Needle Exchanges Work—Now Let's Bring Them to the Suburbs and Countryside - Pacific Standard

Needle Exchanges Work—Now Let's Bring Them to the Suburbs and Countryside

Volunteers in inner cities launched the United States' first needle exchange programs, but now the need has moved to suburban and rural America.
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Used syringes are viewed at a needle exchange clinic where users can pick up new syringes and other clean items for those dependent on heroin in St. Johnsbury, Vermont. (Photo: Spencer Platt/Getty Images)

Used syringes are viewed at a needle exchange clinic where users can pick up new syringes and other clean items for those dependent on heroin in St. Johnsbury, Vermont. (Photo: Spencer Platt/Getty Images)

Since their inception, syringe exchange programs have played an important part in slowing the spread of HIV and hepatitis C in America. But a generation later, the United States' drug-use landscape has changed, and programs haven't been able to keep up, according to a new survey conducted by the Centers for Disease Control and Prevention (CDC).

Needle exchanges tend to be concentrated in big cities, the survey finds. They were often launched there by volunteers in the 1980s and '90s, targeting heroin users living in the inner city. Now, however, at least half of injection-drug users in America live in the suburbs or rural areas. (And they often inject crushed-up opioid painkiller pills, in addition to heroin.) Meanwhile, the CDC has recorded recent outbreaks of hepatitis C and HIV, both of which are spread by dirty needles, in suburban and rural towns struggling with injection-drug abuse. Together, these reports suggest it's past time for states and local jurisdictions to build and fund syringe exchange centers in Commuter Town and Country Village, U.S.A.

Needle exchange programs work by encouraging injection-drug users to turn in used, potentially infectious needles and to instead utilize the programs' free, sterile syringes. Often, the exchange centers offer other health services, such as HIV and hepatitis C testing and referrals to addiction treatment. These centers are controversial; some operate illegally because certain states outlaw the possession of syringes without a prescription. But they're effective. Researchers consider these centers an important reason for the 80-percent decline in HIV infections among heroin and other injection-drug users between 1990 and 2006. Research has also shown the programs don't encourage additional drug use.

Despite the science, needle exchange centers have historically been extremely politically unpopular. Last month, however, Congress partially lifted a longstanding ban that kept such centers from receiving federal funding. (The ban was first put in place in 1988, lifted in 2009, then reinstated in 2011.) Taxpayer dollars still can't go toward buying needles, but they can pay for syringe exchange centers' other programs, freeing money to fund needles as part of an effective disease-prevention package. Hopefully the change will not only bolster existing exchanges, but will also help spread their services to new, needy areas.

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