Amid Opioid Crisis, Needle Exchanges Are Losing Their Stigma

The idea that needle exchanges encourage illegal drug use is fading just as rapidly as the programs are expanding.

In January, Congress lifted a decades-long ban on federal funding for needle exchange programs and clinics. Since then, the number of programs has skyrocketed, driven in large part by the opioid epidemic. Programs have popped up in states that might never have considered them -- or might even have actively opposed them -- only 10 years ago. “Kentucky has gone from zero to 11 programs,” says Daniel Raymond, policy director at the Harm Reduction Coalition. “Florida authorized a program in Miami -- and we thought they would never have one.”

The goal of needle exchanges, in which drug users hand in their used syringes for new sterile ones, is to reduce the number of infections from diseases like HIV and hepatitis -- illnesses that are transmitted through the sharing of contaminated needles.

There’s long been a stigma surrounding needle exchange programs, with many believing that they condone and encourage illegal drug use. But that idea is fading rapidly. “There’s been a sea change,” says Raymond. “The stigma comes from unfamiliarity.” Contrary to common misperceptions, he says, needle exchange programs aren’t crack dens or safe places to shoot up.

Much of the sea change is the result of the opioid epidemic that has devastated communities across the country. The Centers for Disease Control and Prevention estimates that, on average, 78 people die from opioid overdoses every day. Such frightening numbers have united policymakers across party lines. In July, 46 governors signed a compact pledging to make the epidemic a key issue for their states.

Needle exchange programs are increasingly seen as a key tool in dealing with the epidemic. Experts are hoping these programs will not only stop the spread of infectious diseases but also help curb drug overdoses. Many exchange programs incorporate services such as condom distribution, advice on avoiding overdoses, and referrals to substance abuse and mental health treatment centers.

Even early adopters are expanding their existing needle exchange programs. Delaware, Maryland and Massachusetts have had programs for years, but due to limitations they were unable to grow them until now. Maryland, for example, had one of the nation’s first needle exchange programs, but it was restricted to Baltimore. In October, the program was allowed to expand statewide. “We want to have a replicable model for the rest of the state, so we are working with the other localities in Maryland to put together their own programming,” says Leana Wen, Baltimore’s health commissioner. 

Needle exchange programs have proved effective in stopping the spread of infectious diseases when they are part of a larger anti-addiction strategy. Raymond points to an HIV outbreak last year in Scott County, Ind., that has been contained since a needle exchange program was established, as well as a program in southeast Ohio that has seen a reduction in hepatitis C cases.

Much of the effectiveness of a needle exchange program depends, of course, on how it is designed and run. Wen advises her public health colleagues to reach out beyond their own profession. “Health centers cannot go at this alone,” she says. “They have to team up with faith centers and other advocacy organizations, those people who are trusted messengers.”

Obviously, needle exchanges alone won’t end the opioid epidemic or eliminate needle-spread infections, says Andrea Young, supervisor of an HIV/AIDS program in Dayton, Ohio. The city started a needle exchange program last year after a series of drug overdoses. It has served hundreds of residents and exchanged thousands of syringes -- no doubt it has even saved lives. As, she says, “it’s one tool in our arsenal to keep the numbers down.” 

Mattie covers all things health for Governing.