Two Topic Related Debates Debate 2: Needle Exchange
More than a million people in the United States inject drugs frequently, at a cost to society in health care, lost productivity, accidents, and crime of more than $50 billion a year. It is estimated that half of all new HIV infections in the US are occurring among injection drug users. For women, 61% of all AIDS cases are due to injection drug use or sex with partners who inject drugs. Injection drug use is the source of infection for more than half of all children born with HIV. Injection drug use is also the most common risk factor in persons with hepatitis C infection. Up to 90% of injection drug users are estimated to be infected with hepatitis C, which is easily transmitted and can cause chronic liver disease. Hepatitis B is also transmitted via injection drug use.
There are a number of reasons injection drug users are sharing needles, including the lack of availability of needles and syringes, cost prohibition, paraphernalia laws that make it a crime to possess or distribute drug paraphernalia, and prescription requirements.
Needle exchange clinics were first started in Europe in 1983 when Amsterdam introduced a needle exchange program to reduce the transmission of Hepatitis B and HIV among injection drug users and subsequently their sexual partners and children. It was believed that it would be impossible to completely eradicate drug use. Needle exchange programs are not needle distribution programs. Injecting drug users are required to return a used syringe in order to obtain a new, sterile needle. Needle exchange programs have been created to minimize the risk of HIV infection among injecting drug users in more than 80 cities in 38 states in the US. These needle exchange programs often provide drug treatment referrals, methadone clinics, peer education, and HIV prevention programs.
Those in support of needle exchange clinics argue that these programs save lives. In conjunction with a comprehensive HIV prevention strategy, these programs are an effective public health intervention that reduces the transmission of HIV and does not encourage the use of illegal drugs. They also assist clients in breaking the cycle of abuse. They are an effective and comparatively inexpensive method to prevent new HIV infections among one of the highest at-risk populations.
Studies in the US and abroad have demonstrated that needle exchange programs are effective in reducing HIV transmission among substance users. In Southern Australia, 55 needle exchange programs serving a population of 1.2 million have resulted in no new HIV infections among injecting drug users over the past three years. Rates of HIV infection among injection drug users at a Hawaii needle exchange program declined from five percent in 1989 to one percent in 1996. In Connecticut there was a reported increase in re-use and sharing of contaminated injection equipment among injecting drug users after a needle exchange clinic was closed.
There are a number of reasons injection drug users are sharing needles, including the lack of availability of needles and syringes, cost prohibition, paraphernalia laws that make it a crime to possess or distribute drug paraphernalia, and prescription requirements.
Needle exchange clinics were first started in Europe in 1983 when Amsterdam introduced a needle exchange program to reduce the transmission of Hepatitis B and HIV among injection drug users and subsequently their sexual partners and children. It was believed that it would be impossible to completely eradicate drug use. Needle exchange programs are not needle distribution programs. Injecting drug users are required to return a used syringe in order to obtain a new, sterile needle. Needle exchange programs have been created to minimize the risk of HIV infection among injecting drug users in more than 80 cities in 38 states in the US. These needle exchange programs often provide drug treatment referrals, methadone clinics, peer education, and HIV prevention programs.
Those in support of needle exchange clinics argue that these programs save lives. In conjunction with a comprehensive HIV prevention strategy, these programs are an effective public health intervention that reduces the transmission of HIV and does not encourage the use of illegal drugs. They also assist clients in breaking the cycle of abuse. They are an effective and comparatively inexpensive method to prevent new HIV infections among one of the highest at-risk populations.
Studies in the US and abroad have demonstrated that needle exchange programs are effective in reducing HIV transmission among substance users. In Southern Australia, 55 needle exchange programs serving a population of 1.2 million have resulted in no new HIV infections among injecting drug users over the past three years. Rates of HIV infection among injection drug users at a Hawaii needle exchange program declined from five percent in 1989 to one percent in 1996. In Connecticut there was a reported increase in re-use and sharing of contaminated injection equipment among injecting drug users after a needle exchange clinic was closed.
The estimated annual budget for running a needle exchange program is $169,000 per year. Sixty-six percent of an average needle exchange program budget is applied to staffing, rent, and overhead. With an average syringe costing $1.35, there is the potential to serve over 100 clients per day. Considering that as many as 33 Americans are infected with HIV each day due to contaminated syringe equipment, if only two HIV infections are prevented through clean needles, the cost of running a needle exchange program for a year would save money.
Those against needle exchange programs argue that they sent the “wrong message” to children, that clean needle exchange will lead to an increase in IV drug use among populations already ravaged by recreational drug use, that federal funding of exchange programs would allow tax dollars to be used to increase the amount of drug paraphernalia in areas already overburdened with IV drug use, that distributing drug paraphernalia is in complete contrast to the accepted morals of our culture, and question the impact of blood borne infections due to injection drug use in the U.S. as it pertains to morbidity and mortality and the cost to the health system (are there enough resources necessary to address the issue?
Those against needle exchange programs argue that they sent the “wrong message” to children, that clean needle exchange will lead to an increase in IV drug use among populations already ravaged by recreational drug use, that federal funding of exchange programs would allow tax dollars to be used to increase the amount of drug paraphernalia in areas already overburdened with IV drug use, that distributing drug paraphernalia is in complete contrast to the accepted morals of our culture, and question the impact of blood borne infections due to injection drug use in the U.S. as it pertains to morbidity and mortality and the cost to the health system (are there enough resources necessary to address the issue?