Assaf is an epidemiologist and postdoctoral fellow researching substance use, drug-related overdose, and harm reduction.
A needle exchange program, also known as a syringe services program, is a harm reduction strategy that provides clean and sterile injecting equipment to those who inject drugs. At first glance, these programs may sound radical. But the reality is, individuals who are injecting or using drugs are going to do so regardless of whether they have access to clean injecting equipment.
This is where the principle of harm reduction becomes important: these are evidence-based strategies for people who use drugs to prevent or limit the negative outcomes that may come from their drug use. The principle accepts that people use drugs and that there are very real consequences to drug use, but that it is not our role to stop people from using drugs.
Needle exchange programs — which are endorsed by the CDC as a public health strategy — exist in many states throughout the U.S. and have been proven to reduce the transmission of viral infections and to act as a bridge to other services, such as medication-assisted treatment. Yet this life-saving strategy continues to receive backlash.
House Bill 4866, which was recently introduced in the West Virginia House of Delegates, would end needle exchange programs in the state. West Virginia leads the nation in drug-related overdoses per capita and has been struggling with HIV outbreaks over the last several years. Banning needle exchange programs in the state will only make these challenges worse.
I’ve seen firsthand the impact of these programs: for nearly a decade I have worked at multiple needle exchange programs across California. Every program I have worked at also provided many other services such as HIV/hepatitis C testing, medical services, mental and behavioral health services, naloxone distribution for overdose prevention, social services, and housing services.
These programs also provide vaccine distribution for influenza and hepatitis A and B, food pantries, hot meals, and clothing distribution. But most importantly, these services create a space of trust where individuals who use drugs can seek help, referrals, and navigation to substance use treatment and counseling if and when they are ready for it. These programs may also reach and benefit other populations beyond those who use drugs, such as people experiencing homelessness.
In the U.S., drug use continues to grow: in 2022, among people ages 12 and older, 5.3 million people used cocaine (1.9%), 2.7 million used methamphetamine (1%), and 1 million people used heroin (0.4%). Research estimates that over 3.5 million people injected drugs in the U.S. in 2018, a number that has steadily increased over the last 10 years.
Given these increases in drug use and associated harms such as overdose, it is important to meet people where they are and offer an array of non-judgmental strategies and resources to limit the harms they may face with drug use. It is also essential to build trust and offer autonomy so that individuals can make decisions about their drug use without feeling stigmatized.
Specifically, the primary purpose of a needle exchange program is to provide safe injection equipment to prevent sharing of needles with others, and to prevent reuse of needles by the same individual.
In doing so, needle exchange programs aim to reduce the spread of blood-to-blood viral infections such as HIV and hepatitis C while also reducing bacterial skin infectious such as Staphylococcus aureus. These infections are easily preventable, yet have the potential to cause significant harm when the right resources are not available.
A common misconception about needle exchange programs is that they encourage and increase drug use, and increase crime and needle litter. Decades of research have debunked these claims.
Research shows that needle exchange programs do not increase drug use, nor lead to the initiation of drug use. Other research revealed that those engaged in needle exchange services are more likely to receive substance use treatment.
Additional research demonstrates that needle exchange programs do not increase crime, and cities with needle exchange sites are more likely to practice proper needle disposal. Over 30 years of data indicate that needle exchange programs are cost-effective and safe, and help prevent HIV, hepatitis C, other infections, and drug-related overdoses.
Drug use and explanations for drug use are complex. There are many social and structural reasons why people may use drugs, including to cope with trauma, challenges in daily life, experiences with homelessness, historical oppression, income inequality, or because of the environment where a person lives.
Yet, criminalizing drug use and the services aimed at supporting those who use drugs does not make the problem go away. West Virginia — and any other state without access to needle exchange programs or a state that’s considering doing away with them — should rethink its policies.
Policymakers, community advocates, and healthcare workers alike must consider how the benefits and costs of having needle exchange programs far outweigh the risks if these programs are removed.
It is important for all stakeholders to work with community organizations, healthcare providers, and those with a lived experience of drug use to have programs that best meet the needs of the community.
Ryan D. Assaf, PhD, MPH, is a postdoctoral fellow with the Benioff Homelessness and Housing Initiative at the University of California, San Francisco, and a public voices fellow through The OpEd Project.
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