The case of a needle exchange policy debate in Fresno, California

Abstract

Needle exchange is one of the most effective public health interventions to prevent the transmission of infectious disease by injecting drug users. Despite the preponderance of scientific evidence, US federal funding for needle exchange programmes has been banned since 1988. This prohibition has resulted in the lack of a centralised policy on needle exchange and has given birth to a patchwork of diverse practices and regulations throughout the nation. This article focuses on how various local players interpreted the meaning of needle exchange through the debate on an unauthorised site in Fresno, California. In exploring a specific context, this study delineates the narratives used to outline competing views about needle exchange and to offer a snapshot of how the issue of widespread injecting drug use was handled in an impoverished and socially conservative region of the United States.

Qualitative case study of needle exchange programs in the Central Appalachian region of the United States

“…Most large urban programs have also described difficulties stemming from the existence of paraphernalia laws and associated policing behavior ( The Legal Conundrum theme) [ 38 , 39 , 41 , 43 , 45 , 46 ]. The Point Defiance NEP did not experience many operational barriers, at least initially, primarily because the chief of police made a conscious decision to not arrest the founder for violation of state paraphernalia laws.…”

Pharmacists’ role in harm reduction: a survey assessment of Kentucky community pharmacists’ willingness to participate in syringe/needle exchange

“…The pharmacists’ role in harm reduction is being expanded in several states as part of the effort to combat the spread of infectious disease and increases in overdose mortality [ 7 ]. Though NEPs have been shown to be both effective [ 8 ] and cost-effective [ 9 ] interventions for disease prevention in previous studies, they remain politically controversial [ 10 ] in the general populace, manifesting as inconsistencies in federal and state funding for NEP services [ 11 ].…”

The Significance of Harm Reduction as a Social and Health Care Intervention for Injecting Drug Users: An Exploratory Study of a Needle Exchange Program in Fresno, California

“…Unlike other western industrialized countries which made harm reduction interventions a central part of public health strategies against the spread of AIDS, the United States instituted a ban on the use of federal funds for needle exchange in 1989 (Clark & Fadus, 2010). Hence there is a patchwork of laws, regulations, policies and practices across the US with regard to needle exchange that militates against the development of a centralized harm reduction strategy (Clarke, 2015). …”

“…Research on needle exchange in the social sciences has largely focused on medical-anthropological explorations of the dynamics of drug addiction and changing social structures (Bourgeois, 2003), the ethnographic context of needle exchange (Gowan et al, 2012; McLean, 2012; MacNeil & Pauly, 2011), and the politics of needle exchange (Clarke, 2015; McLean 2011; McLean 2013). …”