Repeal the Federal Ban on Funding Needle Exchanges
J.D. Candidate 2016, UCI Law
Since the HIV panic of the 1980s, Congress has prohibited using federal funds for needle exchange programs. Instead, states that chose to establish needle exchanges were forced to pay for and operate them on their own with no federal assistance. This hindered efforts to make such programs widely accepted and available to people who needed them and was a setback to the goal of saving lives. In 2009, President Obama lifted the federal prohibition on funding needle exchange programs, but the glimmer of hope was short-lived. In 2011, Republican-controlled Congress reinstated the ban, which is how the situation stands today.
Needle exchange programs are an example of “harm reduction.” Like the name suggests, harm reduction efforts seek to reduce the physical and societal harms associated with drug abuse, without passing judgment on the individual user. Instead, harm reduction encourages healthy behaviors with the ultimate goals of treatment and recovery. Harm reduction workers realize that it is hard for an addict to quit, especially once they have developed a physical dependence on a substance, so they advocate for programs where addicts are provided support, education, and a safe environment.
Needle exchanges have proven to be effective in reducing the transmission of HIV, Hepatitis C, and other diseases that are contracted by sharing needles. At a needle exchange facility, intravenous drug users are able to dispose of their used syringes and obtain sterile ones without fear of judgment or arrest for coming forth about their use. Needle exchange programs are often housed at facilities (frequently in mobile units, due to local zoning ordinances that prohibit them from permanently setting up shop) that also provide other types of assistance and support for drug users—such as connecting them with community self-help resources, providing free condoms, or conducting HIV testing—and for many people who are struggling with their disease, needle exchanges can provide an important bridge from addiction to treatment.
The scientific community is overwhelmingly in support of needle exchange programs. In 2000, the U.S. Surgeon General came out in support of syringe exchanges as an “effective public health intervention.” The American Medical Association encourages these programs and is actively trying to revoke the federal ban. In 2008, the Director of National Institute of Allergy and Infectious Diseases at the NIH testified, “Clearly needle exchange programs work. There is no doubt about that.” Numerous government-funded reports have concluded that these programs reduce HIV transmission without creating an increase in drug use rates. Even police and firefighters support needle exchanges since they reduce the risk that emergency personnel will get stuck by a dirty needle when searching a building—not an uncommon occurrence.
The problem with the federal ban on needle exchanges is that it simply doesn’t make sense. The empirical data show that: (1) needle exchanges reduce HIV transmission; (2) such programs can help reduce health disparities between racial groups, since the rate of HIV infections is higher in African Americans and Latinos than in Caucasians; (3) needle exchanges improve public safety by providing a place to safely dispose of used syringes, rather than discarding them on the street and putting others at risk of accidental contact; (4) these programs serve as useful bridges to treatment; and (5) needle exchange programs save public resources in the long run, since the cost of providing lifetime healthcare for a person with HIV is significantly higher than the cost of giving people clean needles. A 2012 paper estimated that every dollar spent on expanding access to needle exchange programs would save three dollars in treatment costs down the line.
Caring for the health and welfare of a state’s citizens is traditionally that state’s responsibility, falling under the police powers reserved to the states by the Tenth Amendment. The several states that operate their own needle exchange programs have all found the programs to be beneficial, and even federal authorities have deemed the programs effective; yet the states still cannot benefit from any federal funding. That means needle exchange programs must compete against other important state and local health programs for funding, which presents an unfortunate dilemma since other programs have their benefits as well. An additional complication is that the federal government funds HIV treatment in other areas, but it won’t fund syringe exchanges. The federal government’s message here is contradictory—it claims to promote public health, but refuses to adopt a public health measure that’s been proven to work with little negative consequence.
Community groups have stepped in where Congress has failed. In Washington, D.C., an organization called HIPS (Helping Independent Prostitutes Survive) provides needle exchange services in addition to overdose training, safe sex education, counseling, a wellness center, disease testing, legal assistance, a crisis hotline, and more. HIPS serves over 8,000 clients each year and relies on volunteers, private foundations, and local government to support its work, but imagine how many more people could be served without the federal barrier. Or for a more local example, take the newly formed Orange County Needle Exchange Program, founded by medical students here at UC Irvine. Due in part to the federal ban on these programs and in part to stigmatization, Orange County lacks a working needle exchange despite a real need for it. The new program is still in the introductory phases and cannot begin serving people until it raises more money and navigates the local laws, which differ from state law, surrounding needle exchanges. Again, the federal ban complicates these efforts.
I imagine the reason why Congress opposes needle exchanges is ideological: it thinks that allowing federal funding in this area would make it seem as though the government were encouraging drug use. However, as mentioned earlier, several studies have shown that needle exchange programs do not increase drug use rates, and instead actually facilitate finding treatment. By not funding these programs, Congress is putting American citizens and communities in harm’s way, closing off what is in fact a useful bridge to drug treatment and undermining efforts to combat diseases like HIV and hepatitis C, which pose a serious threat to public health.
Thus, it is time for Congress to lift the ban on funding needle exchange programs. The effectiveness of these programs—for example, a 75% drop in HIV transmission rates in New York City after just a decade—is hard to deny, and money would be saved by not having to provide lifelong treatment for individuals who contract a disease from a contaminated needle. Additionally, the public safety factor is significant; police officers and firefighters shouldn’t have to risk being exposed to dirty syringes while on duty, and likewise children playing in an alley shouldn’t have to worry about accidentally getting stuck with a needle that was on the ground. Finally, since the states’ interest in the public health of their citizens is greater than that of the federal government, a state that needs a needle exchange program but can’t afford to implement one should not be left without an option, but rather should be able to seek federal assistance in enacting a program designed to save lives.
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