“When people look at the data and are faced with the real challenges, they see that these are programs that save lives and save money.” ~ CDC Director Tom Frieden Needle exchange programs have been politically and socially controversial for decades, but research has shown that they are a crucial element of addressing the public health aspect of drug use and abuse. For instance, now-Vice President Pence stood against needle exchange programs in the state of Indiana, but reversed his position when the state faced the worst outbreak of HIV infections in the history of Indiana – caused primarily by needle sharing. Is it possible that these programs may serve the interests of public health and safety? There is no easy answer to this question, but understanding what needle exchange programs are and where their purpose lies can go a long way toward giving you the tools you need to create an informed opinion. You can find answers to all of your questions here, including:
- What are needle exchange programs?
- How do needle exchange programs work?
- Why are needle exchange programs controversial?
- Why are needle exchange programs?
Of course, it is not easy to come up with an answer to whether or not needle exchange programs are the ideal response to a health epidemic as the result of drug use. After all, some would argue that needle exchange programs enable drug users in their habit. Ideal or not, there is no question that needle and syringe programs as public health initiatives are an essential part of reducing the detrimental health effects of continued drug use. More than that, these programs have important implications for drug users – and even those in recovery – all around the country.
What You Should Know: What Are Needle Exchange Programs?
From steroids to heroin, the story is largely the same: the administration of drugs represents a substantial health hazard beyond the detrimental effects of the drug itself. Quite a few drugs can be administered intravenously – that is, the drug can be taken via a hypodermic needle or syringe. Because there is commonly a shortage of needles among drug users, sharing needles for injection has become something of an undesirable norm for those who use drugs. Whether from stigma or prohibitive cost, drug users often turn to previously used needles in order to inject with their drug of choice. The danger with this is found in the fact that used needles and syringes can contain HIV, or human immunodeficiency virus. With this in mind, it is clear that sharing needles for drug use represents a substantial health issue. This is where needle exchange programs come in. Needle exchange programs, otherwise known as needle and syringe programs, are public health initiatives ultimately aimed at reducing the prevalence of HIV in drug users. The idea, as one can surmise from the name of the intervention, is to provide clean needles to drug users as a means of reducing the risk of HIV transmission through drug injection. Because the recommended number of needles per year to avoid HIV transmission altogether is 200, providing enough clean needles requires a significant public health intervention. Unfortunately, these programs have received little legislative support: as of this year, only seventeen states (along with Washington D.C.) have legalized needle-exchange programs. These public health initiatives do not stop just with needle exchanges. According to Avert, which actively works toward providing global information and education on HIV, states that many programs work to reduce other harms associated with injecting drug use. As Avert notes, they do so by providing a variety of additional services and counseling:
- Advice on safer injecting practices
- Advice on minimizing the harm done by drugs
- Advice on how to avoid and manage an overdose
- Information on the safe handling and disposal of injecting equipment
- Referrals to HIV testing and treatment services
- Help to stop injecting drugs, including access to drug treatment and encouragement to switch to safer drug taking practices
- Other health and welfare services (including condom provision)
Needle exchange programs, then, are not only about providing drug users with safe needles. They are also aimed at reducing drug use overall. The key is that these programs treat drug use and abuse as a health issue rather than a criminal one. As you will see below, this can make all the difference. 
What You Should Know: How do Needle Exchange Programs Work?
By now it is clear what the purpose and role of needle exchange programs are as a response to drug abuse around the world. But what do these programs look when they are implemented? Despite having the same overarching goals, not all needle exchange programs look the same in practice. Depending on the program, and which country it is located in, needle exchange programs are delivered in a variety of ways. The more common delivery methods for needles include:
- Fixed sites
- Mobile programs
- Outreach programs
- Syringe vending machines
- Pharmacies
As the name implies, fixed sites remain in the same location so that drug users know where to find them. Typically, this is in an area where drugs are bought and sold. Clients are able to enter the exchange site, where they hand in used injection equipment and receive new needles or syringes. The main benefit, besides consistency for those in need of clean needles, is that these programs are better able to provide additional services to clients, such as HIV testing, healthcare and even drug counseling. In contrast, mobile programs operate from a bus or converted van, distributing injection equipment directly from the vehicle. These can reach more clients than fixed sites, as they are usually more accessible – particularly for communities with lower populations. Related to this, outreach programs combine mobile distribution sites with the aim of reaching those who would not otherwise utilize or engage with other forms of a needle exchange program. This usually consists of a one-on-one interaction, with those working in the outreach program encouraging drug users to utilize the needle exchange program. Currently only in use in European countries, syringe vending machines are exactly what they sound like: stand-alone, unmanned units that accept tokens or coins in exchange for clean injection kits. This is the only way, so far, that needles and syringes can be provided 24/7. Finally, some needle exchange programs have partnered with pharmacies to deliver needles directly to clients. The benefit in this partnership is that pharmacies are usually established in the community and tend to have better hours of operation than fixed needle exchange sites.
What You Should Know: Why Are Needle Exchange Programs Needed?
Now that there is some understanding of what needle exchange programs are and how they work, there still remains an important question: are these public health initiatives accomplishing better health outcomes in the communities they are working with? Based on the quote below, from the director of the Centers for Disease and Control, the answer is clearly ‘yes’. “The big picture here is that we’ve had a lot of progress reducing HIV infections spread by needles and we’re at risk of stalling or reversing that progress. As a result of the opioid epidemic, more people appear to be injecting drugs, more people are sharing needles, and there are more places not covered by syringe service programs.” ~ CDC Director Tom Frieden Needle exchange programs are controversial because some perceive them to be a kind of enabler to drug users and addicts. However, this criticism ignores the fact that a great many drug users face a danger to their health that extends beyond the effects of the drug itself. Rather than encouraging drug use, needle exchange programs are simply aimed at making the process much safer and finding a way to engage clients. A more robust list of the reasons needle exchange programs are needed includes the following:
- They help reduce the risk of HIV infection associated with drug injections
- They increase the possibility of intravenous drug users seeking treatment for addiction
- They are a cost-effective means of addressing the significant burden on health care that HIV infections have become
- Given the various ways needle exchange programs can be implemented, they are flexible to the needs of individual communities
- They help reduce the levels of stigma and discrimination associated with drug use, instead recognizing that drug addiction is a mental health issue with physical effects on the user
More often than not, drug users and addicts are not offered the health and mental treatment that they need for recovery. Implementing needle and syringe exchange programs around the country could be a start to changing that reality.