STERN: Needle exchanges work
A Stern Perspective
STERN: Needle exchanges work
A Stern Perspective
Friday, January 27, 2012
For six and a half years, Margaret Lippitt, a student in the Yale Graduate School of Public Health, worked for an organization with a slightly jarring name: Helping Individual Prostitutes Survive. HIPS provides services including disease testing and support groups to prostitutes, intravenous drug users and other at-risk individuals.
One of HIPS’s many services is to drive a van around many of D.C.’s most dangerous neighborhoods late at night. Workers in this van distribute condoms, lubricant, dental dams and other supplies. They also pass out sterilized syringes and other paraphernalia needed to inject intravenous drugs. This is part of HIPS’s syringe exchange program.
In syringe exchange programs, drug users receive hypodermic needles and other injecting equipment, usually for free. These programs are often known as exchange programs because users exchange their old, dirty needles for new, sterilized ones.
When people initially hear what syringe exchange is, many seem a little unsettled. It does, after all, enable drug use. Many see it as helping addicts continue to behave in a harmful, not to mention illegal, manner. Wouldn’t it be better, critics ask, to not give them new needles? Without the instrument to inject their drugs, wouldn’t they be forced to quit?
Sadly, it’s not that simple. Drug users don’t stop injecting drugs when they run out of needles; they just use dirty needles and share needles with other users. The consequences of this behavior are dire. Sharing needles contributes to a considerable number of new HIV infections, sexually transmitted infections and the spread of hepatitis C.
Syringe exchange programs drastically reduce this risk. A study performed by Baron Edmond de Rothschild Chemical Dependency Institute found that new infection rates plummeted by more than 75 percent when cities instituted syringe exchange programs. In 2002, 45.4 percent of all new HIV infections were caused by injection drug use; in 2009, after the federal government started funding syringe exchange programs across the country, that percentage fell to 12.5. The evidence is incontrovertible. Syringe exchange is an exceptionally cost-effective way to prevent the spread of disease. Syringe exchange also helps people who don’t do intravenous drugs but instead need needles to inject medication or hormones.
Yet syringe exchange programs have been stripped of all of their federal funding. Despite having reinstated federal spending on the programs in 2009, a single line in the 2012 budget banned funding for the programs.
Let’s disregard for a moment that the federal government gave hardly any money at all to syringe exchange, and that lifting the previous ban (and presumably keeping it lifted) was among Obama’s campaign promises. Let’s even disregard how effective the program is. The simple truth is that to lift the ban — and to start funding syringe exchange programs again — would cost nothing at all. Not a penny.
The federal government is already giving money to fight the spread of HIV/AIDS. Eliminating the ban on syringe exchange would just be diverting a small fraction of the money already meant for public health purposes into syringe exchange programs — one of the most cost-effective ways to fight the spread of disease. It would not allocate any new money.
There is little cogent criticism of syringe exchange. Its opponents simply hate it because it seems so unsavory. Sort of like putting condoms in schools, syringe exchange may sound off-putting when one first hears about it. But — like putting condoms in schools — it is very effective at reducing the transmission of diseases.
We now have a few months to get the ban lifted in the new federal budget. This is such a minor part of the budget, an inexpensive, effective little program that is happening anyway but would be so much better and broader with federal support. No one can argue with the effectiveness of syringe exchange; its opponents can only obfuscate with misplaced moralizing.
Scott Stern is a freshman in Branford College. Contact him at scott.stern@yale.edu.
Comments
River_Tam 4 months ago
The first sign of a closed mind is one that does not spend the time to find what the opposing argument actually is.
I'll explain: I hate it because it enables intravenous drug users and by extension, intravenous drug dealers. You've cited statistics on how incidence of HIV from IV drug use went down. Are there any statistics on how IV drug use ITSELF was effected by syringe exchange? IV drug use might not kill as dramatically as HIV, but it tears apart families and communities all the same. It is reprehensible for the government to ban IV drug use on the one hand and on the other toss needles to addicts.
Spend that money on treatment programs. Better one guy gets the help he needs than a million junkies get a clean fix.
River_Tam_Biggest_Fan 4 months ago
READ:
"Wouldn’t it be better, critics ask, to not give them new needles? Without the instrument to inject their drugs, wouldn’t they be forced to quit?
Sadly, it’s not that simple. Drug users don’t stop injecting drugs when they run out of needles; they just use dirty needles and share needles with other users. The consequences of this behavior are dire. Sharing needles contributes to a considerable number of new HIV infections, sexually transmitted infections and the spread of hepatitis C."
River_Tam 4 months ago
I addressed this precise so-called "point" (actually just a bit of folk wisdom without any citation or evidence)
River_Tam_Biggest_Fan 4 months ago
1) Are you denying that when addicts runout of needles, they just reuse old ones? 2) The point of needle exchange isn't to discourage IV drug use. It doesn't do that. It's to make sure that disease doesn't spread. Seeing as how we have no effective ways to stop people from injecting, why not at least make sure they don't get AIDS?
River_Tam 4 months ago
If something is safer, more people will do it. If drug use becomes synonymous with HIV/AIDS (like it has in some communities), people will be less likely to use IV drugs. I personally know people who stayed far clear of IV drugs (although they did do other drugs) because they didn't want to get the bug.
Of course clean needles will reduce the risk of a user contracting HIV, but I want to know how many additional addicts we're creating by enabling this destructive behavior.
No one seems to be able to tell me, but they are very eager to keep skewing the incentives in favor of more and more drug use.
xfxjuice 3 months, 4 weeks ago
http://www.ncbi.nlm.nih.gov/pubmed/8395856
"RESULTS: No negative consequences of needle exchange were detected. Specifically, the presence of the exchange program was not associated with (1) increases in injection drug use, (2) increases in needle-sharing behavior, or (3) changing drug-use behavior from non-injection to injection. "
River_Tam 3 months, 3 weeks ago
These aren't two-year effects I'm talking about. I'm referring to long-term sociological damage. I'm not saying some guy's going to say "oh, free needles? Better use drugs!". It's more subtle than that. cf: the entire history of HIV/AIDS in the US.
xfxjuice 3 months, 4 weeks ago
"If something is safer, more people will do it. If [unprotected sex] becomes synonymous with HIV/AIDS (like it has in some communities), people will be less likely to [have unprotected sex]. I personally know people who stayed far clear of [unprotected sex] (although they did do other [sexual acts]) because they didn't want to get the bug. Of course [condoms] will reduce the risk of a user contracting HIV, but I want to know how many additional addicts we're creating by enabling this destructive behavior. No one seems to be able to tell me, but they are very eager to keep skewing the incentives in favor of more and more [unprotected sex]."
Subsitute "unprotected sex" or other variations for "drugs," and "condoms" for "clean needles," and what we have is the conservative argument for handing out condoms to teens.
Stephanie_Nichole 3 months, 4 weeks ago
The difference between sex and drug abuse is that sex isn't inherently a bad thing. Although some forms of it are rightly restricted (rape, sex with minors, etc.) you could generally say that it's a good thing. Drug abuse, however, has no redeeming social value and should be restricted in all cases.
River_Tam 3 months, 3 weeks ago
Several problems with your bad analogy:
I AM opposed to handing out free condoms to teens / at Yale. Assuming I'm not is just you being insulated in the Yale bubble.
There are no (physical) downsides to sex with a condom, whereas there are still serious harms to IV drug use.
It's undeniable that giving out condoms increases sex. No one's NOT going to have sex because of the free condoms (ie: it does nothing to discourage sex), and I know of scenarios where Yalies couldn't get it on because drunk idiots stole the entire bag of condoms from their entryway.
Sex is not illegal. IV drug use is.
Declines in unprotected sex are attributable specifically to its association with HIV/AIDS, which is precisely my point. Associate something with HIV/AIDS and you get less of it.
harvardsucks 3 months, 3 weeks ago
River Tam, based on your argument am I correct in saying that you would be forced to change your mind if it were empirically proven that syringe exchange programs do not increase drug use?
Because I have news for you: this has been proven.
"Hundreds of studies of SEPs have been conducted and summarized in a series of eight federally funded reports over the last two decades. Each of the eight reports has concluded that SEPs reduce the number of new HIV infections and do not lead to increased drug use among injecting drug users or society as a whole."[http://www.aidsaction.org/attachments/518_Syringe%20Exchange.pdf]
Any other objections?
River_Tam 3 months, 3 weeks ago
An interesting link - But I'm curious to look at the actual 'eight reports', and the link you're citing from (from a partisan source) contains no citation for their claim. Care to track them down for me?
yalengineer 3 months, 3 weeks ago
I would point out that the early mathematical models of the value of needle exchanges were developed by the late Serge Lang. Would love to hear further details about his work too.
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