Needling Policy Makers and Sharpening the Debate: Do Syringe Exchange Programs Improve Health at the Population Level?

Abstract

Context: In the midst of the current opioid epidemic, states have selected differing legislative routes implementing pathways to ensure access to clean needles and syringes. Objective: To determine whether states that implemented laws supporting syringe exchange programs (SEPs) had reductions in transmission rates of hepatitis B, hepatitis C, and HIV infection compared with states without such laws. Design and Setting: Utilizing a longitudinal panel design, we determined the legal status of SEPs in each state for years 1983-2016. Disease transmission rates for this period were estimated via a simple Poisson regression, with transmitted cases as the dependent variable, law categories as the predictor variables, and the log of state population as the exposure. The mean number of incident cases per state-year was also calculated. Participants: US states were utilized as the unit of analysis. Results: Hepatitis B and hepatitis C mean transmission rate per 100 000 population declined in states with local ordinances/decriminalized statutes and legalized SEPs (hepatitis B: 71% and 81%, respectively, differences P < .001; hepatitis C: 8% and 38%, respectively, differences P < .001). Reductions in mean incident cases per state-year mirrored these findings. HIV infection among injection drug users yielded inconsistent results. Conclusions: Hepatitis B and hepatitis C transmission were reduced at the population level in states with SEP laws in a pattern reflecting the degree of legal intervention. HIV infection, based upon a smaller data set, showed a mixed impact. Policy Implications: The results show promise that SEPs have population-level effects on disease transmission. States lacking SEPs should reconsider current policies.

Cardiac surgeons’ perspectives and practices regarding people who use drugs: A scoping review

“…HIV/HCV/STI testing, sterile syringe and injection equipment distribution, naloxone distribution, etc.) is a vital part of reducing the burden of drug‐use related pathology, and should be highly considered in the setting of continued injection drug use 4,5,51 . The absence of harm reduction discussion in the cardiac surgery literature therefore, highlights an educational gap among physicians, and is an important area of improvement.…”

“…Moreover, people who use drugs (PWUD) are a marginalized social group who are heavily impacted by the nature of the current crisis. In terms of healthcare, PWUD have poorer health outcomes largely due to psychosocial factors like poverty and institutional barriers to equitable medical care like poor access to specialty physicians 5,6 . Specifically, past studies have demonstrated that PWUD have greater mortality and rates of infection reoccurrence and postprocedural complications compared to non‐PWUD 7 .…”

The nationwide trends in hospital admissions, deaths, and costs related to hepatitis C stratified by psychiatric disorders and substance use: an analysis of US hospitals between 2016 and 2019

“…On a state-by-state level, there is evidence for NEP reduces HCV incidence. However, as access improves across the USA, this intervention's effect would need further analysis of its case and cost burden alongside a comparison against DAA or NEP with DAA solutions to optimize a solution to reported disproportionate cost burdens [48].…”

Local Policy and Programmatic Activity to Address the US Opioid Crisis: A Cross-Sectional Survey of County Governments

“…From an implementation perspective, some activities for tackling OUD and adverse outcomes are likely more challenging and may require greater resources and political and planning commitment than others. For example, needle exchange programs have long been a source of political controversy 38 despite evidence that such programs are generally safe, economical, and effective, 39 and reduce rates of viruses at the population level related to OUD such as hepatitis B and hepatitis C. 40 Establishing needle exchanges may thus be more politically or legally challenging for some policy makers than a less contentious harm reduction activity such as having police carry naloxone while on duty.…”