Needle exchange programs (NEPs) or syringe services programs (SSPs) are public health initiatives that provide clean needles and other injection equipment to people who inject drugs. They aim to reduce the transmission of blood-borne infections, such as HIV and hepatitis C, among drug users. NEPs also often offer other health services, such as:
Needle exchange programs provide needles and syringes to people who inject drugs. The program allows injection drug users to safely dispose of used needles and access new sterile ones. This helps reduce the spread of HIV/AIDS, hepatitis B and C, and other blood-borne diseases that can be transmitted through sharing or reusing needles. NEPs also provide additional services mentioned above.
NEPs are usually located in pharmacies, clinics, and organizations that provide health or community services. But the services can be delivered at fixed sites, outreach programs, mobile programs, and syringe vending machines.
Studies have shown that NEPs are extremely beneficial to public health. The Centers for Disease Control (CDC) shared a summary of information on the safety and effectiveness of SSPs, which included data from 30 years of research on the matter.
According to the report, comprehensive NEPs are safe, effective, and economical and don't promote crime or illegal drug use. In fact, new program users are 3x more likely to stop using drugs and 5x more likely to join addiction treatment than those who don't use SSPs. The report also points to the effectiveness of NEPs in reducing the transmission of HIV and other blood-borne diseases.
Beyond the CDC report, other bodies, including the United States Department of Health and the National Institute of Health, endorse the program's effectiveness in reducing HIV transmission and saving lives without losing ground in the battle against illegal drugs.
In addition to harm reduction, NEPs are cost-effective. They have reduced healthcare costs by preventing HIV, hepatitis, and other infectious diseases, including endocarditis. A 2014 analysis revealed that each dollar spent on syringe exchanges saves the government about $7 in HIV-related healthcare costs.
The programs have also effectively reduced dangerous conditions in the communities where they are implemented. They do this by providing addicts with a safe, healthy place to dispose of used needles, thus eliminating the need to discard them on streets or playgrounds. This helps keep neighborhoods cleaner and reduces the risk of injury from discarded needles.
NEPs are designed to reduce the spread of HIV/AIDS and other blood-borne diseases by providing a safe place for injection drug users to access sterile needles and dispose of used ones. This can help break the chain of transmission through sharing or reusing needles, as well as connect these individuals with substance abuse services.
Some argue that NEPs encourage substance abuse. But evidence from reputable sources, including the CDC, NIH, and Department of Health, shows that NEP does not promote drug use. The few cases indicating increased drug use should be analyzed to establish the circumstances under which negative effects might occur.
However, these scattered cases should not be used as a basis for discrediting the overall effectiveness of NEPs. These programs have reduced public health risks and provided a much-needed entry point into treatment and support services for people struggling with addiction.
Syringe services programs save lives by training drug users to prevent, quickly identify, and reverse opioid overdoses. Many NEPs give drug users and community members "overdose rescue kits" and educate them on how to recognize an overdose, give rescue breathing, and administer naloxone. Based on measures like hospitalizations for drug overdoses, there is no proof that community norms change in favor of drug use. For example, there were no increases in new drug users after the introduction of NEP in New Jersey, Hawaii, California, etc.
According to studies, NEPs protect the public and first responders by offering safe needle disposal and reducing the presence of needles in the community.
SSPs do more than improve health. Because they're so practical and far cheaper than the lifetime cost of treating HIV and viral hepatitis, they save taxpayers money. There have been a lot of politics surrounding the programs, with most states and local governments limiting or prohibiting SSPs. However, some restrictions have been lifted, providing further opportunities to assess their effects.
NEPs are effective at reducing the spread of HIV and other infectious diseases, promoting safe needle disposal, and providing access to evidence-based addiction treatments and support services. They are cost-effective and have been shown not to encourage drug use in the communities they serve. With proper implementation, NEPs can help reduce the burden of infectious diseases, drug use, and overdose-related deaths in communities worldwide.
The number of drug overdose deaths in the United States has skyrocketed in recent years, with opioids leading the way as one of the most deadly and addictive substances. Many even consider it a drug overdose epidemic. According to the CDC, there were approximately 107,000 overdose deaths in 2021. In the same year, SAMSHA identified 141,529 unweighted drug-related ER visits from its analysis of 52 hospitals.
If these numbers are anything to go by, it's evident that addiction is a major problem in the US.
And yet, despite this alarming trend, many US hospitals and emergency departments lack dedicated addiction specialists who can help those suffering from substance or opioid use disorder. This is a glaring omission, especially given how critical an early intervention can be for someone in the throes of addiction.
Without access to addiction specialists on staff, people with substance abuse problems may not get the help they need at a crucial juncture. As a result, they may go through multiple hospitals or ER visits. A lucky few will be connected with a treatment facility while they're still at the hospital.
For everyone else, they walk out with a phone number to call, or often, nothing at all. Once they leave, many of these people go back to their old habits and never make the effort to call the number they've been given.
There's a clear need for hospitals to do better when it comes to addiction treatment. So why is it that so many don't have addiction specialists on staff?
If you go to a hospital with a kidney problem, you'll likely be seen by a nephrologist. If you have a heart condition, you'll be seen by a cardiologist. But if you're struggling with addiction, chances are you won't see an addiction specialist.
Only a few hospitals have someone who specializes in addiction medicine on staff. A majority of hospitals focus on primary care. Addiction is left untreated.
This is a problem because addiction is a disease requiring specialized care. Without access to an addiction specialist in ERs, people with substance use disorder are often left at the mercy of whoever happens to be on call. This could be a general practitioner, an ER doctor, or even a social worker, most of whom have very little training in physiology, medications, and other aspects of treatment.
For years, addiction prevention and treatment services have been delivered separately from other general and mental health care services. Drug and alcohol abuse has traditionally been viewed as a criminal or social problem. As such, prevention services were not typically considered a responsibility of health care systems. For this reason, those struggling with substance use disorders have had access to only a limited range of treatment options that were generally not covered by insurance.
In a nutshell, most hospitals don't have specialists because:
For a long time, addiction has not been seen as a medical problem but rather a social or psychological one. Some medical staff still see it as a moral issue and not something that requires formal medical treatment. This attitude can make it hard to justify dedicating staff and resources to addiction treatment.
Additionally, many hospitals are already understaffed and overstretched, so it could be difficult to add another specialist.
And finally, there's the question of reimbursement. Addiction treatment is notoriously underfunded, and many insurance companies don't cover the cost of specialized care. Hospitals can find it hard to recoup the cost of hiring an addiction specialist.
NPR shared a story of a 63-year-old heroin addict, Marie, who was admitted to Salem Hospital, north of Boston, for COPD. The next day, she was told she was ready for discharge after the doctor had confirmed that her oxygen levels were good. But the woman was experiencing heavy withdrawal symptoms and could not move. She didn't want to leave the hospital but felt like she had no choice.
Sadly, most hospitals would still let her go despite her pain and condition. Sometimes, she'll be issued a list of detox programs or rehab centers to call. But more likely, she'll be sent on her way with no real plan or hope for recovery.
This is a typical story of what's happening in many US hospitals. Marie was lucky to have found a doctor who administered her some medications that helped. But every day, people with addiction walk into ERs across the country only to be discharged without real help or support.
This is dangerous because it increases the likelihood of patients relapsing and overdosing. In fact, research shows that patients have a higher chance of overdosing within a few days or weeks of being discharged from the hospital.
An addiction specialist is a medical professional specifically trained to diagnose and treat patients with substance use disorders. These specialists can provide critical support to patients who walk into the ER for various reasons but have an underlying addiction problem. Salem Hospital is one of the few hospitals that has succeeded in naming addiction as a specialty and hiring people with training in the disease.
And despite reservations from some staff, the addiction specialists get overwhelmed many days with referrals - a clear sign of the need for their services. The trend is similar in five other Massachusetts hospitals that added addiction specialists in the last three years. These facilities are funded by HEALing Communities study. Addiction specialists can help patients in several ways, including:
Addiction specialists are vital in helping patients get the treatment they need. They can also refer them to a reputable treatment facility for specialized care. Hospitals can provide a much-needed service to their communities by having these professionals on staff.
According to the National Institutes of Health, effective integration of addiction prevention, treatment, and recovery solution across healthcare systems can help address drug abuse and related issues. This is also the most promising way to improve access to and quality of treatment.
Drug addiction doesn’t only affect the drug user. Drug use also affects entire families, probably more than most people acknowledge.
In the United States alone, approximately 21 million people above 12 years suffer from substance use disorders, including alcohol and drug abuse. Most young people start abusing drugs in high school or earlier. To prevent drug abuse among young people, the Substance Abuse and Mental Health Services Administration is tasked with developing programs, services, and policies on drug abuse and misuse.
Drug addiction takes a toll on an individual’s psychological, emotional, and physiological well being. This is one way alcohol and drug abuse has a negative impact on families.
This article will discuss the various effects of drug use on families.
When a loved one is struggling with addiction, family members have to find ways to cope with it. More often than not, family members have conflicting and intense emotions regarding the situation at hand. As a result, family relationships become strained.
Addicts’ families are made to understand that their loved ones don’t intentionally want to hurt them. Therefore, they try to empathize by supporting, encouraging, and loving them regardless of the situation.
Unfortunately, the emotional abuse, deceit, and manipulation that addicts subject them to can be overwhelming. Consequently, there is a high probability that family relationships will suffer.
Here are some of the ways drug use affects the family
The National Center on Substance Abuse and Child Welfare reported that in the United States, approximately 8.7 million children live in households where at least one parent has a substance use disorder. Most of these children experience abuse or parental neglect.
Children whose parents use drugs or that have an alcoholic parent suffer both physically and emotionally. Most times, the parents neglect the children. Parents who abuse drugs tend to stop focusing on their role as parents; thus, they become emotionally and physically unavailable for their children. Sometimes, the parents stop taking care of their children’s basic needs. They don’t provide meals or a clean environment, and neither do they go out of their way to be involved in their children’s health care, social life and education.
Growing up in an environment where neglect is the norm affects children’s mental health. Additionally, it affects their ability to have healthy relationships with other people.
Children in such family settings are also more likely to experience emotional, physical, and sexual abuse. The abuse may be from their parents or other people, including relatives and family friends.
Parents’ drug addiction can have long-term psychological effects on children. There is a high probability that the children of alcoholics and drug users will have behavioral problems like anxiety, detachment, angry outbursts, and depression. They can also develop mental health problems as they get older.
Research has also shown that children who suffer from neglect and abuse are more likely to abuse drugs in the future.
Drug addiction tends to take a toll on family finances. Drug users often lose their jobs since they can no longer perform or show up as expected. Consequently, they start using family savings to finance their drug addiction.
Since illegal drugs are expensive, the family may run into financial problems quickly. Paying for basic needs like food, utilities, clothing, and rent may become a problem. There is also a need to pay for addiction treatment which can be expensive.
Other than that, drug users may get into trouble with the law. When this happens, it is up to the family to raise money to ensure their loved one doesn’t end up in jail.
Drug users may also feel entitled to family members’ money. Since they cannot finance their lifestyle, they rely on money from other family members, or eventually they could become homeless.
When a loved one is an addict, most, if not all, of their responsibilities become their partner’s responsibilities.
The partner has to juggle between paying bills, raising the children, cleaning up after the addict, and making important decisions regarding the family, among others. Consequently, they may become stressed. Stress is a risk factor for other conditions like depression and high blood pressure.
Most addicts make promises they can’t keep. They also don’t live up to their agreements with family members, further straining their family relationships.
Family members become frustrated when the addict doesn’t live up to their promises and obligations.
Children are also affected by this. When an addict promises his children something and does not follow through, the children have trust issues. They will find it hard to trust other people since their parents have already set a bad precedent.
Drug use can lead to emotional and physical abuse. Since drug users are irrational and most family members are on edge due to their behavior, simple disagreements can lead to big fights, sometimes physical.
Substance abuse and mental health issues go hand in hand. Drug users tend to be emotionally abusive and manipulative. Their behavior negatively affects family members and other people they are close to.
Sometimes, children whose parents are drug addicts become abusers. In an attempt to mask their struggles, they misbehave and act out, hurting other people in the process. Eventually, some become drug users too.
Most drug addicts are unpredictable. As discussed above, drug abuse and mental health issues go hand in hand.
It is almost impossible to predict how a drug user will react to situations. Consequently, most family members resort to being extra careful with their words and actions to avoid confrontation.
Children that grow up in settings where one or both parents are addicts tend to be highly reserved. They are conditioned not to say or do anything that would rub their parents the wrong way from a young age. This tends to reflect in their day-to-day lives.
Generally, drug use breeds fear in the family.
When you realize your loved one is struggling with an addiction, you should encourage them to seek professional help. Try to make the addict see how their drug use affects them and other family members. Remember to be compassionate while doing this.
If they don’t seem to care, you can stage an intervention with the help of other family members. You can also involve an intervention specialist to increase its chances of success.
The entire family should also consider getting therapy or counselling. Therapy goes a long way in helping everyone deal with the effects of a loved one’s addiction.
If the family member agrees to seek treatment and join support groups, the healing process will be much easier. The chances of successfully rebuilding strained family relationships are also much better.