In March 2019, Governor Brad Little signed into law legislation that will allow needle exchanges in Idaho. Earlier this year, the original bill passed by a wide margin, 47 to 20 in the State House and 22 to 11 in the State Senate. The new law will take effect on July 1st.
“While substance abuse prevention and treatment remain vital, it is also essential that the health consequences of injection drug use be mitigated by needle exchange programs.”
~ Al Lamberti, former Sheriff, Broward County, Florida
This newest step aimed at addressing the ongoing drug crisis in Idaho is not without controversy. While supporters say that needle exchanges and other so-called “harm reduction” measures save lives, opponents say these kinds of programs enable and even encourage illegal drug use.
Here, we will take a look at what you need to know about clean needle programs, as well as the expected pros and cons of this huge step for the State of Idaho.
What You Need to Know about Needle Exchanges
Needle exchange programs establish sites where users of intravenous drugs like heroin, cocaine, and methamphetamine can go obtain sterile needles for free, with no questions asked and no interference from law enforcement. Any used needles that are brought in will also be safely and properly disposed of.
According to Aimee Shipman, who works for the Idaho Department of Health and Welfare as the Section Manager for HIV, STD, and Hepatitis, the new program will have three main public health goals:
- To stem the opportunity for disease transmission that can happen when addicts use contaminated syringes
- To expand the opportunity for referrals to drug treatment programs
- Safe disposal of used needles, thereby preventing accidental infections within the community
It is important to understand that needle exchange programs are not implemented to stop drug abuse. They are put in place as a means of reducing the public harms resulting from a drug epidemic that has been called the worst public health crisis in American history.
Why are Needle Exchanges Needed in Idaho?
Of all the ways to consume drugs, intravenous injection carries the most risks. By bypassing the body’s natural filters, IV drug users are at far greater risk for infection from bacteria or viruses such as HIV, AIDS, or Hepatitis B or C.
- From 2002 to 2013, heroin injection in the United States increased by 63%.
- In 2015, Idaho State Police seized 800% more heroin than they did in 2014.
- During that same timeframe, the Domestic Highway Enforcement Team handled a 775% increase in heroin cases.
- The ISP reports that methamphetamine cases tripled during that one-year period.
- 63% of Idaho law enforcement officers responding to the National Drug Threat Survey call meth the greatest drug threat in the region.
- Among People Who Inject Drugs (PWID) who have been doing so for less than five years, up to 40% admit to sharing needles.
- In 2015, the Centers for Disease Control and Prevention found that 9% of new HIV infections are directly attributable to IV drug use.
- This is very significant because PWID only makes up between 1% and 3% of the population.
- However, in Idaho, the number is significantly higher. Among males, over 11% of new HIV cases involve IV drug use. And among females, the rate is over 12%.
- Of special relevance, the HIV virus can survive within the blood found in a used needle for up to 42 days.
- Even washing a needle with bleach does not kill the HIV virus.
- In 2016, up to 20% of U.S. males living with HIV had contracted the disease from IV drug use. Among women living with HIV, the rate was 21%.
- Again, those infection rates are significantly higher in Idaho. Among HIV-positive Idaho men, IV drug use is involved in over 25% of cases. Among Idaho women living with HIV, more than 29% of cases are attributable to IV drug use.
- In 2016, 13% of AIDS diagnoses were among PWID.
- 56% of HIV-positive PWID are homeless.
The CDC has also recently confirmed that new Hepatitis C infections in America nearly tripled from 2010 through 2015. The single largest contributing factor was intravenous opioid abuse.
- Hepatitis is 10 times more transmissible than HIV.
- In 2010, there were “only” 850 confirmed new Hepatitis C infections.
- By 2015, that number had jumped to 2436.
- But because there few symptoms of Hepatitis and testing is limited, the CDC has estimated that the real numbers are probably much higher. Up to 34,000 Americans may be living with Hepatitis.
- Up to 90% of HIV-positive PWID also have Hepatitis C.
- There were nearly 20,000 Hepatitis C deaths in 2015.
- Of special relevance, people between the ages of 20 and 29 experienced the newest infections.
- 33% of PWID between the ages of 18 and 30 are infected with Hepatitis C.
- Among older and former PWIDs, the rate of HCV infection is estimated to be between 70% and 90%.
The Hazards Go Beyond HIV and Hepatitis
Although HIV, AIDS, and Hepatitis all of the disease are most often thought of in connection with IV drug use, there are a number of other serious health conditions that go largely unmentioned:
- Staph infections
- Necrotizing fasciitis
- Septic Thrombophlebitis
- Bacterial endocarditis
This last condition, endocarditis, is a potentially fatal bacterial infection of the heart. Although it is normally the result of a heart defect, it can also be caused by the use of unsanitary needles. Bacteria from the needle directly enters the bloodstream and quickly reaches the heart.
IV drug users with endocarditis are 10 times more likely to die or require a second surgery than other patients.
The Controversy Surrounding Needle Exchanges
Even though the goals of needle exchanges and other harm reduction programs are lofty, they are still a very controversial response to the drug crisis. The biggest complaint is because their goal is NOT to stop drug use or to treat HIV, AIDS, Hepatitis, or any other medical condition.
The philosophy of harm reduction programs is that illicit drug abuse is an unfortunate reality, so the best response is to find ways to limit the personal and public harms that it causes. Criticisms of exchange programs include:
- Enabling continued IV drug abuse
- Normalizes, or even increases IV drug use
- Encourages even more drug use within the community
- “Centralizes” drug use and criminal behavior in the neighborhoods where the needle exchanges are located
- Not a viable solution for rural areas
This could be a significant stumbling block for Idaho’s program. 29% of the state’s population lives in a rural area.
But supporters say there are many positives that come with needle exchange programs:
- Fewer contaminated needles within the community
- A decrease in new infections
- Reduced criminal and drug-related behaviors
- Reduced high-risk sexual behaviors
- Expanded outreach to marginal populations
- Better access to education about substance abuse
- Increased availability of diagnostic and testing services
- Access to drug rehab referral services
The WHO Weighs In
“(there is a) compelling case that (needle and syringe programs) substantially and cost-effectively reduce the spread of HIV among IDUs and do so without evidence of exacerbating injecting drug use at either the individual or societal level.”
~ World Health Organization
In 2004, a report by the World Health Organization concluded that:
- More clean needles mean fewer HIV infections.
- Needle exchange programs are cost-effective.
- Harm reduction services help facilitate recruitment into drug rehab.
Reduces the Spread of Infectious Diseases
“SSPs [syringe services programs] are widely considered to be an effective way of reducing HIV transmission among individuals who inject illicit drugs and there is ample evidence that SSPs also promote entry and retention into treatment.”
~ Dr. Regina Benjamin, Office of the U.S. Surgeon General
Because of legal restrictions and prescription requirements, PWID can find it extremely difficult to use a clean needle for every injection. This is why needle-sharing is so common. IV drug users who are afraid of being arrested while carrying drug paraphernalia are almost twice as likely to share needles.
This also explains why exchange programs that place limits on how many clean needles they distribute are less effective than those with no limits.
The CDC reports that when combined with other services, even “moderate” increases in infection treatment among PWID can lead to significant decreases in the incidence and prevalence of new infections.
A number of studies investigated how New York’s exchange programs affected the spread of blood-borne diseases between 1990 and 2002:
- HIV prevalence dropped from 50% to 17%.
- Person-years at risk for HIV declined sharply, from over 3 years, 6 months, to approximately 9 months per 100 person-years.
- Among HIV-negative PWID, the prevalence of HCV infections dropped from 80% to 59%.
Similarly, when the District of Columbia Department of Health initiated a needle exchange program, there was a 70% decrease in new HIV cases among PWID.
Increases Access to Drug Treatment and Health Services
“I understand that research has shown these programs when implemented in the context of a comprehensive program that offers other services such as referral to counseling, healthcare, drug treatment, HIV/AIDS prevention, counseling, and testing, are effective at connecting addicted users to drug treatment.“
~ Gil Kerlikowske, former Director of the White House Office of National Drug Control Policy
It must be understood that needle exchange programs do not explicitly try to stop IV addicts from using drugs and they do not directly offer any form of treatment.
However, that does not mean that clients are not exposed to education, safety information, and the availability of local resources and treatment options. Pamphlets are available, and anyone who expresses a desire to get help are put in touch with detox and treatment programs.
New needle exchange clients are five times more likely to enter drug rehab programs than non-participants. Equally, as encouraging, research shows that participants are also more likely to reduce or even stop injecting drugs altogether than those who do not exchange needles.
In fact, exchange programs usually offer a lot more than just clean needles, including:
- Safety practices
- Information on avoiding overdose
- Narcan distribution and training
- Referrals to clinics that test for and treat HIV, AIDS, Hepatitis, and other conditions
- Provision of condoms
- Appropriate health, welfare, and hygiene services
Protects the Local Community
In 2012, Drug and Alcohol Dependence published a study that compared a city without needle exchanges – Miami – to San Francisco, a city with such programs.
Over 8 times as many used needles were found on Miami streets than there were in San Francisco. Not surprisingly, IV drug users in Miami admitted to improperly disposing of their needles far more often than their San Francisco counterparts. In 2000 alone, 3.5 million used syringes were collected and safely disposed of in San Francisco.
Similarly, after exchange programs were put into place in Portland, Oregon, the number of improperly discarded syringes dropped by nearly two-thirds.
Bob Scott, formerly a Captain in the Macon County, North Carolina, Sheriff’s Office, said, “(Exchange programs) take dirty needles off the streets and increase the safety of our police officers.”
In a survey of San Diego police officers, nearly 30% reported suffering into the needle stick injury at some point in their careers. And among those, 27% experienced multiple stick injuries. When Connecticut implemented the exchange programs, stick injuries among police officers decreased by two-thirds.
Other first responders are also at risk. In 2011, Charles Aughenbaugh, the President of the New Jersey Deputy Fire Chiefs Association, said, “In the cities that have adopted needle exchange programs, there is a dramatic reduction in needle sticks to firefighters who crawl on their hands and knees through smoke-filled rooms to search for victims.”
Finally, contrary to critics’ worries, exchange programs are not associated with an increase in crime. In fact, in Baltimore, neighborhoods with needle exchange programs saw an 11% decrease in burglaries and break-ins. That reduction is even more interesting when you consider that at the same time, the city as a whole was experiencing an 8% increase in crime.
Are Needle Exchanges Cost-Effective?
Stopping the spread of new infections automatically reduces the lifetime medical costs. For example, using the New York City needle exchange program saved the local government between $1300 and $3000 per client per year.
It is estimated that every $1 spent on clean syringes grants a return on investment of $7.58.
Also, many harm reduction programs rely heavily on private donations, rather than just taxpayer money.
Special Challenges for Idaho
Even though it is now a law, there are still wrinkles that need to be worked out:
- Exactly how these needle exchange programs are to be implemented has yet to be determined. They can be established in clinics, pharmacies, storefronts, or even temporarily on the sidewalk in neighborhoods when drug use is high. Some programs are mobile, operating out of vans that go where the need is greatest.
- The locations must also be considered. Obviously, needle exchanges are expected to be put in place in the larger cities of Boise, Meridian, and Nampa, but because there are so many rural communities in Idaho, thought must be given to how to service the rest of the state.
But by far, the biggest barriers to the successful implementation of any start-up needle exchange programs in Idaho are misinformation and preconceptions about addiction as a problem and harm reduction as a response.
Even though addiction is recognized as a legitimate medical condition known as Substance Use Disorder, there is still a great deal of stigma attached. Too many people are still under the impression that drug abuse is somehow a choice, rather than a disease of the brain that removes choice.
And as long as that negative perception exists, it will extend to harm reduction programs like needle exchanges. It will be up to officials to educate the public, learn from successful programs around the country, and reach out to those IV drug addicts who are most in need at at-risk.
The Bottom Line about Needle Exchanges in Idaho
Even though it is not a perfect solution, this new Idaho law is at least a positive step in the right direction. Needle exchange programs reduce crime, protect public health, ensure the safety of emergency personnel, and save lives that might otherwise be lost to disease or overdose. These are efforts that should be recognized and supported.
At a bare minimum, needle exchanges help keep IV drug users alive longer, until such time as they are ready to get help. And when they are ready, they can be quickly referred to an appropriate drug rehab program. This is should be the ultimate goal of any harm reduction program.
Northpoint Recovery applauds any evidence-based efforts at reducing the deaths caused by drug abuse and addiction. For more information about what you can do if you or someone you care about is abusing intravenous drugs or any other substance, click here.