Doing harm reduction better: syringe exchange in the United States

Abstract

While syringe exchange has remained controversial in the United States, there has been very substantial growth in numbers of programs, syringes exchange and program budgets. Utilizing secondary exchange to reach large numbers of injecting drug users and utilizing SEPs as a new platform for providing health and social services beyond basic syringe exchange have been the two major organizational strategies in the growth of SEPs in the United States.

EXPANDED ACCESS TO SEPs AND OTHER HARM REDUCTION MEASURES IN FRANCE

“…The good news, as reported by Des Jarlais and colleagues [1], is that over the last 13 years the number of syringe exchange programmes (SEP) and the number of syringes exchanged in the United States has expanded from 68 to 186 and 8 to 29.5 million per annum, respectively. The expansion of SEPs (and pharmacy-based programmes) has been accompanied by substantial declines in human immunodeficiency virus (HIV) prevalence and incidence in injecting drug users (IDU) [2].…”

“…Des Jarlais et al [1] describe the remarkable effort made in the United States to scale-up syringe exchange programmes (SEPs) and their contribution to decreasing human immunodeficiency virus (HIV) incidence among injecting drug users (IDUs), despite the lack of federal government support. The effectiveness of SEPs in reducing HIV transmission has been established scientifically [2].…”

Social Movements in Health

“…Bush, William Clinton, and George W. Bush sought to find the right balance in national drug policy; Clinton's administration was most clearly committed to tilting the scales away from interdiction, incarceration, and other forms of enforcement (47,50). During Barack Obama's presidency, a public health-oriented set of policies have reemerged, although the administration has also opposed the legalization of marijuana as recently legislated in Colorado and Washington (29).…”

“…In the 1950s, the public health community also supported the efforts of the American Bar Association and the American Psychiatric Association to shift from viewing addiction as a crime to seeing it as a preventable and treatable medical condition. During President Clinton's administration, Department of Health and Human Services Secretary Donna Shalala endorsed needle-exchange programs as a useful harm-reduction strategy for heroin-addicted HIV/AIDS patients (29). During the Obama administration, the public health community contributed to the National Drug Control Strategy of 2012, which backs away from the "war on drugs" and includes emphasis on early interventions "to prevent illicit drug use and addiction before their onset and bring more Americans in need of treatment into contact with the appropriate level of care" (p. v).…”

Benefits of concurrent syringe exchange and substance abuse treatment participation

“…Community syringe exchange programs (SEPs) are consistently associated with reduced rates of injection equipment sharing and reduced rates of HIV infection (e.g., Bluthenthal, Kral, Gee, Erringer, & Edlin, 2000;Des Jarlais et al, 1996;Des Jarlais, McKnight, Goldblatt, & Purchase, 2009;Gibson et al, 2002;Huo & Ouellet, 2007; see Wodak & Cooney, 2006 for a review). The fact that syringe exchange participation does not fully suppress the sharing of injection equipment is most likely related to the high rates of continuing drug injection in this subgroup of substance users (e.g., Des Jarlais, Braine, Yi, & Turner, 2007;Fisher, Fenaughty, Cagle, & Wells, 2003;Wood et al, 2002).…”