To combat an outbreak of new HIV transmissions linked to injectable prescription drug abuse, Indiana Gov. Mike Pence issued an executive order today allowing local officials to establish a short-term needle exchange program.
Needle-exchange programs, which give people who abuse an injectable drug the opportunity to exchange dirty needles for clean ones without fear of legal consequence, are banned by state law. But in declaring a public health emergency, Pence can get around the ban in an effort to put a halt to a rash of recent HIV diagnoses -- 71 confirmed cases and nine preliminary cases (cases that need to be confirmed with additional testing) linked to the abuse of prescription drugs.
The public health theory behind needle-exchange programs, known as harm reduction, is that providing people with clean syringes reduces disease transmission -- one of the most negative consequences of drug abuse and the one with the biggest public health impact. For instance, if a person who abuses injectable drugs contracts HIV or hepatitis C from a dirty needle, they can also pass the diseases on to others who share future needles as well as their sex partner.
Needle exchange programs are also a way to help draw people into social service programs that may eventually help them quit their habit. In a previous story for the Huffington Post on this issue, Adam Carrico, an assistant professor at the University of California, San Francisco described it this way:
“People don’t want to get HIV, but maybe they’re not motivated at that point to abstain from drugs or pursue drug treatment,” he said. “We can use needle exchanges almost like a net to move them into more comprehensive approaches, so that they hopefully become abstinent through biomedical and behavioral approaches that we know work.”
But despite the promise of needle-exchanges, stigma around drug abuse prevents many states from taking up with a public health intervention that has been shown to reduce the transmission of deadly viruses. As of Jan. 1, only 15 states and Washington, D.C. explicitly authorize needle exchange programs.
Indeed, during the announcement of the needle-exchange program creation, Pence made sure to emphasize that he did not endorse their long-term use in the state’s anti-drug abuse initiatives. He also promised to veto any bill from his legislature that would make the programs a permanent statewide initiative, reports AP.
Robert Childs, M.P.H., executive director of the North Carolina Harm Reduction Coalition, says stigma around needle exchange programs stems from a fundamental misunderstanding about people who abuse drugs.
“People think that if you give someone a syringe, it means they’re going to go out and inject drugs, and if don’t give them syringes, they won’t inject drugs,” Childs said to HuffPost. “But the thing is that if you don’t give them syringes, they share them, and then people will start getting HIV and viral hepatitis C. And then you see what happens in [Indiana]."
While Childs commends Pence’s initial decision to authorize needle exchanges, he thinks that the benefits of such a program far outweigh the relatively few costs. Syringes are, after all, very cheap compared to the cost of lifetime HIV care.
“If it’s short term and they cut it off after a month, they’re probably going to see something very similar popping up elsewhere in that state or returning to the county,” said Childs. “These are extremely costly diseases, and there’s no reason to get them if people can get access to clean syringes -- an incredibly cheap product."
Between 1994 to 2000, injection drug use was linked to 23 percent of new HIV infections in the U.S., according to the National Institute on Drug Abuse, but in 2010 that rate dropped to only eight percent.
Needle exchange programs are endorsed by health organizations like the American Medical Association and the World Health Organization. The U.S. Congress bans federal funding for needle exchange programs.