What Are the Benefits and Risks of Needle Exchange Programs?
Needle exchange programs are controversial programs that provide sterile needles to people who inject drugs. Many programs also offer the disposal of unsterile needles, among other services.
The goal of programs like these is to reduce the transmission of diseases such as HIV and hepatitis C. In 2016, the CDC reported that 9% of HIV infections diagnosed each year occur among people who inject drugs, while injection drug use also helped cause a 150% increase in acute hepatitis C infections.
Injection drug use is often associated with addiction to illegal drugs such as heroin or meth, and drug addiction causes people to make compulsive and risky decisions, such as sharing used needles.
The goal of needle exchange programs is not to treat addiction or any medical conditions, but to reduce harm by preventing the transmission of deadly diseases.
Many programs also provide brief counseling services and refer people to addiction treatment providers. Some even provide access to other disease prevention resources such as condoms and naloxone, an overdose reversal medication.
A lot of research supports the benefits of needle exchange programs, and the risks associated with needle exchanges are few. However, people often criticize the programs, in many cities going so far as to outlaw them.
Pros of Needle Exchanges
Needle exchange programs have had positive impacts on communities across the world and advocates for the programs say the benefits outweigh the risks.
Supporters say some of the pros are:
- Fewer contaminated needles in communities
- Reduced drug-related behavior
- Reduced sexual-risk behavior
- Increased access to drug treatment referral services
- Increased access to testing and diagnostic services
- Increased access to education about substance abuse
- Increased communication with hard-to-reach populations
- Reduced prevalence of new infections
Many of these benefits are supported by research, but harm reduction supporters usually have to educate community members because drug use is stigmatized. They have to dispel myths and correct misconceptions that have no factual basis.
Cons of Needle Exchanges
Opponents to these programs say they are enabling drug use and making matters even worse. Some people don’t believe in the science of addiction and think taxpayers shouldn’t help fund resources to help people who make unsafe choices.
Opponents say some of the cons are:
- Enabling current drug use
- Increasing injection drug use
- Increasing drug use in communities
- Increasing rates of infection
- More contaminated needles in the community
- Increased financial burden on taxpayers
- Increased crime near needle exchange sites
- Reduced access to injection drug users in certain rural areas
Some of these cons are backed by research; for example, most programs do in fact rely on taxpayer funding, but others are paid for by private donors. At the same time, several studies also show that needle exchanges are more cost-effective than paying for emergency room visits or other health care services.
Some evidence has shown that participants in needle exchange programs have high rates of infections, while other studies have shown that the programs attract high-risk drug users who were already at high risk for transmission, meaning that participating in the program didn’t actually increase their risk.
What Research Says About Needle Exchange Programs
Researchers have been studying the effects of these programs for decades. A strong body of evidence supports their effectiveness, while a small amount of evident supports either conflicting or neutral results.
In 2001, a review of studies published in the journal AIDScience identified seven studies that reported that needle exchange studies were associated with reduced prevalence of HIV, hepatitis B, and hepatitis C. Three studies concluded that the programs reduced needle sharing, and three other studies showed that they were associated with increased rates of entry into drug rehab programs.
There was, however, one study that found no benefit associated with a needle exchange program, and three studies actually found higher rates of HIV among people who used needle exchange programs. There are disagreements about the causes of the findings, but some believe the results were influenced by selection bias. The AIDScience review also concluded that there was no evidence showing that the programs caused increases in drug use or crime.
In 2004, the World Health Organization (WHO) produced an in-depth report on the effectiveness of needle exchange programs and they concluded that:
- HIV infection is likely reduced because of the increased availability of clean needles.
- There is no evidence of negative consequences.
- The programs are cost-effective.
- These services have the possibility of increasing recruitment into substance abuse treatment.
In 2012, researchers summarized in the International Journal of Drug Policy the results of 15 years of research on Vancouver’s Insite program, which is one of the most studied needle exchanges in the world. The authors concluded that:
- Participating in needle exchange programs was not actually associated with HIV infection.
- High-risk drug users frequent needle exchanges, explaining the increased rates of HIV infection.
- The programs are more effective when they collect contaminated needles and distribute clean ones separately.
- Programs which limit the number of clean syringes that are distributed are not as effective.
Research suggests that needle exchange programs also keep communities clean of discarded syringes. In 2012, a study published in the journal Drug and Alcohol Dependence compared San Francisco, a city with a needle exchange program, with Miami, a city without one. More than eight times as many syringes were found on the streets of Miami and drug injection users reported improperly disposing of used needles much more often than those in San Francisco.
Overall, the pros of needle exchange programs very likely outweigh the risks and public health experts have been recommending them to combat disease outbreaks for decades. Unfortunately, there are myths and misconceptions that have prevented the development of such programs in many communities.