In 1988, Congress passed an omnibus bill that included a federal funding ban on needle exchange programs. This ban continued despite scientific reports demonstrating the effectiveness of such programs in preventing HIV and hepatitis infections among intravenous drug users. President Obama repealed the ban in 2009 only to have Congress reinstate it in 2012. About 200 programs across the U.S. exist through a combination of local, state, and private funding.
A recent HIV outbreak in Indiana has highlighted the need for needle exchange. Last year, rural Scott County experienced a sudden increase in HIV infections that reached a peak of 184 new cases. Republican Governor Mike Pence, a vocal opponent of needle exchange, declared a state of emergency and approved a temporary program to combat the outbreak. Health officials criticized the response, pointing to the Governor's delay in waiting until the spread of HIV had reached epidemic proportions and his eventual legislation that limited needle exchange to treating emergencies rather than preventing outbreaks.
Faced with unprecedented opioid use the highest Hepatitis C infection rate in the country, Kentucky became the first Southern state to legalize needle exchange programs in 2015. It is not coincidence that two Kentucky Republicans (Rep. Hal Rogers, R-Ky and Sen. Mitch McConnell R-Ky) recently supported a change to federal funding ban. Tucked in the omnibus spending bill approved last month by President Obama was language effectively ending the federal ban on needle exchange programs. Funds can now be used to pay for vans, staff, and all supplies except for the needles and syringes themselves.
This policy reversal is surprising but gratifying. Jurisdictions that have conducted needle exchange have decades of data to demonstrate their efficacy. In Baltimore, our Health Department has distributed more than 8 million clean syringes in twenty years, preventing tens of thousands of infections. The percentage of HIV diagnoses attributed to drug use has fallen from nearly 63% to an all-time low of 11%. Nearly 4,000 clients are served by needle exchange every year; these clients also receive on-the-spot HIV testing, counseling, and referral to addiction services.
In Washington, D.C., the average monthly rate of HIV infections among drug users dropped by nearly 70% after they began needle exchange in 2008. Within the last two years alone, D.C.'s needle exchange program prevented 120 new cases of HIV infection and saved an estimated $44 million of taxpayer dollars.
Studies from the Center for Disease Control and Prevention (CDC) and the World Health Organization unambiguously illustrate that needle exchange decreases disease transmission and does not increase drug use. Lifting the federal ban provides much needed support for existing programs and paves the way to funding new ones.
While this shift in policy is encouraging, public health leaders and advocates still have much to do to ensure this evidence-based intervention is implemented nationwide. According to the North American Syringe Exchange Network, 33 states and the District of Columbia currently operate needle exchange programs; however, only 17 states currently explicitly authorize these programs while 14 states have removed syringes from their definition of drug paraphernalia. That means that needle exchange remains illegal in many states, including Pennsylvania, Florida, and West Virginia. Allowing for their legal operation will save lives and money: the CDC estimates that new cases of HIV in Scott County will cost at least $100 million to treat.
Furthermore, existing programs should consider expanding from one-for-one needle and syringe exchange. In 2014, the Maryland State Legislature authorized Baltimore City's Health Department to expand distribution to as many syringes as patients need, following the lead of New York, Chicago, and San Francisco. Research demonstrates that such programs are effective at preventing disease and do not increase drug use or syringe littering.
The rise in opioid use across the country must also be accompanied by an understanding that addiction is a disease and that there needs to be high-quality, on-demand treatment for addiction including medication-assisted treatment and psychosocial support. Recently, the Senate HELP Committee held a hearing on the opioid abuse epidemic; there is urgent need for bipartisan legislation that will prevent and treat addiction based on science and evidence.
America's policies toward drug addiction are changing, with growing recognition that addiction is a disease, treatment is possible, and prevention of harm is paramount. Congress's repeal of the funding ban for needle exchange is an important victory of science over stigma and research over rhetoric, but far more needs to be done to prevent disease and save lives.