8/14/21
Syringe-access sites have been widely effective in reducing opioid overdoses and the spread of disease. But amid new health emergencies that include a record-setting nationwide increase in opioid overdoses and a global pandemic, needle-sharing programs are increasingly under fire and in danger of being shut down.
As reported by The New York Times, New Jersey is about to shut down its largest needle-exchange program. Called Oasis, the program is operated by the South Jersey AIDS Alliance from a modest, single-story building on an Atlantic City side street, a few blocks from the casinos that once promised an economic rebirth in the seaside resort town. Programs similar to Oasis operate in Asbury Park, Camden, Jersey City, Newark, Paterson and Trenton.
Last month the Atlantic City City Council voted to evict Oasis. Their justification is the belief that the program draws transient drug addicts into a city that Lady Luck hasn’t smiled upon in decades. The council’s vote defied lobbying efforts by New Jersey’s Democrat governor, Philip D. Murphy, to try to block the closure.
Frustrating indeed, when you consider that programs like Oasis have been proven to reduce HIV infection rates by limiting the reuse of contaminated needles.
What are needle-exchange programs, and are they effective?
According to the Centers for Disease Control and Prevention (CDC), Syringe Services Programs (SSPs) and Needle Exchange Programs (NEPs) are community-based programs that provide access to sterile needles and syringes, facilitate safe disposal of used syringes, and provide and link to other important services, such as referral to substance use disorder treatment programs, vaccinations for hepatitis A and hepatitis B, and screenings for sexually transmitted infections.
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According to the CDC, people who inject drugs and have used an SSP regularly are nearly three times as likely to report reducing or stopping illicit drug injection as those who didn’t use such programs. They are also more likely to enter treatment for substance use disorder and reduce or stop injecting. A Seattle study1 found that new users of SSPs were five times as likely to enter drug treatment as those who did not use such a program.
There is also strong evidence that SSPs provide an economic benefit to communities where there is a high concentration of intravenous drug use.
A 2019 study2 found that SSPs established in Philadelphia and Baltimore in the 1990s have averted thousands of new HIV diagnosis among people who use drugs and saved hundreds of millions of dollars in public health costs. The study’s findings were published in October 2019 in the Journal of Acquired Immune Deficiency Syndromes.
Using data from Philadelphia between 1984 and 2015, and from Baltimore from 1985 to 2013, researchers from Johns Hopkins University and George Washington University measured the impact of SSPs and concluded that more than 10,500 HIV diagnoses tied to injection drug use were averted in Philadelphia between 1993 and 2002, and nearly 2,000 were averted in Baltimore from 1995 to 2004.
They also found a significant average annual decrease in injection drug-related HIV diagnoses in Baltimore when comparing the period before a needle exchange program was implemented with the period after. In Philadelphia, a significant decline in diagnoses was seen among men who have sex with men and were exposed to injection drug use. That’s a population with multiple risk factors for HIV infection.
The researchers also calculated that, even after deducting the estimated costs of operating such programs, the overall savings to municipalities are substantial. Cost savings for both cities are based on the averted HIV diagnoses and a lifetime cost of HIV treatment per person of $229,800. They determined Philadelphia experienced an estimated annual savings of $243.4 million, while Baltimore saved $62.4 million each year.
What are the politics behind this situation?
Across the country, programs like Oasis are increasingly under fire. Likely pressured by residents of urban neighborhoods affected by the flow of transient drug users, local politicians are pushing back against needle exchange programs.
Studies show that SSPs protect the public and first responders by providing safe needle disposal and reducing the presence of needles in the community. Officials from Oasis say that 95 percent of the needles they distribute are returned.This reality, however, did not stop the council president from holding up a jar of syringes that he said were collected from Atlantic City streets as evidence of the “used needle scourge” allegedly brought upon the city by the Oasis program.One could easily envision a similar tactic being used in other city council meetings across the country.
You might think this issue is unfolding along clear political lines, with politicians and morally outraged influencers from the far right behind efforts to shut down SSPs. You would be mostly wrong. Red state? Blue state? It doesn’t matter.
Kentucky, the state represented by Senate Minority Leader Mitch McConnell and anti-vaccine crusader Rand Paul, is home to 54 of the 220 counties identified nationwide as most vulnerable toH.I.V. infections among intravenous drug users and it has more than 70 SSPs.
Meanwhile, deep-blue New Jersey has lagged far behind other states on initiatives that enable easier access to sterile needles.
I think even the most conservative influencers would agree on the cost-saving benefits SSPs to communities. If we are to stem the tide of increasing opioid overdoses and HIV infection rates, it seems to me that proven-effective programs like SSPs should be given the opportunity to flourish. But if the current state of affairs regarding our response to COVID-19 has been any indication, with political theater overshadowing common-sense public health policy and rampant misinformation around vaccines, Programs like Oasis will most likely be fighting for their very existence for a good long time.
1. Hagan H, McGough JP, Thiede H, Hopkins S, Duchin J, Alexander ER. Reduced injection frequency and increased entry and retention in drug treatment associated with needle-exchange participation in Seattle drug injectors. J Subst Abuse Treat. 2000;19(3):247–252.
2. Ruiz, Monica S. PhD, MPHa; O'Rourke, Allison MPHb; Allen, Sean T. DrPH, MPHc; Holtgrave, David R. PhDc; Metzger, David PhDd,e; Benitez, Jose MSWf; Brady, Kathleen A. MDg; Chaulk, C. Patrick MD, MPHh; Wen, Leana S. MD. Using Interrupted Time Series Analysis to Measure the Impact of Legalized Syringe Exchange on HIV Diagnoses in Baltimore and Philadelphia. JAIDS Journal of Acquired Immune Deficiency Syndromes: December 1, 2019 - Volume 82 - Issue - p S148-S154