Yes, needle exchange programs do work—both in terms of harm reduction and promoting abstinence. In fact, research shows that people who inject drugs are 5 times more likely to enter a treatment program after visiting a needle exchange. Further, they are more likely to reduce or abstain from injecting when using a program. 4
Full Answer
Can we evaluate needle exchange programs?
· In fact, research shows that people who inject drugs are 5 times more likely to enter a treatment program after visiting a needle exchange. Further, they are more likely to reduce or abstain from injecting when using a program. 4 Additionally, these programs can prevent new HIV and viral hepatitis infections.With 1 in 3 young adult (aged 18-30) intravenous …
Can needle exchange schemes reduce harm in injecting drug users?
· INTRODUCTION. Infectious disease remains a significant social and health concern in the United States. More than 1.2 million people are currently living with the human immunodeficiency virus (HIV), (CDC a, 2015) and between 2.7 – 3.9 million people infected with Hepatitis C (HCV) (CDC b, 2015).The cost of infectious disease can be counted in the strain on …
What is the average age of a needle exchange participant?
· A 2012 study published in the journal Drug and Alcohol Dependence compared San Francisco, a city with a needle exchange, to Miami, a city without needle exchanges. More than eight times as many syringes were found on the streets of Miami, and injection drug users in Miami reported improperly disposing of needles much more often than those who ...
Are needle exchange programs effective in the fight against AIDS?
This chapter assesses the effects of needle exchange programs on HIV infections and drug use behaviors. Five major sources provide the evidentiary basis for the panel's assessment: (1) a 1991 review carried out by congressional request of the effectiveness of needle exchange programs (U.S. General Accounting Office, 1993), (2) a second comprehensive evaluation carried out by …
Are syringe exchange programs helpful or harmful?
Taken together, these findings suggest that while SEPs are successful in reducing disease, lowering the cost of obtaining clean needles and other supplies unintentionally encourages more drug use, leading to more opioid-related overdoses.
What are the cons of needle exchange programs?
Cons of Needle ExchangesEnabling current drug use.Increasing injection drug use.Increasing drug use among entire community.Increased rates of infection.More contaminated needles in the community.Increased financial burden on taxpayers.Increased crime near needle exchange sites.More items...•
What are the benefits of a needle exchange program?
The Benefits of Needle Exchange ProgramsReduce Use of Contaminated Needles. ... Access to Sterile Injection Equipment. ... HIV Infection Rates. ... More Drug Treatment Referrals. ... Less High-Risk Behavior. ... Free Access. ... Flexible Programs. ... Various Services.
Which result has been demonstrated in needle exchange programs?
provide clear evidence that needle exchange programs decrease HIV infection rates," (p. 20) but that "the majority of studies of [program] clients demonstrate decreased risk of HIV drug risk behavior, but not decreased rates of HIV sex risk behavior'' (p.
Do needle exchanges work?
Do Needle Exchange Programs Work? Yes, needle exchange programs do work—both in terms of harm reduction and promoting abstinence. In fact, research shows that people who inject drugs are 5 times more likely to enter a treatment program after visiting a needle exchange.
How does a needle exchange program reduce the spread of infection?
“NSES are based in areas where there is an existing pattern of people who inject, but the scheme benefits the entire community, not only by providing a place for injecting equipment to be safely disposed of and reducing the risk of drug-related litter, but also lowering the risk of diseases such as HIV and Hepatitis B ...
How many needle exchange programs are in the US?
There are about 200 needle-exchange programs in 33 states and the District of Columbia, according to the North American Syringe Exchange Network.
When did needle exchange start?
Syringe access in San Francisco is certainly at the top of the list. The city's first needle exchange program began in 1988 when a group of people recognized they needed to do something to stop the spread of HIV among people who inject drugs.
Who Discovered injection?
Scottish doctor Alexander Wood is credited with inventing the modern hypodermic syringe in 1853. His goal was to treat pain in just one area of the body. He attached a hollow needle, an earlier invention by Irish doctor Francis Rynd, to a plunger.
Which route of drug administration is considered the best overall?
Oral route Many drugs can be administered orally as liquids, capsules, tablets, or chewable tablets. Because the oral route is the most convenient and usually the safest and least expensive, it is the one most often used. However, it has limitations because of the way a drug typically moves through the digestive tract.
What states have syringe service programs?
Data TableStateSyringe Exchange Program Legality (2021)HawaiiSyringe Exchange Programs are LegalNew JerseySyringe Exchange Programs are LegalKentuckySyringe Exchange Programs are LegalCaliforniaSyringe Exchange Programs are Legal48 more rows
Are needle exchanges legal in the US?
At the federal level, needle exchanges aren't banned. But until as recently as 2016 federal dollars were not allowed to go to such programs. Now, legalization doesn't necessarily mean that needle exchanges can be easily opened and remain in place.
What is needle exchange in social work?
Needle exchange programs are based on a harm reduction approach that seeks to minimize the risk of infection and damage to the user and community by non-judgmentally meeting injecting drug users where they are at and providing them with the tools to keep themselves and their communities safe.
When did needle exchanges start?
There were also concerns that needle exchange could encourage injection drug use (McLean, 2012). The first American needle exchanges emerged in the 1990s through the work of grassroots community-based harm reduction groups, who often focused on a range of social justice issues (McLean, 2011). Public health research focused on whether NEPs actually prevented infection (Hou et al., 2007) as well as cost calculations of the value of harm reduction prevention efforts through NEPs (Lurie & Drucker, 1997). There were also studies of how the health behavior of people using NEPs was impacted by access to clean needles, especially with regard to reduced needle sharing (Ksobiech et al., Latkin & Forman, 2001). By 1998, needle exchange was considered a best practice in the medical community for the prevention of the transmission of blood borne diseases (Royner, 1998). During the same year, Health and Human Services Secretary Donna Shalala stated that “...needle exchange programs can be an effective part of a comprehensive strategy to reduce the incidence of HIV transmission and do not encourage the use of illegal drugs.” (Shalala, 1998) The federal ban on funding for needle exchange nonetheless has remained in force until today amidst fears that NEPs could promote drug use (Clark & Fadus, 2010; Rovner, 1998), even though studies of needle exchange indicated that users of its services were more likely to enroll in addiction treatment services than non-users (Latkin et al, 2006).
How long has the needle exchange program been in Fresno?
The needle exchange program in Fresno has been operated by volunteers for over 20 years. Until California law changed in 2012, legalizing needle exchange, the Fresno program operated as a “tolerated illegal” intervention. The Fresno NEP is set up on a quiet street and accepts and exchanges needles for approximately 100-150 people each week during a period of two hours every Saturday. It has a mobile medical clinic located next to it.
Where was the NEP study conducted?
This study was approved by the California State University, Fresno Institutional Review Board and was conducted between December 2010 and March 2011 at the NEP in Fresno, California. A convenience sampling procedure was used, offering participation to individuals standing in line to exchange needles. Each participant received a $5 card redeemable for groceries as an incentive. Participants completed a closed-ended questionnaire developed by the medical staff at the NEP. During the pilot study, the participants completed the questionnaire independently but left much of the questionnaire blank or asked for assistance when completing the questionnaire. Therefore, the method was changed to an interview format where the participants were asked the questions verbally and the researcher transcribed responses.
What was the treatment for alcoholism in the 19th century?
In the 19th century, alcoholism treatment was largely divided between temperance movements , which reflected a strong community-based self-help model of abstinence, or through confinement in inebriate asylums, which utilized a medical model to provide treatment and restraint. Drugs such as morphine, cocaine and opium were widely used because they were marketed as cures for many ailments until the Harrison Act of 1914, which brought the paradigm of criminality to drug policy (Ghatak, 2010). Hence, after the passage of the Act, physicians were no longer allowed to prescribe narcotics for the purpose of maintaining an addict's comfort. Moreover, addicts themselves became criminalized and some have argued that drug policy became a means to control urban ethnic minority working class young men (Cohen, 2006).
How did Freud influence addiction?
As White points out, there are three key areas where psychoanalysis has had an influence: 1). the view that addictive behavior is driven by unconscious motivations, 2). the belief that practitioners must have certain qualifications , and 3). the notion that addicts must reconstruct their sense of self and identity as sober (White: 1998, 99). The psychoanalytic paradigm thus made addiction treatment a clinical practice.
Why do people use psychotropic drugs?
From earliest recorded history, human beings have used psychotropic substances for many reasons, including the spiritual achievement of altered states of consciousness for ceremonies or to alleviate hunger and fatigue. Human beings would not survive long in a harsh environment if they were intoxicated. ’Addiction’ in reference to drug misuse, thus, appears to be a rather recent phenomenon. It emerged with the rise of modern colonial empires that developed a global trade in substances, such as opium and coca, which could be refined into concentrated forms that produced the compulsive need for continuous consumption (Singer, 2012). The evolution of the human brain towards more complex emotional development meant that alcohol or drugs began to be used as a coping mechanism to compensate for feelings of dysfunction or depression, especially in a rapidly changing world in which communities were disrupted in the name of progress (Durrant, 2009). Currently, the roots of addiction are seen as a complex intertwining of biological, psychological, and social factors (Saah, 2005).
How has needle exchange positively impacted communities across the world?
Needle exchanges have positively impacted communities across the world. Supporters of needle exchange programs say the pros are: Lower numbers of contaminated needles in a community. Reduced drug-related behavior. Reduced sexual-risk behavior.
What polls found varying levels of support for needle exchanges?
Polls from the 1990s found varying levels of support. Support was largely dependent on how questions were worded, according to a 2003 study published in The International Journal of Drug Policy. A wealth of research supports the benefits of needle exchange programs, and few risks are associated with needle exchanges.
What are the pros and cons of needle exchange?
Supporters of needle exchange programs say the pros are: 1 Lower numbers of contaminated needles in a community 2 Reduced drug-related behavior 3 Reduced sexual-risk behavior 4 Increased access to drug treatment referral services 5 Increased access to testing and diagnostic services 6 Increased access to education about substance abuse 7 Increased communication with hard-to-reach populations 8 Reduced prevalence of new infections
What diseases are associated with needle exchange?
A 2001 review of studies published in the journal AIDScience identified seven studies that reported that needle exchange programs were associated with reduced prevalence of HIV, hepatitis B and hepatitis C.
Why are needle exchanges bad?
Opponents of needle exchange services say the programs enable drug use and make existing problems worse. Some people don’t believe in the science of addiction. They don’t think taxpayers should fund resources to help people who make unsafe choices.
What is injection drug use?
Injection drug use is associated with addiction to illicit drugs such as heroin, crystal meth and cocaine. Drug addiction causes people to make compulsive and risky decisions, such as sharing used needles. Needle exchange programs are not designed to treat addiction, HIV, hepatitis C or other medical conditions.
Why is harm reduction important?
Many benefits are backed by research. But harm reduction supporters have to educate community members because drug use is stigmatized. They have to dispel myths associated with drug use and correct misconceptions that have no factual basis.
How many studies have been published on needle exchange?
They conducted site visits to programs located in Tacoma, Washington, and New Haven, Connecticut. Their review identified a total of 20 published studies and 21 abstracts on evaluations of needle exchange programs originating from nine distinct research projects, all but one of which (the Tacoma study) involved programs outside the United States. Among the nine research projects were one from Australia, one from Canada, two from the Netherlands, one from Sweden, and three from the United Kingdom.
Why is it difficult to evaluate needle exchange programs?
There are at least two broad reasons for this: (1) multiple actions generally are initiated in a given community setting, making it difficult to separate the effects of a needle exchange program from those of other prevention efforts by studying time trends and (2) the development of a comparative research design that relies on random assignment of individuals to receive needle exchange program services (or not) has technical, ethical, and logistical difficulties. Given these limitations, it seems reasonable to explore alternative means of assessing the credibility of the evidence's underlying claims about the effectiveness of needle exchange programs. Before doing so, however, it is useful to examine how previous research reviews have attempted to incorporate the traditional emphasis on design-induced control.
What is the pattern of evidence surrounding the needle exchange program?
The pattern of evidence surrounding the New Haven needle exchange program involves a set of models, driven in large measure by empirical data gathered from participants and the needles they exchanged. Although the estimates of relative and absolute reduction in HIV incidence are based on mathematical models, Kaplan and his colleagues have explored the computational implications of a range of parameter values. These varied models provide estimates that are not dramatically different, lending credibility to the methods. Nevertheless, the models are not infallible.
What are the outcomes of needle exchange?
That is, research findings concerning four of the five possible positive outcome domains were reviewed: reduction in drug-related and sexual risk behaviors, increase in referrals to drug abuse treatment , and reduction in HIV and other infection rates. The report addressed all four possible negative outcomes: increases in (1) drug use by program participants; (2) new initiates to injection drug use; (3) drug use in the community in general; and (4) the number of contaminated needles discarded.
How does needle exchange work?
Needle exchanges are established in order to: (1) increase the availability of sterile injection equipment and (2) at the same time, remove contaminated needles from circulation among the program participants. Operation of the exchange, then, is expected to result in a supply of needles with reduced potential for infecting program participants with HIV and also to reduce sharing between individuals because of easier access to clean needles for any program participant. Typical exchanges also maintain such services as education concerning risk behaviors, referral to drug treatment programs (a step toward eliminating the route for all infection), and distribution of condoms. These measures offer independent prospects for reducing the spread of HIV. Appraisal of the success of a needle exchange program may involve measuring, for example, the numbers of needles exchanged; the cleanliness of circulating needles; the prevalence and incidence of HIV and other needle-borne diseases; referrals to drug treatment programs; enrollments in treatment programs; and changes in the risk behaviors of needle exchange participants. An observed pattern of favorable outcomes would reflect health benefits from the operation of the program.
What are the negative effects of needle exchange?
One possible negative outcome is an increase in the number of improperly discarded used needles. Another possibility is that the issuance of injection equipment, condoned by government, will "send a message" undercutting efforts at combatting illegal drug use and will promote more drug use (with more attendant HIV incidence). A third possible negative outcome is that needle exchanges will lower the perception of risk of injection drug use and thus attract more users to inject drugs and to other forms of illegal drug use.
What is a definitive study?
In many areas of social sciences and public health research, the so-called definitive study—a randomized control experiment (that is, a randomized double-blind placebo controlled trial)—is an ideal that cannot be implemented . For example, it is unethical to consider use of a clinical trial design to show that smoking causes lung cancer (Hill, 1965). Scientific judgment develops instead through a series of studies using cross-sectional retrospective and prospective designs, in which later research avoids the flaws of earlier work but may introduce problems of its own. The improbability of being able to carry out the definitive study of the effects of certain HIV and AIDS prevention programs, including needle exchange programs, does not necessarily preclude the possibility of making confident scientific judgments about the effects of such prevention programs. As A. Bradford Hill (1965:300), one of this century's foremost biostatisticians, commented three decades ago:
What are the benefits of needle exchange?
Injection Drug Use and Infectious Disease Make Needle Exchange Programs Imperative: 1 There are an estimated 350,000 regular injection drug users in America – all at increased risk of contracting and spreading fatal blood-borne diseases. 1 2 Approximately 950,000 U.S. residents are living with HIV/AIDS. 2 3 More than a quarter of AIDS cases in the U.S. among people age 13 or older are directly linked to injection drug use. 3 4 When mother-to-child HIV transmission is taken into account, roughly 35 percent of all AIDS infections can be related to injection drug use. 4 5 An estimated 61 percent of AIDS cases among women are due to injection drug use or sexual contact with someone infected with HIV through injection drug use. 5 6 Over half of HIV infections in children result from injection drug by a parent. 6 7 AIDS is the second leading cause of death among African American women and third leading cause of death among African American men. 7 8 Injection drug users are also at serious risk of contracting Hepatitis B and Hepatitis C. Hepatitis B infects between 140,000 and 320,000 people every year and kills between 5,000 and 6,000 people in the U.S. Hepatitis C infects about 36,000 people in the U.S. every year, killing 8,000 to 10,000 of those infected. 8
How many HIV infections were prevented by needle exchange?
An analyses of a New York State-approved NEP found that during a 12-month period, an estimated 87 HIV infections were averted as a direct result of the use of needle exchange. 18
What is the most effective way to limit HIV transmission associated with injection drug use?
According to the Centers for Disease Control, the one-time use of sterile syringes remains the most effective way to limit HIV transmission associated with injection drug use. 14
What is the second leading cause of death among African American women?
Over half of HIV infections in children result from injection drug by a parent. 6. AIDS is the second leading cause of death among African American women and third leading cause of death among African American men. 7. Injection drug users are also at serious risk of contracting Hepatitis B and Hepatitis C.
How many times more likely are NEP participants to enter drug treatment than those who had never used an exchange?
NEP participants have been found five times more likely to enter drug treatment than those who had never used an exchange. 16
What percentage of AIDS is related to injections?
When mother-to-child HIV transmission is taken into account, roughly 35 percent of all AIDS infections can be related to injection drug use. 4
How many states have needle exchanges?
Federal law forbids use of federal funds to support needle exchanges – nonetheless, exchanges operate in 38 states. 12
So What Exactly Are Needle Exchange Programs?
Needle exchange programs are social services that offer clean hypodermic needles to injection drug users at no cost. Those who participate in the program bring their used needles back in exchange for new needles. Hence the name “needle exchange.”
Major Pros and Cons
Needle exchange programs reduce the risk of sharing contaminated needles by offering clean needles and disposing of used needles.
What is needle exchange?
Many of these needle exchange programs take place within community social service programs. This provides an opportunity for a person who is using drugs to interact with and potentially gain access to the support they need to stop using. Though there isn’t a strong push towards requiring them to use these services, knowing that free testing, diagnostic services, and even treatment services are available can be a motivating factor to getting clean.
Why are injection points important?
They also facilitate a safe place to dispose of those products. Otherwise, they can end up in public locations. The New York Post reported in May 2018 that over 5,000 used needles are collected from Bronx parks every week; many of these could carry infections. As a result, safe injection sites create safer environments for all people.
What is the purpose of implanting programs in all communities?
By implanting these programs in all communities, it’s possible for individuals to gain access to educational materials and supportive guidance. This may include accessing prevention services for the next generation. It may also include helping children and teens to understand the risks of drug use, even if their parents have an addiction.
What are the consequences of physical dependency?
People who have a physical dependency towards a drug will do anything they can to gain access to it. This often creates high-risk scenarios for those people but also the community as a whole, including drug-related behaviors such as stealing and overdosing in parks. It also reduces the amount of sexual-risk behavior present, such as using sexual trafficking to support an addiction.
How does needle exchange affect HIV?
Current needle exchange programs have shown to have an immense impact on rates of HIV transmission. In New York, legalization of needle-syringe programs between 1990 and 2002 was attributed to a decrease in HIV prevalence from 50 percent to 17 percent. A CDC study also found that if the U.S. invested $10 million annually into needle exchange programs, 194 HIV infections would be prevented each year. Additionally, the government itself would benefit from these programs, receiving a lifetime treatment cost savings of $75.8 million. In other words, the government would receive a $7.58 return on investment for every $1 spent nationally.
Is needle exchange legal?
Although there once were laws banning the use of federal funding to support needle-exchange programs, the programs themselves are not illegal on a federal level. However, at the state level, there may be different regulations. During the Obama administration in 2016, Congress lifted the ban on providing federal funding for needle exchange programs, a ban that had been in place since 1988. This legislation allowed for federal funds to be used for program expenses such as staff, substance-use counseling, and outreach, but not for syringes themselves. Even so, federal funding is incredibly useful — needles tend to be the least expensive aspect of needle exchange programs, and education coupled with treatment allows for more effective long-term solutions.
What are the benefits of needle exchange centers?
Reducing the risk of contaminated needles being shared. Reducing the risk of law enforcement officers becoming infected by accidental needle sticks. Many of the needle exchange centers offer free HIV testing and counseling.
Which countries have needle exchange programs?
European countries who have similar community programs, including Switzerland, Brazil and Norway, have seen a reduction in new cases of HIV contraction and the overall spread of AIDS. Needle exchange programs can ultimately serve as a solid middle ground for people who aren’t fully ready to stop using yet, but are aware ...
What would happen if we took away the positive stepping stones like needle exchange programs?
Taking away the positive stepping stones like needle exchange programs would likely exacerbate what has already becoming an opiate epidemic of monstrous proportions.
Do IV drug rehabs help?
But contrary to the criticisms, studies show these programs can generally help to improve the situations of thousands of IV drug abusers. In fact, data indicates that addicts involved in these programs are actually more likely to attend long-term rehab than those who don’t. European countries who have similar community programs, including Switzerland, Brazil and Norway, have seen a reduction in new cases of HIV contraction and the overall spread of AIDS.