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Experts: Needle exchange programs prevent outbreaks among IDUs
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In a commentary published in the New England Journal of Medicine, experts argued for the permanent implementation of needle exchange programs to reduce to the spread of HIV, hepatitis C virus and other infections spread through the use of injection drugs
Steffanie A. Strathdee, PhD, director of the Institute of Global Health at the University of California-San Diego, and Chris Beyrer, MD, MPH, of the Johns Hopkins Bloomberg School of Public Health, wrote the perspective that addressed a recent outbreak of HIV among injection drug users in Scott County, Indiana. While a state of emergency declared by Gov. Mike Pence temporarily allows the county to sell syringes over-the-counter and operate needle-exchange programs, the authors argued that maintaining these measures is necessary to prevent recurrence.
“Legislation allowing Scott County to operate needle-exchange programs is a step in the right direction,” they wrote. “However, the current provision extends for only 1 year, a limit that ignores the reality that three interrelated chronic diseases — addiction, HIV and HCV — will continue to challenge this community and others like it for decades unless a very aggressive, multipronged public health prevention strategy is implemented.
Chris Beyrer
“Regrettably, other Indiana counties contemplating authorizing needle-exchange programs must first demonstrate the existence of a public health emergency — a requirement that ensures that they can only respond to, rather than prevent, outbreaks.”
Strathdee and Beyrer noted that the affected demographics of this outbreak and a previous cluster of HCV cases in 2011 were younger white men and women. While these cases may be unusual when compared with historically affected IDUs (black, urban males aged older than 35 years), their similarities to the demographic most commonly associated with heroin use could have served as a warning sign before the outbreak.
Despite the temporary measures, Strathdee and Beyrer wrote that barriers still prevent this group from accessing sterile needles.
“Scott County’s needle-exchange program requires that [IDUs] register with their initials and date of birth, which deters many people from participating and prevents clients from obtaining needles for others,” they wrote. “The program is not open past 6 p.m. most evenings, and unregistered [IDUs] are subject to prosecution for carrying syringes.”
Other outbreak factors identified by Strathdee and Beyrer included weak substance-use treatment options, insufficient infection testing and frequently inappropriate opioid medication prescriptions, all of which were common in this rural area.
“Permanently lifting the ban on using federal funds to support needle-exchange programs will be a critical component of HIV prevention, since these programs reduce HIV incidence and front-line exchange workers are often the first people injection-drug users reach out to for help,” they wrote. “States can adapt prescription-drug monitoring programs so they are secure, enable searches in real time and are used as clinical and public health tools rather than law-enforcement weapons. But such supply-reduction measures will work best when complemented by the harm reduction achievable with opioid-agonist therapy and needle-exchange programs.”
Disclosure: The researchers report no relevant financial disclosures.
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