Needle Exchange Programs: Policy Analysis and Benefits

What Is a Needle Exchange Program?

A needle exchange is a harm reduction strategy in which a program provides clean, unused needles to people who inject drugs intravenously. The underlying 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 established in areas with a high concentration of intravenous drug users, and they provide clean, unused needles free of charge.

Arguments in Favor of Needle Exchange

The arguments in favor of needle exchange center on 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 users but merely seeks to reduce the spread of HIV/AIDS within that community. This matters because it reduces the overall spread of HIV/AIDS and because it gives drug users a better opportunity to recover from their addiction if they are free from illness.

Needle exchanges also provide a safe venue for intravenous drug users. These individuals are among the most vulnerable in society, often before they ever began using drugs. The needle exchange environment gives health care workers an opportunity to counsel and intervene, and to provide individuals with the resources they need to end their addiction, should they choose to pursue them. Drug users report frequent experiences of trauma, abuse, and violence, and describe the world around them as unsafe. A needle exchange provides a safe place, free from violence. Violence exacerbates the cycle of drug use because users report using drugs to numb the pain that violence causes. When violence is removed from their lives, they are more likely to seek help with their addiction (Macneil & Pauly, 2011). Needle exchanges can also serve as a source of methadone treatments, which can further support a user's recovery.

Implementation: Keys to an Effective Program

The key to successful implementation of a needle exchange program is to separate the program from any public order objectives. Free availability of syringes should be a central component, and services should be removed from the shadow of law enforcement authorities. When public order objectives are included, they discourage addicts from using the program. Such programs should also emphasize 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 by needle exchange programs (Hyshka, Strathdee, Wood & Kerr, 2012).

Cost Savings and Public Health Impact

When the incidence of disease is lowered, overall costs to governments and society decrease accordingly. Health benefits and moral arguments aside, needle exchange programs are typically run by governments, and those governments experience measurable cost savings as a result. In the United States, uninsured drug users are likely to seek care in emergency wards, generating costs for taxpayers — a problem even more pronounced in countries with publicly funded health systems. 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 estimated cost savings from this prevention reached $6.9 million for a small community of just 63 users. Given that thousands of users exist in major cities, the aggregate cost savings would be substantial. The cost of running a needle exchange is relatively low compared with the resulting savings in the health care system.

Politicians tasked with managing public budgets have sought to blend morality with financial arguments, claiming that public money should not support the habits of drug users or anything that might encourage drug use. Advocates of harm reduction counter that needle exchange programs serve a community of drug users who were going to use drugs regardless. The harm reduction achieved by reducing disease transmission results in substantial savings in public health expenditure. It is estimated that needle exchange programs return $1.3 to $5.5 in savings for every $1 invested, directly invalidating arguments based on responsible stewardship of public funds (Kwon et al., 2012). Furthermore, needle exchanges represent a relatively small portion of any government budget, meaning their presence or absence makes no meaningful fiscal difference at the macro level — but makes an enormous difference to the people who rely on them.

References

Duplessy, C. & Reynaud, E. (2014). Long-term survey of a syringe-dispensing machine needle exchange program: Answering public concerns. Harm Reduction Journal, 11(16), 1–9.

Huang, G. (2014). Modeling the impact of needle exchange programs accounting for both HIV and HCV infections and HIV/CV co-infections. Queen's University. Retrieved March 21, 2015, from http://qspace.library.queensu.ca/jspui/bitstream/1974/12155/1/George_Huang_Y_201404_MSc.pdf

Hyshka, E., Strathdee, S., Wood, E. & Kerr, T. (2012). Needle exchange and HIV epidemic in Vancouver: Lessons learned from 15 years of research. International Journal of Drug Policy, 23(4), 261–270.

Kwon, J., Anderson, J., Kerr, C., Thein, H., Zhang, L., Iversen, J., Dore, G., Kaldor, J., Law, M., Maher, L., & Wilson, D. (2012). Estimating the cost-effectiveness of needle-syringe exchange programs in Australia. AIDS, 26(17), 2201–2210.

Macneil, J. & Pauly, B. (2011). Needle exchange as a safe haven in an unsafe world. Drug and Alcohol Review, 30(1), 26–32.