¶ … Exchange Definition of Policy

A needle exchange is a harm reduction strategy wherein the program provides clean, unused needles to addicts for the injection of intravenous drugs. The principle is that when addicts do not have access to clean needles, they are far more likely to share needles among themselves. Needle exchanges are typically set up in areas with a high concentration of intravenous drug users. They provide clean, unused needles free of charge.

Arguments for the Policy

The arguments in favor of a needle exchange center around the harm reduction principle. Intravenous drug users exist, and will continue to exist. The role of health providers with respect to these individuals is to reduce the harm that they do to themselves and to others. The policy makes no value judgments against the users, but merely seeks to reduce the spread of HIV / AIDS among that community. This is important because it reduces the overall spread of HIV / AIDS, and because it gives the drug users a better opportunity to recover from their addiction, if they are free from illness. There are other benefits as well.

The needle exchange also provides a safe venue for intravenous drug users. These individuals are among the most vulnerable in society, and of were even before they began using. The needle exchange environment provides health care workers an opportunity to counsel and intervene, and provide these individuals the resources that they need to end their addiction, should they choose to avail themselves of such resources. Drug users report frequent incidences of trauma, abuse, violence, and find the world around them to be unsafe. A needle exchange provides a safe place, free from violence. The violence exacerbates the cycle of drug use, because the users report using drugs to numb the pain of the violence. When violence is removed from their lives, they are more likely to seek help with their addiction (Macneil & Pauly, 2011). Needle exchanges can also be a source for methadone treatments as well, which can further set a user on the right track.

The key to successful implement of a needle exchange program is to separate the program from any sort of public order objectives. Free availability of syringes should be a key part of the program and the services should be removed from the shadow of authorities such as police. When public order objectives are included, this dissuades addicts from using the program. Further, such programs should emphasis all intravenous drug users, not just heroin addicts. A study in Vancouver showed that a rise in intravenous cocaine use was correlated with an increase in HIV rates among IV drug users, because this group had not been targeted for the needle exchange programs (Hyshka, Strathdee, Wood & Kerr, 2012).

When the incidence of disease is lowered, this lowers the overall cost of drug use to governments, and society as a whole. Health benefits and moral arguments aside, needle exchange programs are typically run by governments, and those governments experience cost savings as a result. In the U.S., uninsured drug users are likely to use emergency wards for their medical conditions, so there are still costs to the taxpayer, let alone in countries where health care is publicly provided. Huang (2014) determined that needle exchanges prevent disease at a rate of 33.9 individuals per 100 users for HIV and 8.2 individuals per 100 for Hepatitis C The cost savings from this prevention was estimated at $6.9 million, and this for a small community of just 63 users. There are thousands of users, so the cost savings for a major city would be substantial. The cost of running a needle exchange is relatively low compared with the savings in the health care system.

Arguments Against Needle Exchanges

There are no evidence-based arguments against needle exchanges. The arguments range from theorizing that needle exchange programs will encourage intravenous drug use, to NIMBYism opposing the presence of a needle exchange in a specific area, to morality-based arguments along the lines that public funding should not be used to support illegal drug use (Duplessy & Reynaud, 2014). Ultimately, the data collected from needle exchange programs refutes the idea that they encourage drug use, and also that they are a poor use of public dollars. There is no absolute morality in this world, so such arguments can never be reconciled with data. Health care is and should be an evidence-based field, where arguments based on other criteria are invalid. Evidence is king, and a survey of the literature did not find a single academic paper with evidence arguing against needle exchange programs.

Politicians tasked with stewarding public budgets have sought to blend morality with financial arguments,...

Advocates of harm reduction note that needle exchange programs serve a community of drug users who were going to use drugs anyway. The harm reduction, by way of reducing the spread of disease, results in substantial cost savings in the public health care system. It is estimated that needle exchange programs result in $1.3 - $5.5 in savings for every $1 invested, invalidating arguments based on stewardship of public tax monies (Kwon et al., 2012). Furthermore, needle exchanges account for a relatively small part of any government's budget, so that whether such a program exists or not, there will be no meaningful difference to the budget, just to the people who rely on the program.
The morality-based arguments are rejected for a few reasons. First, morality is in the eye of the beholder -- everybody has their own, and there is no one morality. Second, where this morality is supposedly religion-derived, it has no place in the laws of a secular society, as the separation of church and state is a fundamental principle. If anything, harm reduction should be a religious principle.

Third, the drug use is already happening; morality-based suppression of needle-exchange programs will not change that. There is also the question of the morality in exacerbating human suffering when a cost-effective investment in needle exchange programs would reduce that suffering. The point of needle exchange is to reduce harm on a community-wide level. To reject needle exchange is to increase harm. More people suffer, and more people die, when there are no needle exchange programs. There is a definitely lack of morality on the part of anybody who would oppose needle exchanges on supposed moral grounds.

Recommendations

Needle exchange programs represent a victory for common sense, and evidence demonstrates that anywhere they are tried, they have succeeded in reducing infection rates for HIV / AIDS and other blood-borne diseases. This reduction has resulted in cost savings in the health care system far beyond the original cost of the needle exchange program. The evidence suggests that lowering barriers to needle access even further has increased the benefits of the program. Such programs need to be separated from any public order programs (i.e. police presence should be avoided, and persecution of addicts in the vicinity of exchange centers should be avoided). Vending machines with needles have demonstrated success in lowering rates further, by increasing access to clean needles.

Needle exchange programs are often tied to information and assistance for addicts to kick their habits, but they can also be a source of help with other risk-taking behaviors. Evidence shows that needle exchange programs reduce risky behavior with respect to drugs, but not with sex. To further reduce harm among the addict community, condoms should also be distributed free, in order to encourage less risk-taking in sexual behavior. The objective of harm reduction programs is to reduce the incidence of disease, and changing behaviors in drug use should be paired with lowering risky sexual behavior as well, as a means of further reducing the spread of such communicable diseases.

My position is that needle exchange programs have been an overwhelming success. The arguments against such programs evaporate in the face of the evidence that has been gathered around the world for the past thirty years. There are not even credible financial arguments, as evidence shows overwhelmingly that needle exchange programs save governments money by preventing disease. If there is anything to recommend, it is to follow the evidence and expand needle exchange programs. Some recommendations include decentralizing such programs, to reach more users who are more dispersed from central area, and to use needle exchange facilities to promote risk reduction in sexual activity as well.