Want to hear an understatement? Completely preventing opioid use is hard. So hard that many reformers pursue a different goal entirely: to create the safest opioid use possible, not to jail anyone who touches a syringe.
These programs are called “syringe exchange programs,” and their logic is more complicated than just that. First we’ll explain what syringe exchange programs (SEPs) are and where you can find them.
These initiatives offer clean needles to those who inject drugs, who can then exchange their used needles. Receiving a clean syringe is often free. If you visit a SEP, it’ll likely be a private location. After all, SEPs protect drug users’ privacy to hopefully decrease the stigma of opioid addiction.
SEPs, also called “needle exchanges,” practice a different prevention strategy for needle-injection drug use: making sure that the people using needles have a clean supply which won’t give them a blood-transmitted disease. If you’re addicted to an opioid, you’ll be more likely to make poor decisions when you use. For instance, you might borrow someone else’s unclean needle and use it on yourself. Unclean needles easily transmit diseases like HIV and hepatitis C, and so having clean needles becomes crucial.
SEPs also give out other safety-first products to drug users. They might also provide alcohol swabs and condoms to help prevent transmitting other diseases and infections. And some SEPs provide light addiction counseling and can refer drug users to addiction treatment.
But just to reiterate—most SEPs intend first and foremost to prevent disease transmissions. Opioid addiction recovery isn’t their primary goal, though they can support it through their efforts.
You can find SEPs all across the United States, as well as throughout countries like the United Kingdom, Australia, and others. Some organizations, like the North American Syringe Exchange Network, have directories of SEPs around the United States.
So far, you can find them in 28 states, from California to Texas to the far northeast (Vermont and Maine). And earlier in 2019, new laws in Florida, Missouri, Iowa and Arizona proposed SEPs for the first time in those states. That’s a good sign for the exchanges’ supporters, especially since they’ve historically faced controversy.
Controversy over SEPs as a public health initiative comes from the sharp criticism it receives. Here are two summaries of the debate:
Opponents of SEPS point out that giving out free needles might make existing drug addictions worse, and that city and local funds shouldn’t be used for users’ drug habits. Their argument proposes that enabling injection drug use won’t help any of the users to get better, even if it might prevent blood-borne diseases.
Opponents also argue that ease of drug use and more needles in the streets won’t create good change in the community. If cities facilitate drug use for those addicted to opioids, then users may feel less pressure to enter rehab and more invitation to hang around SEPs full-time. And if free needles become more available, then cities might expect to find them as litter (as has been happening recently in San Francisco).
Proponents of SEPs argue that giving clean needles reduces disease and infections, and that reducing stigma can help addiction professionals reach those addicts who need their help.
That’s what traditional “law and order” approaches to stemming drug addictions have lacked—respectful concern for those suffering addiction. SEP supporters believe that making sure drug users stay healthy despite their drug use is the surest long-term way to get them the help they need.
Research has generally supported the benefits of SEPs in preventing the spread of HIV and hepatitis C. For example, a 2012 review of a Vancouver SEP (published in the International Journal of Drug Policy) concluded that SEP participation didn’t connect to HIV infection, and that limiting the number of needles given out proved less effective. Other research suggests that drug use and crime rates haven’t increased due to SEPs.
But there are some dissenting findings. A 2019 article from the National Economic Research Bureau found that SEPs correlate with more hospitalizations and opioid-usage deaths. The study also found that HIV rates tied to SEPs dropped, but the study questions whether needle exchanges help opioid addicts. One dissenting study hardly means consensus, but wary policymakers pay attention when the communal stakes are high. That’s where SEPs have become important to opioid responses around the country.
We at Buprenorphine Doctors have coveredhow federal, state, and local governments respond to opioid addiction and fatal overdoses. Some of these efforts include SEPs, especially when the needle providers give out naloxone (an overdose antidote), addiction rehab information, and tests for fentanyl (a deadly opioid sometimes mixed into heroin).
Many advocates believe that insuring the health of opioid addicts will become a strategic step towards slowing the opioid crisis. Their opponents worry that enabling continued opioid use won’t bring people into recovery and may risk more fatal opioid overdoses. For now, many cities and states institute needle exchange programs in their opioid response efforts. Only time and diligent research will tell how effective they ultimately are.
You can learn more about national opioid responses here. And if you have questions about opioid addiction treatments or opioid recovery, feel free to look through our educational content. Learn how Buprenorphine Doctors can serve you today!