Needle Exchange Programs

A variety of studies have found that needle exchange programs can be very cost-effective in reducing the spread of disease.

NEP programs also vary in the extent to which they are free or charge the injecting drug user for the equipment (or some components—for example, in Australia all equipment is freely provided but users pay for sterile water). Programs also vary in the extent to which they collect used equipment, and whether they operate as a strict exchange (one for one) or make equipment freely available and in unlimited quantities irrespective of the return of used syringes. Australian programs do not require “exchange” of dirty needles to receive clean ones. Secondary NEPs are now being explored, especially in the United States where there is limited access to primary NEP. Secondary NEPs operate via one peer attending the primary NEP for equipment, then distributing it among his or her own networks.

Criticisms and Concerns

NEPs have been controversial partly because of the nonjudgmental nature of their interactions with injection drug users (IDUs). This is consistent with the overall “harm reduction” approach, anathema to some fervent believers in the “War on Drugs.” Opponents of NEPs offer three criticisms: that it is immoral, especially using public funds, to provide equipment for an act—heroin injection—that is not only illegal in itself but is often financed from the proceeds of predatory crime; that the availability of equipment via NEPs and their implicit endorsement of continued illicit drug use will tend to increase the initiation rate and decrease the quit rate to injection drug use; and that the programs are ineffective in reducing disease-transmission risk.

In most of the world, concern about the AIDS epidemic overwhelmed these objections, but in the United States, where the “drug war” impulse is especially strong, as is the link between heroin use and crime, NEPs became fiercely controversial. Some African American community leaders strongly resisted NEPs, along with methadone maintenance, as a tool to continue to hold black people in thrall to drug addiction.

...