Needle exchange programs are controversial harm reduction programs that provide sterile needles to people who inject drugs. Many programs also dispose of unsterile needles and provide an array of other services.
The goal of the programs is to reduce the transmission of diseases, such as HIV and hepatitis C. In 2016, the Centers for Disease Control and Prevention reported that 9 percent of HIV infections diagnosed each year occur among people who inject drugs. Injection drug use also helped cause a 150 percent increase in acute hepatitis C infections.
Injection drug use is associated with addiction to illicit drugs such as heroin, crystal meth and cocaine. Drug addiction causes people to make compulsive and risky decisions, such as sharing used needles.
Needle exchange programs are not designed to treat addiction, HIV, hepatitis C or other medical conditions. They’re designed to reduce harm by preventing the transmission of deadly diseases.
Many programs also provide brief counseling services and referrals to addiction treatment providers. Some also provide access to other disease prevention resources, such as condoms, and the overdose reversal medication naloxone.
Researchers have not measured national opinions on needle exchanges in recent years. Polls from the 1990s found varying levels of support. Support was largely dependent on how questions were worded, according to a 2003 study published in The International Journal of Drug Policy.
A wealth of research supports the benefits of needle exchange programs, and few risks are associated with needle exchanges. But people often criticize the programs, and many cities have outlawed needle exchanges.
Pros of Needle Exchanges
Advocates of needle exchange programs say the benefits outweigh the risks. Needle exchanges have positively impacted communities across the world.
Supporters of needle exchange programs say the pros are:
- Lower numbers of contaminated needles in a community
- Reduced drug-related behavior
- Reduced sexual-risk behavior
- Increased access to drug treatment referral services
- Increased access to testing and diagnostic services
- Increased access to education about substance abuse
- Increased communication with hard-to-reach populations
- Reduced prevalence of new infections
Many benefits are backed by research. But harm reduction supporters have to educate community members because drug use is stigmatized. They have to dispel myths associated with drug use and correct misconceptions that have no factual basis.
Cons of Needle Exchanges
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.
Critics of needle exchange programs say cons include:
- Enabling current drug use
- Increasing injection drug use
- Increasing drug use among entire community
- Increased rates of infection
- More contaminated needles in the community
- Increased financial burden on taxpayers
- Increased crime near needle exchange sites
- Low access to injection drug users in rural areas
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 evidence has shown that people who participate in needle exchange programs have high rates of infection. Other studies have shown that needle exchanges attract high-risk drug users who were already at high risk for transmission, so participation in the program didn’t increase their risk.
What Research Says About Needle Exchange Programs
Researchers have studied the effects of needle exchange programs for decades. A strong body of evidence supports the effectiveness of the programs, and a small amount of evidence supports conflicting or neutral results.
A 2001 review of studies published in the journal AIDScience identified seven studies that reported that needle exchange programs were associated with reduced prevalence of HIV, hepatitis B and hepatitis C. Three studies concluded that the programs reduced needle sharing, and three studies showed they were associated with increased rates of entry into drug rehab programs.
However, one study found no benefit associated with a needle exchange program. Three studies found higher rates of HIV among people who used needle exchange programs. Researchers disagree about the causes of the findings, but some believe selection bias influenced the results. The AIDScience review also concluded that no evidence showed the programs caused increases in drug use or crime.
In 2004, the World Health Organization produced an in-depth report on the effectiveness of needle exchange programs.
The report concluded that:
- Increased availability of clean needles likely reduces HIV infection.
- There is no evidence of negative consequences.
- The programs are cost-effective.
- The services can help increase recruitment into substance abuse treatment.
In 2012, researchers writing in the International Journal of Drug Policy summarized the results of 15 years of research on Vancouver’s Insite program, one of the most studied needle exchanges in the world.
The authors concluded that:
- Participation in needle exchange programs was not associated with HIV infection.
- High-risk drug users frequent needle exchanges, explaining increased rates of HIV infection.
- Needle exchanges are more effective when they collect contaminated needles and distribute clean needles separately.
- Programs that limit the number of clean syringes distributed are less effective.
Research also suggests that needle exchange programs keep communities clean of discarded syringes. A 2012 study published in the journal Drug and Alcohol Dependence compared San Francisco, a city with a needle exchange, to Miami, a city without needle exchanges.
More than eight times as many syringes were found on the streets of Miami, and injection drug users in Miami reported improperly disposing of needles much more often than those who injected drugs in San Francisco.
Overall, the pros of needle exchanges likely outweigh the risks associated with the programs. Public health experts have recommended needle exchanges to combat disease outbreaks for decades. Unfortunately, myths and misconceptions have prevented the development of the programs in many communities.