SYRINGE EXCHANGE & HARM REDUCTION
CDC data show a 56% decline occurred between 2008 and 2014 in annual HIV incidence among people who inject drugs. They attribute this to syringe exchange — a community-based, structural intervention. Sharing needles and other drug paraphernalia increases the risk of infection with HIV Hepatitis and other blood-borne infections. Syringe exchange (the process of providing injection drug users with sterile needles in exchange for used ones reduces transmission risks without increasing drug use. Studies also show that that providing sterile equipment does not increase drug use and, in fact, increases the probability that exchangers will eventually choose treatment for substance use disorders.
The use of certain illegal drugs can involve self-injection using hypodermic syringes. In some areas, these syringes are available solely by prescription. When availability is limited, users may share their syringes and use them more than once. As a result, one user’s infection (such as HIV or Hepatitis C) can spread to other users through the reuse of syringes contaminated with infected blood.
One method of preventing HIV transmission is to make clean syringes should be available without a prescription or through a Needle and Syringe Exchange (NSE) program.
Abundant research, endorsed by the findings of eight federally commissioned reviews, has demonstrated that syringe exchange 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.
In 2009, Congress lifted a 21-year ban on Federal funding for needle-exchange programs. The ban was originally instated in the 1980s due to public controversy surrounding the concept. Congress reinstated the federal funding ban as part of a spending bill it passed in 2011 funding the federal government through fiscal year 2012.
The Consolidated Appropriations Act of 2016 subsequently 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).
Federal funds can now be used to pay for staffing, mobile units, office space, and supplies including sterile syringes and cookers for drug preparation. Federal funding can also be used for case management and navigation services. In brief, it covers virtually all expenses except the purchase sterile needles or syringes for illegal drug injection. To receive funding, applicants have to “consult with CDC and provide evidence that their jurisdiction is (1) experiencing, or (2) at risk for significant increases in hepatitis infections or an HIV outbreak due to injection drug use.”
In a 2017 briefing, CDC Director Tom Frieden, MD, released a report showing that only about one in four people injecting illicit drugs receive their needles and equipment from sterile sources. He urged state and local health departments to expand access to SSPs and noted that white people, who now comprise more than 50% of all new people who inject drugs, have the highest rate of syringe sharing. He urged participants to “recognize that we have to deal with the world and the problems of the world as they are and not as we would wish they were.”