11 Needle Exchange Programs Pros and Cons

Needle exchange programs, which often include syringes as well, are social service programs that are designed to reduce risk factors for certain blood-borne diseases. The typical program will provide equipment without cost. Someone brings in used needles or syringes and exchanges them for an equal number of safe, sterile needles and syringes. In doing so, the need to reuse needles or share them with others is reduced.

The primary benefit provided be needle exchange programs is that they can reduce the spread of certain diseases without a high cost to the community. In 2004, the World Health Organization found that HIV rates amongst illicit drug users could be reduced substantially without promoting higher levels of injectable drug use within a specific community. In the United States, the cost of a needle is less than $1, whereas the typical cost of 1 dose of HIV medication is about $36 before insurance.

The disadvantage of needle exchange programs is that those who use illicit drugs tend to stay close to the facility. This affects the neighborhood which surrounds the facility because it increases the availability of the drug while bringing potentially higher levels of crime with it. In program areas, a study in Baltimore discovered a 4.3% increase in drug possession arrests.

Here are some additional needle exchange programs pros and cons to discuss and think about.

Pros of Needle Exchange Programs

1. It can reduce the number of needles in the community.
When injectable drug use is high within a community, there is usually a correlation in the number of needles that are found in public. Many of the leftover needles are left in places with high traffic movements, such as public parks or beaches. That creates a sharps risk to the community if the needle is not seen and stepped on. By instituting a needle exchange program, these littered needles can often be reduced.

2. It increases access to social services.
Individuals who participate in needle exchange programs typically have higher levels of access to community social services. This may include testing services, diagnostic services, or even drug treatment referrals. At the same time, many programs offer higher levels of access to educational opportunities, substance abuse recovery services, and other community options that can reduce long-term dependence on the injectable drug.

3. It can reduce infections associated with reusing needles.
Information released by the Centers for Disease Control and Prevention from 2016 data shows that 9% of new HIV infections that are diagnosed annually in the United States occur from injectable drug use. At the same time, these needles have created a 150% increase in the diagnosis rates of Hepatitis C. By taking used needles off the streets, these programs are reducing the risks of infection.

4. There may be reductions in drug-related behaviors.
By removing one of the obstacles to illicit drug use, many of the negative social behaviors that are required of users to obtain all the supplies they need can be reduced as well. This means a community with a needle exchange program may see reductions of sexually risky behaviors, drug-related behaviors, and crime that is linked to drug use.

5. It provides a layer of protection for support networks.
Individuals who struggle with illicit drug use often have a support network with them. This may include children, neighbors, and sexual partners. By providing a program that protects against the transmission of certain infections and diseases, the network of people who interact with the user receive a peripheral level of support and protection at the same time.

6. Needle exchange programs can be structure in a variety of ways.
Many programs are designed to be primary stand-alone services. Some are offered as secondary services with a social service, health service, or pharmacy. They can be on-call programs, vending programs, or be part of a peer service. Some can be based in prisons. Some programs are even part of an overall informal distribution network.

Cons of Needle Exchange Programs

1. They are not designed to be treatment facilities.
Needle exchange programs are designed to reduce harm to communities and individuals by lessening the impact of certain communicable diseases. HIV is usually the point of focus, but other medical conditions, such as Hepatitis C, can be reduced with the presence of these programs. Some may offer referrals to social services, medical providers, or counseling services, but that is usually the extent of their involvement.

2. They enable illicit drug use.
By offering illicit drug users access to free needles, communities are essentially enabling people to continue using their current drug of choice. It may even encourage higher levels of injection drug use because there is better access to the needles that are required to use the drug. That creates a risk where the entire community may begin to see increased levels of illicit drug use.

3. Needle exchange programs can increase infection levels.
Many people who decide to participate in a needle exchange program are often already at a high risk of suffering an infection or disease that is transmitted from their behavior and activities. Because they are already at such high levels of risk, participating in the program does lower their risk. It doesn’t increase their risk either, but some communities have found higher rates of blood borne infections that link directly to the presence of a needle exchange program.

4. Some programs may increase financial liabilities.
Although some needle exchange programs are privately funded, most of them are subsidized by taxpayers. The programs are designed to provide a cost savings ratio of up to $35 for every needle exchanged, but that is based on the assumption that a user would be infected with HIV and taking prescription medication to treat it. In reality, many needle exchange programs are an added cost to communities and the taxpayers which live in them.

5. There can be rural access issues.
Needle exchange programs are designed to work with illicit drug users who live in an urban environment. Yet, for many communities, injection drug use is more prevalent in rural areas. According to research from the National Institutes of Health, about 50% of methamphetamine users in Nebraska prefer injection-based use over other methods. That’s double the rate of urban users and similar ratios can be found throughout the United States.

Needle exchange programs are activity supported by the Centers for Disease Control and Prevention and the National Institute of Health. Although the pros and cons of these programs may be community-specific, there are some general trends that can be evaluated.

Is it better to reduce the threat of an infection or disease by potentially encourage higher drug use levels? Or are there treatment solutions that might work better than these exchange programs?