Introduction
Drug use by injection is the cause for approximately half of all new hepatitis C and one-third of all new AIDS cases in the United States each year. The implementation of clean needle exchange programs has been encouraged by numerous health officials as a method of reducing the infection and transmission of these and other viruses which result from the sharing of contaminated syringes by injection drug users (IDU).
In order to successfully diminish blood-borne infection transmissions such as hepatitis and HIV, programs should implement a wide-ranging methodology when addressing the IDU. The methods must include realistic policies that focus on both intravenous drug users and unsafe sexual activities. One of, if not the most significant of these methods, is making certain that IDU who will not or cannot discontinue drug use via injection have proper and unabated access to clean (sterile) needles. The U.S. Public Health Service as well as many other social, governmental and medical establishments have strongly and consistently recommended the use of clean needles as an essential strategy for the reduction of health risks associated with this practice of drug use (“HIV Prevention Bulletin”, 2006).
Among many other health associations, the Institute of Medicine of the National Academy of Sciences supports this position and has stated “For injection drug users who cannot or will not stop injecting drugs, the once-only use of sterile needles and syringes remains the safest, most effective approach for limited HIV transmission” (Abdala et al, 1999). Unfortunately, many view clean needle exchange programs as a state-sponsored encouragement for drug users to continue their practice. After exploring this issue, it will be clear that clean needle exchange programs should be implemented in all parts of the world as a means of reducing the spread of disease by syringes and dirty needles. implementation of an exchange program could have on the health concerns regarding the spread of disease.
Main body
According to the Centers for Disease Control and Prevention (CDC), from 1981 to 1999, nearly 700,000 new cases of AIDS had been confirmed in the U.S. alone (“Trends”, 1998). This number has risen to approximately 800,000 cases today. Currently, the CDC estimates over one million Americans are HIV infected with approximately 40,000 new infections identified every year. Risk factors associated with intravenous drug use accounts for twenty-five percent of these cases.
Hepatitis, a disease contracted by ‘dirty needle’ use affects more than four million Americans. More than one million Americans are afflicted with chronic Hepatitis B and nearly three million have chronic hepatitis C (“Hepatitis B”, 1999; “Hepatitis C”, 1999). Women who have been infected with the HIV virus via the process of sharing previously used needles or if they have had sexual relations with a person who has been infected from IDU can possibly transmit the virus to their child either before or during childbirth birth or through breastfeeding. Thirty-six percent of all AIDS cases can be traced to IDU when ‘mother-to-child HIV transmission’ and sexual contact with an IDU are taken into consideration.
The Substance Abuse and Mental Health Services Administration approximates that “as many as 2.4 million Americans may be injecting drug users” (“Policy Facts”, 2001). The connection between HIV, as well as other blood-born diseases, with the abuse of drugs via injection and the consequential spread to children and sex partners cannot be understated or refuted.
Procedures involved in the preparation and injection of drugs presents various opportunities for the transmission HIV and hepatitis. Before the IDU actually injects the drug into their bloodstream, they must first determine whether the needle has found a vein by means pulling the syringe plunger back. The IDU confirms that the needle has found the vein if blood is present in the syringe.
The plunger is again depressed thus injecting the drug into the vein. After injection, the IDU, using the plunger, ‘cleans’ the syringe with water. This same water is then used to make ready additional drugs for later injections or for other persons. “If the IDU has HIV or viral hepatitis, his or her blood will contaminate the entire syringe and the preparation equipment with the virus, which can remain viable for several weeks” (Normand, Vlahov & Moses, 1995).
The transmission of viruses can occur either directly, such as when an infected IDU shares the same needle with others, or indirectly, when an infected IDU shares injection equipment such as spoons, water or cotton, or when they use the same needle and drug with other IDU’s. Blood-born viruses are transmitted very efficiently through the practice of injection. A vitally essential approach in the prevention of disease transmission involves making certain that habitual IDUs have unrestricted access to sterile syringes (Guydish et al, 1993).
Hundreds of studies have been conducted across the U.S. examining the effectiveness of needle exchange programs (NEP). These studies have been summarized over the past decade into eight reports through the auspices of the federal government and each of these eight reports have reached the same conclusion. NEPs do, in fact, decrease the spread of newly contracted HIV cases while, contrary to the rhetoric of those that oppose these programs, do not lead to increased drug use among IDUs or to other sections of society that did not previously use drugs via injection.
“Ensuring access to sterile syringes does not increase the number of persons who inject drugs or the number of drug injections. It does reduce the sharing and reuse of syringes” (Gleghorn, Wright-De Aguero & Flynn, 1993). The National Institutes of Health and the Institute of Medicine confirmed in an independent study conducted in March of 1997 that NEPs contributed to an 80 percent reduction in risk activities by IDUs and at least a 30 percent decrease in the transmission of HIV occurrences.
The NIH study also demonstrated a tremendous amount of evidence which clearly illustrated proof that NEPs do nothing to encourage an increase of substance abuse occurrence (“Policy Facts”, 2001). The results of a study conducted of a San Francisco NEP revealed that this program neither encourages nor increased drug use. The study also concluded that, over a five-year span, there was not a noteworthy increase in either current, new or young IDUs.
A surprising result of the study was that the frequency of daily injections actually decreased from an average of two injections per day, per person to a rate of less than one. The rate of new IDUs also decreased dramatically, from three percent at the beginning of the program to one percent at the end of the study. Intravenous drug use in every respect declined following the implementation of the NEP.
A related study of a Baltimore NEP indicated that such programs that are directly allied and incorporated with a drug treatment program prove to have a higher level of retention for those undergoing treatment for drug abuse. The study demonstrated that NEPs help IDUs in refraining from drug abuses if it is connected to a drug treatment facility (“Policy Facts”, 2001).
The evidence is overwhelming that NEPs are effective in the prevention and transmission of viruses and do not encourage drug use. However, Congress has severely limited the use of funding for NEPs for more than a decade. At the outset, Congress believed that NEPs would promote and encourage drug abuse and that their implementation would only serve to send a message that the national government endorsed drug use by promoting the dispersal of clean needles.
Although many numerous studies have countered this way of thinking, Congress still refuses to support these programs. Fear and ignorance within the public sector have trumped scientific data, again. The department of Health and Human Services (HHS) does not require Congress approval for the implementation of NEPs as it has the legal authorization to establish such programs itself. HHS has in its possession the facts regarding the effectiveness of NEPs and knows well the consequence of not utilizing these programs is the further spreading of deadly viruses.
However, outside philosophical and political concerns have taken precedence over science, logic and human compassion. In 1998, Secretary of HHS Donna Shalala testified that “based on extensive scientific research, needle exchange programs are an effective component of a comprehensive strategy to reduce HIV transmission and do not encourage the use of illegal drugs” (“Policy Facts”, 2001). Nevertheless, the prohibition of federal funding for NEPs remains in effect.
The support for lifting the federal ban on NEPs is growing and includes many well recognized, influential and credible sources such as Surgeon General David Satcher, the American Bar Association, the American Medical Association, the National Conference of Mayors and the American Public Health Association. In addition, the American public overwhelmingly supports for NEPs. A recent poll conducted by the Lindesmith Center-Drug Policy Foundation showed that 71 percent of those surveyed indicate that they would support eliminating the ban of federal funding for NEPs. In addition, a Kaiser Family Foundation poll concluded that 66 percent of the American public supported NEPs (“Policy Facts”, 2001).
In addition to reducing the spread of viruses, NEPs reduce costs as well. The annual budget for operating a NEP is estimated to be approximately $170,000. Two-thirds of this budget is needed for costs such as rent, overhead and staffing. The average wholesale price for syringes is currently about $1.35 apiece which when factored with the other expenses; NEPs can exchange more than 100 syringes per day. The health costs associated with a person infected with AIDS is considerable. It is estimated that if just two people per NEP does not contract the virus, the exchange program would save the tax payers money (“Policy Facts”, 2001).
As many as 33 Americans contract HIV every day as a result of using contaminated syringes. The total costs savings would be tremendous if only the federal government would fund these programs. The up-front costs would be negligible when compared to back-end savings, not to mention the costs of human suffering that would be alleviated. Mathematical models predict that NEPs prevent HIV infections among injecting drug users, their partners, and family members at a cost of approximately $9,400 per avoided HIV infection (“Policy Facts”, 2001).
The costs incurred over a lifetime of treating a person with AIDS comes to approximately $200,000. These calculations translate to a total savings of more than 95 percent per life. Again, these programs also save the life as well, an immeasurable cost savings. If Congress would fund NEPs, it could save billions of health care dollars as well as many thousand lives.
Conclusion
The impetus is on the public to demand that policy makers, public health professionals, law enforcement officials, pharmacies as well as schools and community organizations to come together to analyze the current political, social and legal barriers that disallow IDUs from the easy acquisition of sterile syringes. As was pointed out earlier, most people agree that safe syringes should be readily available for those that simply cannot stop using drugs.
Most understand the health consequences for not implementing NEPs. To avoid the further spread of deadly viruses, the public must put pressure on their city, state and federal representatives. They can then instigate broad-based programs to educate all within their communities and their states regarding the vast health and fiscal benefits that providing easy access to sterile syringes will bring. Just as in the way other health programs such as proper nutrition, dental care and safe-sex facts are related to the public, the health benefits of NEPs should be dealt with in the same manner and with similar intensity.
This education should include information regarding blood-born infection and prevention techniques (“Access”, 2000). There is no question within the medical or scientific community that using sterile needles which can be acquired through NEPs, diminishes the possibility of contracting AIDS and hepatitis among IDUs. The evidence is clear, NEPs save lives. As an integrated element of a wide-ranging disease prevention program, NEPs are a valuable public health asset while, at the same time, not proliferating the illegal drug use. NEPs, if used in association with substance abuse care helps to break the patterns of abuse for IDUs.
These programs are extremely cost effective as compared to costs associated with health care for AIDS patients in addition to human costs. The American people have overwhelmingly offered their support for NEPs and numerous scientifically conducted studies have proven their effectiveness in reducing the transmission of viruses but, as is so often the case in this country, special interest groups control the actions of congress. The ignorance and fear of the few continue to cause untold harm to the many.
References
Abdala, N.; Stephens, P.C.; Griffith, B.P.; & Heimer, R. (1999). “Survival of HIV-1 in Syringes.” Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology. Vol. 20, N. 1, pp. 73-80.
“Access to Sterile Syringes.” (2000). The Body.
Gleghorn, A.A.; Wright-De Agüero, L.; & Flynn, C. (1998). “Feasibility of One-Time Use of Sterile Syringes: A Study of Active Injection Drug Users in Seven United States Metropolitan Areas.” Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology. Vol. 18, Suppl 1, pp. S30-S36.
Guydish, J.; Bucardo, J.; Young, M.; Woods, W.; Grinstead, O.; & Clark, W. (1993). “Evaluating Needle Exchange: Are There Negative Effects?” AIDS. Vol. 7, pp. 871-876.
“Hepatitis B Fact Sheet.” (1999). Centers for Disease Control and Prevention. Web.
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“HIV Prevention Bulletin: Medical Advice for Persons who Inject Illicit Drugs.” (2006). U.S. Department of Health and Human Services, Public Health Service. Web.
Normand, J.; Vlahov, D.; Moses, L.E. (Eds.). (1995). Preventing HIV Transmission: The Role of Sterile Needles and Bleach. Washington D.C.: National Academy Press.
“Policy Facts: Needle Exchange Facts.” (2001). Aids Action Council. Web.
“Trends in the HIV/AIDS Epidemic.” (1998). Centers for Disease Control and Prevention. Web.