Will The Tide Of Opinion On Needle Exchange Programs Change?

America is a nation in the grips of a heroin epidemic, and the number of heroin users in the country has exploded in the last decade. On Wednesday 3rd November, the 2015 National Drug Threat Assessment Summary was released and it found that heroin availability is at an all-time high across the country, and is now considered to be the country’s number one drug threat. In conjunction with this, the heroin death rate has quadrupled over the last decade, reaching an annual rate of 8,300 according to the most recent statistics. There are a myriad of reasons for this increase in numbers of heroin addicts across the nation, however it is thought that one of the main factors is the huge clamp down on the abuse of prescription pharmaceuticals in the country.  In 2014, the DEA made the decision to restrict the use of many of the country’s most common prescription opioid painkillers(such as Oxycontin and Demerol), in a bid to clamp down on the number of Americans addicted to them.  The new restrictions meant that rather than be automatically issued a repeat prescription, patients would have to see their doctor to be issued with a new script every 90 days. These tight new restrictions meant that not only were prescription painkillers harder to obtain, they were also more expensive to secure illegally on the black market.

Heroin and opioid painkillers are both derived from the poppy plant, meaning that their chemical structures are very similar, as are the effects that they have on the body and on the receptors in the brain. The result of this is that, rather than seek help and rehabilitation, many of the millions of Americans who were addicted to prescription painkillers instead turned to the cheaper and easier to secure option of taking heroin. This has lead not only to an unprecedented epidemic of heroin use in the country, but also huge numbers of new cases of HIV/AIDs as a result. This means that, once again, the debate around whether or not needle exchange programs can be beneficial in treating these dual epidemics across the country is at the forefront of the public psyche.

The Impact of Changes in Florida

Florida has historically always been a conservative state, and one of the states with the most vocal opposition to the introduction of needle exchange programmes. However, at the beginning of November, state law makers have (for the fourth time) given their full support to the introduction of a needle exchange program in Miami-Dade County. Like many other states, Florida is a state struggling with an epidemic of both HIV/AIDs and hepatitis B and C as a result of their increased number of heroin users, and law makers, medical professionals and other officials hope that by introducing a needle exchange program in their district, they can begin to reverse this trend.

The much-needed bill is being sponsored by Oscar Braynon, and it is hoped that it will be successful this time as the plan is for the program to be fully funded by private donations; no state or local funds would be ear marked to go into the program. If the bill is successful then it could mark a huge victory for those in Florida hoping to reverse the rising HIV epidemic that the state is experiencing and blossom into a program that could be rolled out across the whole state. An incredible 101,977 people in the state of Florida are already infected with HIV, according to the Florida Department of Health, and a fifth of those individuals are intravenous drug users. This figure is only set to rise. Florida was once informally known as the prescription drug capital of America, so it stands to reason that they would be most affected by this unexpected outcome of the clampdown on illicit prescription drug use. If this bill is successful, and passed in Florida then the nationwide impact will also be huge, marking the way for programs such as this to be introduced in every state, enabling the reduction of both intravenous drug use and HIV/AIDs infection across the nation.

What Are The Benefits of Needle Exchange Programs?

Whilst their detractors are very vocal about the negative aspects of needle exchange programs, claiming they make it easier for individuals to use illegal drugs, the fact is that they offer many practical benefits, both to heroin users and to states that are struggling with epidemics of diseases such as HIV/AIDs and hepatitis B and C as a result of this drug use. In reality, those individuals who turn to needle exchange programs are already utilising illegal drugs. Addiction is a cruel and debilitating condition that needs both understanding and support if we ever hope to reduce the number of addicts in the country: needle exchange programs can often go some way to providing that support. Needle exchange programs allow intravenous drug users to both safely discard their used needles (preventing needle sharing and anyone becoming accidentally sticked with an infected needle) and receive new, clean needles which will again minimise the risk both of infection and cross contamination.

Whilst at their most basic level, needle exchange programmes allow individuals to access clean needles and exchange their used ones, they also offer other practical benefits of intravenous drug users. Many offer free HIV testing and free counselling for those who find they are infected with HIV/AIDs, which can serve the dual purpose of both providing empathy and compassion those who need it, whilst simultaneously equipping them with the knowledge they need to avoid spreading the disease and further infecting others. The most enlightened needle exchange centres will also offer support to their users who want to get help for their drug problem by providing them with referrals to treatment programs, support groups, and other services within their local area. These programs offer a halfway house for addicts that aren’t quite ready to be rehabilitated, but want access to help and support for when they are ready to take that final step.  The biggest opposition to needle exchange programs comes from those communities where they are proposed to be based, who don’t like the idea of bringing addicts into their neighbourhoods. By handling the locations of needle exchange programs sensitively, it is possible to ensure that they are set up in areas where they will have a minimal impact on the local community and ensure that the needs and concern of the community are both acknowledged and managed, to the satisfaction of all the parties involved.

Do Needle Exchange Programs Actually Work?

Providing heroin addicts and other intravenous drug users access to clean sterilised needles in order to help stem the spread of blood borne viruses (such as HIV/AIDs and Hepatitis) is a policy that has been approved by the World Health Organisation (WHO). In their official documentation, the WHO suggest that each drug injector should be provided with 200 sterile needles and syringes per year in order to ensure they are injecting as safely as possible and to effectively minimize HIV transmission via this route. One of the first states to introduce needle exchange programs as a result of the current heroin epidemic was Washington D.C and as a result they are able to show that their program prevented 120 new cases of HIV over a two year period, whilst not leading to any more drug use within the state. From a financial point of view, this means that over $44 million has been saved in lifetime HIV treatment costs for those individuals whose infected was prevented as a result of the program. A comprehensive report on the success of the needle exchange program introduced in New York, and that has been in place for more than 20 years, has also shown that syringe exchange programs are massively successful for dealing with HIV within the state; in fact, the program is described as “one of the most successful H.I.V. prevention initiatives of the New York State Department of Health AIDS Institute.” In 1992, 52 percent of newly diagnosed AIDS cases in New York were among I.V. drug users. By 2012, intravenous drug users accounted for only 3 percent of new H.I.V. diagnoses. This is clear evidence that needle exchange programs work, and that they are incredibly successful at helping to reduce the number of drug users and HIV infection right here within the United States.

Needle exchange programs are more widely available across the world than in the United States, where conservative forces are largely opposed to them. Elsewhere in the world the programs have also generally been established for much longer, meaning that they provide useful samples to measure the effectiveness and the efficiency of using the programs both to minimise the spread of HIV/AIDs and ultimately reduce and control the rates of intravenous drug use. Standard needle exchange programmes as we know them have been proven to reduce the rates of HIV infection considerably, and have also been shown to help slowly reduce the numbers of drug users where they are wide spread. Some countries, such as the Netherlands, Germany, Italy and Australia compliment their professional lead needle exchange program units with the use of 24 hour access syringe vending machines. These syringe vending machines accept both coins and tokens (which are typically distributed by outreach workers both on the street and within traditional needle exchange program units) in return for harm reduction packs. In Australia, these vending machine ready packs include several needles and syringes ensuring that those users have several days of the supplies they need. They also contain alcohol swabs, cotton wool, sterile water and spoons so that the ultimate cleanliness of every piece of equipment they need for their drug use is ensured. Other countries ensure their packs contain educational materials, in a bid to combine the dual aims of HIV and harm reduction with ultimate rehabilitation goals. All of this evidence combines to show that needle exchange programs do have a place in helping to overcome drug epidemics, and that a proactive and head on approach is the very best way of combatting the problem.

Removing the Stigma

Drug users are stigmatised in the United States, and are ostracized and driven away from mainstream society. This is a cultural mistake, and is actually creating a barrier for those intravenous drug users who do want to receive help and access rehabilitation services. It is clear that needle exchange programs are needed across the country in order to save lives, save money , and stem America’s out of control heroin epidemic. This week’s decision in Florida is a monumental one. By following Florida in opening up these programs to those individuals that need them, public opinion on the programs are likely to see an equally dramatic and positive shift, and we may be able to really see significant changes in both the heroin and HIV epidemics in the country in our lifetime.


[1] “The number of heroin user in the U.S has exploded over the last decade”, Business Insider UKhttp://uk.businessinsider.com/the-number-of-heroin-users-in-the-us-has-exploded-over-the-last-decade-2015-7?r=US&IR=T

[2] “DEA finds heroin use skyrocketing across U.S”, NBC Newshttp://www.nbcnews.com/news/us-news/dea-finds-heroin-use-skyrocketing-n457336 

[3] “Law makers propose needle exchange program to combat HIV/AIDs”, The Tampa Bay Times, http://www.tampabay.com/blogs/the-buzz-florida-politics/lawmakers-propose-needle-exchange-program-to-combat-hivaids/2252337

[4] “The pros and cons of needle exchange programs”, Recovery.orghttp://www.recovery.org/the-pros-and-cons-of-needle-exchange-programs/

[5] “O.C overdue for needle exchange program”, The Orange County Register, http://www.ocregister.com/articles/drug-689383-health-public.html

[6] “DEA restricts narcotic pain drug prescriptions”, The Wall Street Journal, http://www.wsj.com/articles/dea-restricts-narcotic-pain-drug-prescriptions-1408647617

[7] “Unintended consequences: Why painkiller addicts turn to heroin”, CNNhttp://edition.cnn.com/2014/08/29/health/gupta-unintended-consequences/

[8] “Needle and syringe programs (NSPS) for HIV prevention”, AVERThttp://www.avert.org/professionals/hiv-prevention-programming/needle-syringe-programmes

[9] “Report documents success of state needle exchange programme”, Politico New Yorkhttp://www.capitalnewyork.com/article/albany/2014/12/8557819/report-documents-success-state-needle-exchange-program

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