Increase Access to Needle Exchanges

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Background

Needle exchange programs (NEPs) are programs which distribute sanitized needles in exchange for contaminated or used needles. NEPs reduce the spread of blood borne diseases like HIV and Hepatitis C.

  Hepatitis C is more than three time more prevalent among people who inject drugs than HIV. In most countries, more than half the people who inject drugs are living with Hepatitis C. In addition, the number of undiagnosed cases is estimated to be very high: between 50 and 90 percent of people living with Hepatitis C may be unaware of their infection. In countries with repressive drug laws, Hep C testing rates among people who use drugs are often even lower largely due to stigmatisation in health care settings, fear of arrest, or the unavailability of treatment and testing.

  Harm reduction services such as the provision of sterile needles and syringes can effectively prevent hepatitis C transmission among people who inject drugs, provided they are accessible and delivered at the required scale.

  While chronic Hepatitis C is not a death sentence, it creates a slew of long term problems. About one in five people will develop more progressive liver damage with fibrosis (scarring of the liver). Hep C can also cause cirrhosis to the point where the scarring diminishes liver function. Aside from discomfort, this slow burn inflammation can exacerbate other conditions, and in up to five percent of people lead to the kind of full liver failure that requires an organ transplant.
 

  Prevention is a extraordinarily cost effective. In 2013 the FDA approved a new class of direct-acting antiviral drugs for Hep C, which can clear the body 90% of the time. However, a course of treatment for either of the most common medications, Viekira Pak or Harvoni, can cost $85,000 to $94,500. It would cost more than 10 percent of all the medical care in the country to treat the roughly 3.5 million Americans estimated to be infected with Hep C. Hep C treatment is costly to public programs as well. In 2015, Medicaid spent about $2.2 billion on just one Hep C medication, Harvoni, made by Gilead Sciences. This Hep C treatment cost more than any other individual medication.

  Sharing needles has become the most common mode of HIV transmission among injection drug users (IDUs). IN turn, IDUs often spread HIV to other, non-injecting populations through sexual relations. In addition, used syringes and needles are a potential biohazard throughout the geographic area within which IDUs primarily reside, and beyond it as well.

  Studies have found that needle exchange programs also reduce pollution.

 

 

Different Models for Syringe Exchanges

There are several different modesl for syringe exchanges that have different advantages and limitations.  The website for the North Carolina Harm Reduction Coalition (NCHRC) describes these in their website. The models include: 

• Fixed-site Exchanges
• Mobile/Street-based Exchanges or Vehicle-based Exchanges
• Home Delivery or Peer-based Exchanges
• Integrated Syringe Exchanges
   

Return Rates of Needle Exchanges

One prominent study sought to answer the question "is the number of needles distributed from NEPs proportionate to the number of needles returned to NEPs?"
  Overall, the global return rate for NEPs was 90% based on a total distribution of 11,971,584 needles (needles out) and 10,793,270 needles returned to the NEPs (needles in). The US return rate was over 90% (315,942 needles distributed, 282,897 needles returned).

  The evidence regarding return rates presented in this this study makes it clear that supplying IDUs (Injecting Drug Users) with clean needles does not lead to more "dirty" needles in any given community. While NEP critics argue that distribution of needles to IDUs does nothing more than increase the number of needles in circulation, the evidence presented here does not support that assertion.

 

 

Peer-Delivered Needle Exchanges

One option being used in King County, WA is to use peers to bring new syringes to people injecting drugs. (Find out more.)
[2]
[3]
  Research on the influence of peer-delivered syringe exchanges on mental health

 

 

Success Stories

Scott County, Indiana

Before Scott County set up its syringe exchange (plus more) program in 2015, the rural county in Indiana was seeing 10-20 new HIV cases every week. Almost immediately after, the number of new cases was slowed to 1-2 a month.

 

Tools & Resources

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