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Needle exchange programs, which are also known as syringe exchange programs, syringe services programs and needle-syringe programs, are community-based programs that provide access to sterile needles and syringes free of cost and facilitate safe disposal of used needles and syringes. Patients who inject drugs can substantially reduce their risk of getting and transmitting human immunodeficiency virus (HIV), viral hepatitis and other blood borne infections by using a sterile needle and syringe for every injection as opposed to using dirty needles and syringes (Centers for Disease Control and Prevention, 2018).
According to the CDC and U.S. Department of Health and Human Services guidance, these programs are an effective component of an integrated approach to prevent HIV and Hepatitis C in patients who inject drugs. Needle exchange programs also provide other preventative materials like alcohol swabs, condoms, and sterile water. They provide education on safe injection practices, wound care, and overdose prevention. They give referrals on substance use disorder programs like medication assisted treatments. They provide counseling, testing, and treatment for HIV and hepatitis C. They provide hepatitis A and B vaccinations, sexually transmitted disease screenings, tuberculosis screening, medications to prevent mother to child HIV transmission, and mental health services (Centers for Disease Control and Prevention, 2018).
To receive federal funding for needle exchange programs, there is a process that must be followed. The Consolidated Appropriations Act of 2016 gives states and local communities the opportunity to use federal funds to support these programs. State, local, tribal, and territorial health departments then can request permission to use funds to support needle exchange programs. The state or local health department must then consult with CDC and provide evidence for the need of it in the community. After this, the CDC has 30 business days to notify the requested health department whether the evidence proves the need for the needle exchange program (Centers for Disease Control and Prevention, 2018). The state of New Jersey has many needle exchange programs available to the community. They include Prevention Resource Network in Asbury Park, Syringe Access Program Atlantic City in Atlantic City, HARM Reduction Syringe Access Program in Camden, Project X-Change, Works in Jersey City, NJCRI in Newark, and Point of Hope in Paterson (North American Syringe Exchange Network, 2018).
There are many pros and cons to these needle exchange programs. Advocates of needle exchange programs say the benefits outweigh the risks. Needle exchanges have positively impacted communities across the world. Many benefits are backed by research. But harm reduction supporters have to educate community members because drug use is stigmatized. Some pros we found were lower numbers of contaminated needles in a community, reduced drug-related and sexual-risk behavior, increased access to drug treatment referral services and testing and diagnostic services, increased access to education about substance abuse, increased communication with hard-to-reach populations, and reduced prevalence of new infections
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. Some cons are backed by research. Most programs do rely on taxpayer funding, but some are paid for by private donors. A number of studies also show that needle exchanges are more cost-effective than paying for emergency room visits or other health care services. Some cons are the fact that the state is enabling current drug use, there is increased injection drug use among entire community, increased rates of infection, more contaminated needles in the community, an increase in financial burden on taxpayers, poor funding due to lack of political support and stigmas, increased crime near needle exchange sites, and low access to injection drug users in rural areas (Elkins, 2017).
In 2004, the World Health Organization produced an in-depth report on the effectiveness of needle exchange programs. Report concluded that the programs are cost-effective, Increased availability of clean needles likely reduces HIV infection,The services can help increase recruitment into addiction treatment (WHO, 2004). Some recommendations for these programs would be to offer a variety of needle and syringe types (i.e., gauge, size and brand) and educate clients about proper use. They should also provide pre-packaged safer injection kits (needles/syringes, cookers, filters, ascorbic acid when required, sterile water for injection, alcohol swabs, tourniquets, condom and lubricant) and individual safer injection supplies. Finally, there is a great importance in continuing to educate patients, healthcare workers, and the public about drug use, risky behaviors, and prevention of blood-borne infections.
The pros of needle exchanges outweigh the possible risks associated with the programs. Public healthcare workers recommend that needle exchange programs should be used to prevent blood-borne infectious diseases. Myths, misconceptions, and stigmas have prevented the development of the programs in many communities. More education needs to be given about the benefits of needle exchange programs in this vulnerable population.
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