SYRINGE EXCHANGE & HARM REDUCTION
CDC data show that, while deaths among people living with HIV overall declined by 12% between 2011-2015, deaths among people living with HIV as a result opioid overdose rose by 42% in that time period. Chen et al at Massachusetts General Hospital created an Opioid Policy Model using data from 2002-2017. It forecasts that, without adequate interventions, a 147% increase in opioid deaths can be expected between 2016-2025 and that most (80%) of these would be due to illicit opioid use.
The authors concluded that “drug monitoring programs are unlikely to lead to major decreases in the number of deaths from opioid overdose in the near future,” and that a “stronger and multipronged approach” is now required, including an expansion of harm-reduction interventions.
Sharing needles and other drug paraphernalia increases the risk of infection with HIV Hepatitis and other blood-borne infections. Syringe exchanges to provide people who inject drugs (PWID) with sterile needles in exchange for used ones started in the late 1980s as a community-based strategy for reducing HIV transmission risks.
In most states, sterile hypodermic syringes were available only by prescription. When access to them is difficult, PWID are more likely to share their syringes and use them more than once. This facilitates the transmission of HIV or Hepatitis C from one person to another.
Community-based syringe exchanges, now more commonly known as Syringe Access Programs (SAP), reduce this risk by providing clean syringes. They have gained support over the years as studies proved that access to sterile equipment does not increase drug use and, in fact, increases the probability that exchangers will eventually choose to accept treatment for substance use disorders.
With the advent of naloxone, national and some state governments (although not all) have recently endorsed SAPs as essential to reduce the risks of drug-related disease transmission. They now also reduce overdose by providing PWID with Naloxone and training in using it, if necessary. Abundant research, endorsed by the findings of eight federally commissioned reviews, has demonstrated that syringe access is effective in reducing the transmission of HIV without increasing drug use. Studies have also found that providing sterile equipment to injection drug users increases the probability that they will initiate drug treatment, and does not increase drug use.
The federal Consolidated Appropriations Act of 2016 ruled that states and local communities could use federal funds to support certain components of Syringe Services Programs (SSPs – the government’s term for syringe exchanges).
Safe Consumption Services:
Another related and relatively new harm reduction strategy for mitigating the risk of overdose (including fatal overdose) is the establishment of Supervised Consumption Services (SCS), also known as Safe Injection Facilities (SIF). SCS are spaces/programs where individuals are able to use illicit drugs (that they acquire independently and bring with them) in a clinically monitored setting where expert supervision, sterile supplies, and opioid reversal agents are readily available. Over 120 SCSs now exist in ten countries around the world, including Canada.
After conducting a systematic literature review on the subject, Science Direct concluded that “SCSs were efficacious in attracting the most marginalized … promoting safer injection conditions, enhancing access to primary health care, and reducing the overdose frequency.” They added that SCSs were not found to increase either drug use or crime.
As of April 2019, over a dozen U.S. cities are seeking municipal and state approvals to open local SCSs.