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.
Heroin addiction is a global problem. According to the World Health Organization, 58 million people around the world used opioids in 2018. In the same year, 46,802 opioid-involved overdose deaths occurred in the US. This was followed by a significant rise in 2019 to 49,860 overdose deaths.
The problem with the opioid drug is that it is highly addictive. Even those who take prescription opioids have an increased risk of developing an addiction. And when they develop an addiction, a good number of them turn to heroin because it is cheaper and easier to access. Heroin is typically sold as a white or brown powder that’s cut with starch sugars, synthetic opioids, or even powdered milk.
Pure heroin is a white powder. People who use pure heroin often sniff or smoke it. Any dark powder or black powder may indicate impurities. The same applies to heroin that’s hard as coal or sticky as tar. The dark color in black tar heroin results from crude process methods that don’t eliminate impurities. Those who use impure heroin dilute and inject it into the muscle, veins, or under the skin with an intravenous needle. This leaves behind track marks that can visually give away their drug use problem.
These are physical scarring that happen when one injects drugs repetitively. It’s common to spot profound track marks on people who are struggling with addiction because they are often injecting drugs, leading to scarring. Injecting the same place repeatedly disrupts the skin’s natural barriers and mutilates and bruises the veins in that area. So many drug users shift to other places like the ventrogluteal muscle to try to prevent or hide scarring. This makes it hard to discover their using habits.
Many people who abuse heroin inject through the arms. In fact, it is the most common site of injection. That’s because the veins are visible, accessible, and easy to inject into. Unskilled or frequent injections in the arms leave track marks and may also cause infections. Heroin users will frequently switch injection sites to keep track marks and complications to a minimum. When they do, the legs and feet are often the next stop. Intramuscular injection is a bit challenging for many. So some users skip the leg and go for the feet because the veins are somewhat easy to inject into.
When someone keeps injecting drugs, they will develop scars, sores, or track marks that are easy to spot. That’s why many injecting drug users become adept at concealing these marks. They will wear large clothes, long-sleeved shirts, sweaters, and things that cover the marks. But since hiding track marks in the arm isn’t always practical, many people will shift to hidden body parts that are harder to be seen.
People who inject drugs are usually only concerned about getting the drugs into their system. As long as they can see a vein, they are good to go. Like arms and hands, the neck has veins and arteries that are close to the surface, making it an appealing option. But according to experts at the department of health, injecting in the neck is one of the riskiest drug-injecting behaviors. It increases the risk of damaging an artery or vein not directly visible at the injecting site. But since the neck is usually visible, most drug users will wear pull-necks, hoodies, or use shawls and scarves to cover up the track marks.
People struggling with heroin addiction may inject the drug along their hairline to conceal their using behavior. The hair does a great job covering the track marks and makes it hard for anyone to notice. Besides, it’s not easy for anyone to check the hairline in case they suspect use. Most people only check the arms. Injecting drugs along the hairline is a dangerous undertaking with potentially life-threatening side effects. In addition to track marks, subcutaneous injections carry the risk of infections. One may also suffer from issues like receding hairline or hair loss.
The wrist is closest to the arm, making it an obvious site for many people who use drugs. Track marks on the wrist are easier to hide. Besides wearing long-sleeved shirts and sweaters, one could cover the marks with a big bangle, watch, band, or cloth. And since these are everyday accessories, it can be hard for people to suspect drug use.
Armpits are naturally hidden, which makes them a great spot for hiding track marks. People who inject in armpits will almost always wear t-shirts or clothes that conceal track marks, even when they stretch. Unless there’s paraphernalia or other signs that give them away, they might go on using for a long time, completely undetected by their friends and family.
Veins in the legs and feet are common injection sites, especially when those in the arms and hand collapse or get damaged. Those who want to hide their track marks will avoid the legs and feet. Instead, they will inject theirtoes. This way, no one would notice even when they don’t have pants or socks on. Track marks between the toes are hard to spot, thanks to the location of the toes. But they are even harder to notice because those who inject their toes are determined to hide them. They will wear socks, shoes, or even wrap the toes with a Band-Aid. They may also cover their legs with a blanket or throw whenever they’re relaxing at home.
Heroin is not only highly addictive but also potentially life-threatening. With the rising cases of heroin overdose deaths, it’s always best to help your loved one get timely help. Remember, drug use is not a sign of weak morals. Many people who abuse drugs have underlying problems. According to the Substance Abuse and Mental Health Services Administration, substance abuse and mental health issues often co-occur. Addiction treatment can help address the underlying problems so that your loved one can go back to leading a healthy life.
Sharing needles and syringes for any use is a risk for various sexually transmitted infections. A person can get STIs like HIV or Hepatitis by injecting into the vein, fat, or directly into a muscle. Reusing containers to dissolve drugs, sharing water to clean drug equipment, and reusing filters are also risk factors. The STI exposure risk from needle use is very common among drug addicts, so let's look at the statistics.
Studies reveal that those who inject drugs are most vulnerable to STIs. According to UNAIDS special analysis, 2018, the risk of HIV among those who inject drugs was 22 times higher than the general population. Other vulnerable groups included gay men, female sex workers and transgender women whose risks to HIV were 28, 13, and 13 times higher than the rest, respectively.
In another UNAIDS report, men account for the biggest share of higher risk of HIV infection, comprising 80% of the 11.8 million people globally who inject drugs. The report further revealed that approximately 13.1% of those who inject drugs worldwide were living with HIV. Despite the prevalence of drug injection and STIs, most people do not seek treatment for their addiction, due to fear of judgment, among other reasons.
In the last 20 years, the United States has seen a rapid increase in overdose deaths and STIs due to injection and misuse of prescription and illicit drugs like fentanyl and heroin. Injection drug use (IDU) and its vast health impacts are a public health crisis, with approximately a million people reporting IDU in the past year.
The increases in IDU have caused outbreaks of HIV and higher rates of diseases like Hepatitis B (HBV) and hepatitis C (HCV). This is because viruses spread through body fluids – either through:
Drug use and addiction are often connected to HIV/AIDS since AIDS was first determined as a disease. Centers for Disease Control and Prevention indicate that 1 in 10 HIV diagnoses happen among those who inject drugs. In 2016, IDU accounted for over 150,000 (or 20%) and 50,000 (21%) of recorded HIV cases among men and women, respectively. Besides, pregnant and lactating mothers who are HIV infected can pass down the virus to their baby irrespective of their drug use.
Different studies show a close link between injecting drugs and sexually transmitted diseases. This should serve as a wake-up call to those who inject drugs. But surprisingly, the people who inject drugs continue with their needle exchanges and sharing habits despite the glaring danger.
Here are some common reasons they don’t stop.
Easy access: some communities do a good job distributing syringes and needles and disposing of used ones. But not everyone has access to such facilities. Some addicts have to go to the pharmacy stores, which have their own sets of rules around selling such supplies. So, an addict prefers to use what’s available. Besides, most addicts don’t have time to clean or look after themselves, let alone find new drug equipment.
Avoiding expenses: the drug equipment isn’t cheap either. A box might range between $10 and $50, which might be too expensive for someone whose primary focus is on getting money to buy more drugs.
Assumption: most drug users are cautious about sharing equipment with strangers. But they let their guards down when it’s someone close – like a friend or family - because they assume they know them better. So they don’t mind sharing needles and syringes.
Lack of education: some addicts have no idea that sharing drug equipment exposes them to STIs. Others are aware, but only to some extent. A good example is when they avoid sharing needles but end up sharing water used to clean the equipment.
As we’ve discussed above, injecting drugs increases risks for developing a range of infectious diseases, including HIV, which causes AIDS. Studies estimate that about 36% of cumulative AIDS cases in the US resulted from injected drug use.
HIV is transmitted through the exchange of blood and other bodily fluids. According to the CDC, HIV can live in a used drug supply for up to 42 days, depending on temperature and other factors. This explains why sharing needles, cookers, water, and cotton is potentially risky.
Sharing paraphernalia can also cause the transfer and spread of other infections like HBV and HSV, each of which affects the liver and may result in liver cancer, liver failure, liver cirrhosis, and permanent scarring. According to a study by the UCSF, drug injections may account for 60% of HCV cases in the US alone.
IV drug abuse also impairs judgment and lowers inhibitions, making it easy for one to indulge in risky sexual behaviors. It is pretty common for those who are high on drugs to have unprotected sex, which exposes them to HIV, HBV, and HCV. But these aren’t the only infections that can be transmitted sexually. Others include genital herpes and Human Papillomavirus (HPV).
Not using drugs: the best way to lower the chances of contracting STIs through IV drug use is to stop using drugs. Seeking help from a reputable treatment center can be a great way to achieve sobriety.
Not sharing drug supplies: viruses are only transmitted through IV drug use and sexual contact. So, one should avoid ever sharing drug equipment. Many communities have syringe services programs that issue free sterile syringes and needles and safely dispose of used ones.
Getting tested and treated: those who administer drugs intravenously should test for HIV, HBV, and HCV. If the tests turn out positive, treatments exist to help keep everything in check. Drug users who are negative for HBV can take advantage of the vaccination to prevent transmission.
Take pre-exposure prophylaxis (PrEP): PrEP is a daily dose of HIV medications that prevent one from getting HIV. It is effective in lowering the chances of getting HIV infection for those who inject drugs. Those who have been exposed to the virus can take PEP to prevent becoming infected. But this should be done within 72 hours after recent possible exposure to HIV.
