Syringe Exchange Programs and Their Positive Impact on Communities
Syringe Service Programs (SSPs), also referred to as Syringe Exchange Programs or Needle Exchange Programs, are community-based programs that provide access to safe disposal of clean needles and syringes. The name, however, does not do justice to the variety of services provided by these organizations, such as substance use treatment program referrals, screening and care for hepatitis and HIV, education about overdose prevention, and vaccinations, among many other necessary services. In addition, many SSPs provide integrated services to address overdose, addiction, unintended pregnancy, neonatal abstinence syndrome, and other complications of injection drug use (IDU). However, many legislative leaders have pushed back on these useful programs — causing them to be shut down or restricted in ways that limit their effectiveness. Laws have been implemented that reduce, and even eliminate, SSPs altogether in communities that need them most. Communities currently fighting against these SSP closures are Kanawha-Charleston, West Virginia; Scott County, Indiana; and Atlantic City, New Jersey.
Numerous studies have illustrated the positive impact that SSPs have on communities of people who use drugs (PWUD). PWUD who utilize SSPs regularly report a reduction in drug use frequency compared to those who have never used an SSP. Also, when PWUD use these programs, they are more likely to enter treatment than those who do not. Due to the high risks of people who inject drugs through sharing needles, syringes, and other injection drug use equipment, these programs provide a safe and secure way to not only receive sterile injection tools but also to receive education about staying safe. Subsequently, this education can be shared among the community, reaching even people who use drugs but do not engage in SSP programs.
In addition to reducing drug use among PWUD, SSPs have also been proven to have a high impact on health care cost reduction by increasing cost-savings for the community of people who use SSPs. The estimated lifetime cost of treatment for HIV is $420,285 (as of 2019), while the estimated cost per client per year is about $661 for a large rural SSP. In addition, between 2013 and 2019, federal Medicaid spending on HIV increased by 60%, rising from $3.97 billion to $6.3 billion. SSPs save thousands of health care dollars annually by reducing HIV and other disease transmission rates, as well as help uninsured adults enrolled in Medicaid and link SSP users to needed programs. A national survey of syringe exchange and syringe service programs in the United States found that 97% of these programs provide a variety of public health services, including referrals to substance abuse treatment, services for homelessness, services for employment, and other useful resources that the community of PWUD needs the most.
Communities That Are Looking To Eliminate Syringe Exchange Programs After Their Proven Success
Kanawha-Charleston, West Virginia: Spreading False Information and Instilling Fear Among Their Community Members
One example of a community facing SSP closures despite the critical need is the rural county of Kanawha-Charleston, West Virginia. In 2015, the Kanawha-Charleston Health Department launched the first syringe exchange program in the area (KCHD SSP). Despite the many challenges facing their SSP success, by 2018, the KCHD SSP increased from serving less than 100 PWUD per month to a total of 400 per week. Public health officials were astonished at the volume of individuals served considering the many barriers faced by a rural SSP.
Unfortunately, political forces at play caused the downfall of this program, despite vast research that demonstrates the program’s effectiveness. In an interview held in early March 2018, former chief of police of Kanawha-Charleston warned that any officer stuck with a needle would not be able to kiss anyone for a year due to their infection. Not only was this information false, it also was intended to provoke fear and further perpetuate false beliefs about the SSPs. Furthermore, the outgoing mayor during the November 2018 election was a very vocal opponent to SSPs, referring to them as “needle mills” to the public and blaming them for the increase in crime rates that year.
Recently, an additional attempt to eliminate harm reduction programs from operating was put into place with the signing of Bill 334 by Governor Jim Justice, which was set to take effect on July 9, 2021. While this law does not eliminate SSP programs completely, it places harsh restrictions on these programs, thus preventing them from being as effective as they could be. Some of these restrictions require the following: that the SSP provide their clients access to 24/7 rehabilitation or detoxification services; that the serial number of every discarded needle be tracked; and that the programs must only run a 1:1 syringe exchange model where a new syringe is only provided to participants who can provide a used one in exchange. In a promising turn of events, as of June 28, 2021, the United States District Court for the Southern District of West Virginia issued a temporary restraining order to block the implementation of Senate Bill 334, which would place a temporary hold on the restrictive law until further review. On July 2, 2021, several pre-eminent West Virginia health experts — including Dr. Cathy Slemp, the former acting state health officer — filed a friend-of-the-court (or “amici”) brief in support of the lawsuit requesting a federal court in Huntington to issue a preliminary injunction enjoining the enforcement of Senate Bill 334. The hearing for the motion took place last Thursday in Huntington, WV. Although there is much work to be done, this gives hope for a better future.
Scott County, Indiana Is Looking To Get Rid of Exchange Programs After They Temporarily “Fix” the Issue of HIV Outbreaks
Scott County, Indiana, is another example of a county allowing political influences to persuade leaders to phase out needle exchange programs. In 2015, rural Scott County found itself in one of the largest HIV outbreaks caused by needle and syringe sharing. Former Vice President Mike Pence — who was the governor of Indiana at the time — approved the state’s first syringe exchange program in response to this national crisis. During the outbreak, 235 people became infected with HIV, most of them within the first year of the outbreak. After the syringe exchange program was implemented, the number of infected persons dropped significantly. While many credited the needle exchange program for the fall in new cases, on May 26, 2021 — only 6 years after the outbreak — commissioners voted to end the program. President of the Commissioners Mike Jones blames the program for leading PWUD to use more frequently. This erroneous claim has been dispelled through various studies by organizations, such as the Foundation for Aids Research (AmfAR), which says that the claim that SSPs promote or increase drug use is simply not true and when combined with other programs, they actually do just the opposite. Supporters of the syringe exchange program, including Michelle Matern, Scott County’s health administrator, warn that ending the program at this time could cause the county to revert to where it was in 2015. Still, fear and miseducation about syringe exchange programs are leading yet another at-risk county down the wrong path of needle exchange elimination.
Atlantic City, New Jersey Seeks To Enhance Tourism at the Expense of a Successful Syringe Exchange Program
Atlantic City, New Jersey, is home to one of the largest syringe exchange programs in the United States serving over 1,200 clients. This July, its city council voted in favor of shutting down this syringe exchange program, despite the positive impact it has had on this community. As with both Kanawha-Charleston and Scott County, political factors are the main reason for the upcoming closure while choosing to ignore the proven track record of the syringe exchange program. Additionally, city officials are interested in making the city more appealing by eliminating the program they believe could discourage tourists from frequenting the oceanside city. The Oasis Drop-In Center, which runs Atlantic City’s only exchange program, helped reduce HIV infections by 50% since its inception in 2007. Still, Atlantic City has a lot of work to do. New Jersey experienced a record 3,046 people die from opioid overdoses in 2020, indicating that shutting down the syringe exchange program at this time would prove to be counterproductive.
Looking to the Future
Three jurisdictions that are most at risk for overdoses and the spread of communicable diseases are the very same places looking to eliminate the programs that have proven to be highly effective at reducing these public health problems. Political leaders are ignoring science and clear evidence of the public health benefits of these programs, and instead are choosing to uphold their alliance to false ideals about SSPs and ignore their impact on the communities they serve. The choice to remove safe needle exchange programs from communities most at-risk only serves interests outside of the public health and safety of the community members and is an irresponsible exercise of political power and community leadership. As long as there are people who are sharing needles and putting themselves at risk for contracting life-threatening diseases, there is a need for these programs to exist. It is time that the health, safety, and needs of the most vulnerable in our community are placed above political agendas.
Tarihya McClain is former research assistant at the O’Neill Institute and a third-year J.D.-MHA student at Saint Louis University School of Law.