BSC 2347 Needle Exchange Discussion

BSC 2347 Needle Exchange Discussion

The incidence rate of Hepatitis C infection, the most common blood-borne infection in the United States, has more than doubled since 2004 (Zibbell, 2018). The opioid crisis in the U.S. has largely contributed to this
increase because shared needles among injection drug users is the primary factor in hepatitis C transmission.

Needle exchange programs allow drug users to safely exchange used needles for little or no cost. As of 2011, 211 needle exchange programs existed in the United States (Green, 2012) and many more have been implemented
since then.

In your post, address the following questions:

• Are needle exchange programs effective at reducing blood-borne disease transmission?
• Should more state or federal government agencies set up needle exchange facilities to help combat blood borne diseases or do they encourage the use of drugs?
• Is there a better method to help combat blood borne diseases contracted through shared needles?

References

Zibbell, J. E., Asher, A. K., Patel, R. C., Kupronis, B.,
Iqbal, K., Ward, J. W., & Holtzman, D. (2018). Increases in Acute Hepatitis
C Virus Infection Related to a Growing Opioid Epidemic and Associated Injection
Drug Use, United States, 2004 to 2014. American Journal of Public Health,
108(2), 175-181.

Green, T. C., Martin, E. G., Bowman, S. E., Mann, M. R.,
& Beletsky, L. (2012). Life After the Ban: An Assessment of US Syringe
Exchange Programs’ Attitudes About and Early Experiences With Federal Funding.
American Journal of Public Health, 102(5), e9-e16. doi:10.2105/AJPH.2011.300595

This chapter assesses the effects of needle exchange programs on HIV infections and drug use behaviors. Five major sources provide the evidentiary basis for the panel’s assessment: (1) a 1991 review carried out by congressional request of the effectiveness of needle exchange programs (U.S. General Accounting Office, 1993), (2) a second comprehensive evaluation carried out by University of California researchers for the Centers for Disease Control and Prevention (Lurie et al., 1993), (3) selected studies published since the two 1993 literature reviews, (4) detailed examination of a set of recent studies in New Haven, Connecticut, and (5) detailed examination of a set of recent studies in Tacoma, Washington. This chapter concludes with the panel’s conclusions and recommendations, which are based on the evidence presented in the chapter and throughout the report.

Evaluations of needle exchange programs have been published by Stimson et al. (1988), Des Jarlais (1985), the U.S. General Accounting Office (GAO) (1993), and the University of California (Lurie et al., 1993). We highlight the findings of the latter two reports, which were commissioned specifically by the federal government as evaluations of needle exchange programs. Both were published in 1993 and deal with needle exchange programs as they existed up to that time.

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Needle exchange programs operate in a rapidly changing environment, and the panel reviews a number of studies that were published subsequent to the major reviews by GAO and the University of California.

Two strong lines of evidence emerged from the panel’s examination of recent research on the effects of needle exchange programs on the spread of HIV infection: studies from New Haven and Tacoma. These two sets of studies were selected on the basis of the wealth of published information available about the programs they analyze. That is, not only do they provide a sizable amount of information on various endpoints of interest (i.e., incident infection and risk behaviors), but they also have carefully addressed potential alternative explanations for their reported findings.

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Potential Outcomes
At the outset, it is important to recognize that the effects of needle exchange programs can be viewed from a number of different perspectives. Some of these perspectives involve outcomes relevant to improving the health status of injection drug users, and others reflect community-level concerns regarding potential negative effects that may be associated with the implementation of such programs. The following section identifies the outcome domains that are relevant to those distinct perspectives and are most germane to the panel’s task of assessing the effects of needle exchange programs.

Possible Positive Outcomes
Needle exchanges are established in order to: (1) increase the availability of sterile injection equipment and (2) at the same time, remove contaminated needles from circulation among the program participants. Operation of the exchange, then, is expected to result in a supply of needles with reduced potential for infecting program participants with HIV and also to reduce sharing between individuals because of easier access to clean needles for any program participant. Typical exchanges also maintain such services as education concerning risk behaviors, referral to drug treatment programs (a step toward eliminating the route for all infection), and distribution of condoms. These measures offer independent prospects for reducing the spread of HIV. Appraisal of the success of a needle exchange program may involve measuring, for example, the numbers of needles exchanged; the cleanliness of circulating needles; the prevalence and incidence of HIV and other needle-borne diseases; referrals to drug treatment programs; enrollments in treatment programs; and changes in the risk behaviors of needle exchange participants. An observed pattern of favorable outcomes would reflect health benefits from the operation of the program.

Possible Negative Outcomes
The possibility of negative results from needle exchange program operations also demands attention. One possible negative outcome is an increase in the number of improperly discarded used needles. Another possibility is that the issuance of injection equipment, condoned by government, will “send a message” undercutting efforts at combatting illegal drug use and will promote more drug use (with more attendant HIV incidence). A third possible negative outcome is that needle exchanges will lower the perception of risk of injection drug use and thus attract more users to inject drugs and to other forms of illegal drug use.

Appraisal of the success of a needle exchange program, then, should also attend to measures of these possible negative outcomes. An observed pattern of negative outcomes would weigh against the idea that needle exchange programs are beneficial.

Assessment of the effects of needle exchanges involves the simultaneous consideration of a number of intended positive and unintended negative outcomes (Table 7.1). Ideally, a successful exchange program would reduce the risk of new infection among injection drug users without increasing drug use and health risks to the public.