On this past Sunday’s episode of his weekly news show, Last Week Tonight, host John Oliver delivered a searing report on the lack of Congressional power the inhabitants of Washington, D.C. have been forced to struggle with since the city’s founding. While America’s fifty states are largely governed by their own laws, our nation’s capital is under the thumb of Congress and its federal rule – meaning that D.C. is most often used as a political pawn, while the desires and concerns of the city’s residents go ignored. In 2011, President Barack Obama avoided a government shutdown by permitting Republican Speaker of the House John Boehner to forbid D.C. from spending its own tax dollars to fund abortions for low-income women.
Later in the segment, Oliver disclosed that for nearly a decade, Congress had stopped the city from once again funding a program to help its socioeconomically disadvantaged citizens – a clean needle exchange, to aid in battling the HIV epidemic. One of the men responsible for this, Georgia representative Bob Barr, imparted these words in a 1999 Congressional hearing: “I would also remind our colleges of a very basic principle – if you give people the means to do something and encourage them to do it, well for heaven’s sake, no surprise, they will do it.” This is one of the main arguments made in objection to clean needle exchanges. But as Oliver retorted, “Providing clean needles to drug users is not that same as putting out a bowl of chips at a party. No one sees a needle exchange and thinks, ‘Well, I had no intention of ever taking heroin, but seeing as you’ve offered, don’t mind if I do!’” Barr’s comment is further skewered by the fact that, at the time, his home state of Georgia had a needle exchange program of its own.
The point I would like the reader to take away from this story is that in the nine years of Congress denying D.C., more than 1,500 of the district’s injection drug users were diagnosed with HIV. Since the city was finally able to fund its exchange in 2008, HIV diagnoses linked to injecting drugs have decreased by 87%. Because of course they did. As much as conservatives like to threaten that these programs fuel drug addiction and destroy communities by sending mixed signals about drug use to children and adolescents, there are few, some would argue no, negative consequences found to be associated with them. The simple truth is that needle exchanges save money and they save lives, and our country needs more of them.
For those who are unfamiliar, needle exchange programs (or NEPs) are a social service that allows injecting drug users (IDUs) to obtain clean hypodermic needles and associated paraphernalia for little or no cost in exchange for used needles. The goal of NEPs is to stop the spread of preventable diseases like HIV and hepatitis, while also safely disposing of contaminated needles. They also put drug users into contact with helpful people whom they probably would not have known previously – counselors, medical professionals, and social workers. Some NEPs operate out of stationary sites while others are mobile, and some are legally authorized while others are not. As of 2011, there were over 221 NEPs operating in the United States. (Green, Martin, Mann, & Beletsky, 2012, p. 10).
The most important reason that our country needs NEPs is their incredible impact on the reduction of intravenously spread diseases. Needle sharing “is the most dangerous behavior in terms of drug-related risk of HIV transmission,” and NEPs do more than any other program to stop this (Vlahov & Junge, 1998, p. 77). The first federally funded study of an NEP was an evaluation of a program in New Haven, Connecticut. The study relied on “mathematical and statistical modeling, using data from a syringe tracking and testing system” to determine the impact of the needle exchange in the community (Vlahov & Junge, 1998, p. 76). The results clearly showed that HIV infection among needle exchange participants had decreased by 33% as a result of the program (Vlahov & Junge, 1998, p. 76). In 1993, researchers at the University of California at Berkeley’s School of Public Health conducted fourteen studies on NEPs affect on needle sharing. Of those studies, ten showed needle sharing decreased and the remaining four showed that the NEP had no effect. None showed any increase in the sharing of used and dangerous needles (Lurie, Reingold, Bowser, Chen, Foley, & Guydish, 1993, p. 16). Three years later, in 1996, a group of New York City researchers published a study in which they estimated a 70% reduction in HIV incidence among attendees at a local NEP (Des Jarlais, Marmor, Paone, Titus, Shi, & Perlis, 1996, p. 988). I could find no study during my research which posited results different to the aforementioned examples – never did a NEP do more harm than good regarding to spread of infectious diseases.
Secondly, NEPs save hundreds of millions of dollars of taxpayers’ dollars which would otherwise be spent on HIV-related healthcare for the poor. It’s estimated that the average annual cost of HIV care per person in the United States is $15, 745, while individuals in an advanced stage of disease may be forced to pay as much as $40, 678 every year (Gebo, 2009, p. 1). As of November 2006, it was estimated that the cost of living with HIV for a lifetime is between $300,000 and $600,000 (Gebo, 2009, p. 1). According to the CDC, the average cost per clean needle at an NEP is $.97 – while the daily dose of HIV medication Truvada is $36.
As evidenced in the John Oliver example, conservative politicians have an arsenal of claims that they use to object NEPs. However, a final reason why I believe NEPs are such a benefit to our country is that there is data to conclusively discredit each argument presented by opponents. There is virtually no negative to these programs. One complaint often made, as previously stated by Bob Barr, is that NEPs will encourage drug use. According to Vlahov and Junge (1998), “a series of government-commissioned reports have reviewed the data on positive and negative outcomes of NEPs. The major reports are from the National Commission on AIDS; the U.S. General Accounting Office; the Centers for Disease Control/University of California; and the National Academy of the Sciences” (p. 76). The aggregated results conclusively stated that NEPs do not result in increased drug use among participants, or in the recruitment of first-time drug users.
Another debate is that these programs send a message of condoning drug use to children and adolescents. This is difficult to measure. However, in 1993, the University of California and the Centers of Disease Control conducted a longitudinal report which examined this question by monitoring drug-abuse-related emergency room admissions. Comparison of data before and after the opening of needle exchanges showed absolutely no increase (Vlahov & Junge, 1998, p. 77). From 1981 to 1986, IDUs under the age of twenty-two decreased from 14-5%. The NEP there opened in 1984. As Vlahov and Junge (1998) state, “the opening of the needle exchange increased neither the proportion of drug users overall nor the proportion of those younger than twenty-two years. Thus, the currently available data argue against the belief that needle exchange encourages drug use” (p.77).
Many often argue that an increase in the number of needles given away will inevitably result in dirty and contaminated needles being thrown out onto the street once they are used. In Baltimore, a systematic street survey showed absolutely no increase in discarded needles following the opening of an NEP. Two years later, there had still been no noticed increase (Vlahov & Junge, 1998, p. 77).
In 1993, six researchers analyzed data on drug-treatment admissions in the San Francisco County over a four-year period to evaluate the potential negative effects of the San Francisco NEP. There results showed absolutely “no negative consequences of needle exchange were detected… specifically, the presence of the exchange program was not associated with (1) increases in injection drug use, (2) increases in needle-sharing behavior, or (3) changing drug-use behavior from non-injection to injection. We also compared high-drug-use neighborhoods with and without local needle-exchange sites. Neighborhoods without needle-exchange sites showed a greater increase in proportion of admissions for injection drug use, and in frequency of injection, over time” (Guydish, Bucardo, Young, Woods, Grinstead, & Clark, 1993). These results have been continually tried and tested, and we still see the same positive outcome every time.
In my opinion, there is virtually no reason why NEPs are not viewed as an asset to all communities, and more are not being established. We continually see them demonstrate their ability to greatly lower the percentage of HIV infected drug users, without creating any consequences. The people who are fighting these programs, in my mind, are simply ignorant and uneducated. We need to break down the stigma of NEPs as being bad places that condone drug use, because the truth is, even the people lobbying for them would rather see IDUs quit using instead of buying more needles. However, this just is not a viable choice for many, who either cannot or will not quit. NEPs remain the tried and true next best alternative for promoting safety and health among the addicted.
References
Avery, K. (Writer), & Hoskinson, J. (Director). (2015). District of Columbia [Television series episode]. T. Carvell (Producer), Last Week Tonight. New York City, NY: Home Box Office, Inc.
Des Jarlais, D.C., Marmor, M., Paone, D., Titus, S., Shi, Q., & Perlis, T. (1996) HIV Incidence Among Injecting Drug Users in New York City Syringe-Exchange Programmes. The Lancet, 348, 987-991.
Gebo, K.A. (2009). Contemporary Costs of HIV Health Care in the HAART Era. Presentation for the 13th International Workshop on HIV Observational Databases, March 26-28, 2009, Lisbon, Portugal.
Green T.C., Martin E., Bowman S., Mann M., & Beletsky, L. (2012). Life After the Ban: An Assessment of US Syringe Exchange Programs’ Attitudes About and Early Experiences with Federal Funding. American Journal of Public Health, 102 (5), 9–16.
Guydish, J., Bucardo, J., Young, M., Woods, W., Grinstead, O., & Clark, W. (1993) Evaluating Clean Needle Exchange: Are There Negative Effects? The Official Journal of the International AIDS Society, 7(6).
Lurie, P., Reingold A.L., Bowser B., Chen D., Foley J., & Guydish J. (1993). The Public Health Impact of Needle Exchange Programs in the United States and Abroad. The Regents of the University of California. 1-33.
Vlahov, D., & Junge, B. (1998). The Role of Needle Exchange Programs in HIV Prevention. Public Health Reports, 113(1), 75-80.
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