costs averted from HIV transmission. Each HIV infection delayed by one year is expected to save over $7,000. Preventing HIV through needle exchange programs can cost between $4,000 to $12,000, but treating a patient with HIV can cost as much as $190,000.
A 10-year overview of Philadelphia found that their NEP Prevention Point prevented 10,592 cases of HIV. The savings were calculated using $230,000 per lifetime HIV costs and found to save Philadelphia $2.4 billion over ten years.
Despite the effectiveness and cost savings associated with needle exchange programs, there is an issue of sustainably funding them. Several smaller harm-reduction efforts have been closed when not adequately funded. These programs are usually state-funded. Federally funding would provide more financial sustainability, but was federally blocked until the Consolidated Appropriations Act of 2016.
Currently, 50 percent of needle exchange programs in the United States are run by non-governmental organizations, but are often operated and guided by local and state health departments. One of the largest barriers they face is the legal challenge of criminalized syringe possession. Needle possession is still a crime in many states.
Despite being illegal in some states, law enforcement in Central Appalachia has grown supportive of the program. Needle exchange programs there faced unexpected demand. Even with police and community support, they couldn’t maintain financial solvency without federal funding. Without substantial federal funding and decriminalization of syringes NEPs will have difficulty operating. Without addressing barriers to needle exchange programs, policy makers are promoting the sharing of needles, leading to transmission of blood-borne diseases.
Needle exchange programs are an evidence-based, harm-reduction strategy that have proven to be cost effective and to reduce blood borne transmissions. They are not associated with increases in crime or drug use. Harm-reduction approaches such as needle exchange programs can save more lives and money by scaling up these proven approaches. They exemplify that small investments can result in large savings. These savings can be reinvested in other services for people who inject drugs, such as housing and overdose prevention. Criminalization of syringes is the largest barrier to full implementation of needle exchange programs in the United States. Passing the legalization of needle exchange programs in St. Louis, could provide support for progressing similar legislation at the state level.
Joel Sjerven is a social worker who has served people who use drugs, people with mental illness, and those experiencing homelessness. He will graduate from UMSL in December with his Master of Social Work.