Black A, Smith M. Needle exchange is authorized after an HIV outbreak in an Indiana county. New York Times. 26 March 2015. www.nytimes.com/2015/03/27/us/indiana-declares-health-emergency-after-hiv-outbreak.html. Retrieved 13 January 2016. Decisions about the use of PHC in prevention programs are made at the state and local levels. The 2016 Consolidated Federal Appropriations Act includes language that allows states and local communities that meet certain criteria to use federal funds provided by the Department of Health and Human Services to support certain components of PHC, with the exception of the provision of needles, syringes, or other equipment used solely for illicit drug use. American Foundation for AIDS Research. Public safety, law enforcement and needle exchange. May 2011.
www.amfar.org/uploadedFiles/_amfarorg/Around_the_World/TREAT_Asia/factsheetJan2010.pdf. Retrieved 19 January 2016. 16. Hagan H, et al. Reduced injection frequency and increased entry and retention in drug treatment associated with needle exchange participation in injecting drug users in Seattle. J name abuse treat 2000; 19(3):247-52. Since their first appearance in Amsterdam in 1983 [11], NEPs have been a lightning rod of controversy when they have been proposed as a means of limiting disease transmission [12]. In the United States, opponents of NEP have largely focused on three main arguments for blocking their use [13]. First, they argue, federal funding for PINs would contradict law enforcement efforts in the U.S. “war on drugs” by signaling the government`s tacit approval of illicit drug use [14]. Second, they argue, federal funding for NEPs and the availability of sterile syringes could lead to an increase in drug abuse and affect public health [14].
Third, they argue, federal approval of NEPs and removal of a barrier to dangerous drug use could have a corrupting effect on children [15]. Some states have passed laws specifically legalizing PHC because of its potential to save lives. PHC may also be legal in states where possession and distribution of needles without a prescription is legal. Opposition to the NEP in the United States was purely ideological [12] and stemmed from the political position that the NEP “undermines the credibility of society`s message that drug use is illegal and morally reprehensible” [20]. The federal ban on NEPs began in 1988 after North Carolina Senator Jesse Helms equated the NEPS with federal support for drug addiction [17] and led Congress to enact a ban on the use of federal funds for such programs [21]. This prohibition was imposed by the Public Health and Welfare Act, Section 300ee-5, which stated that “no funds provided under this Act or any amendment to this Act shall be used to provide needles or syringes to individuals to enable such persons to consume illicit drugs” [22]. However, this was not an absolute prohibition [21], as Congress had included a provision in the ban stating that the funding ban could be lifted if “the Surgeon General of the Public Health Service determines that a needle exchange demonstration program would be effective in effectively reducing drug abuse and the risk of public infection with [HIV]” [22]. Despite evidence from the medical and public health community that NEPs reduced the transmission of infectious diseases, subsequent legislation in the years following this legislation focused solely on treatment, renewed the ban, and included it in the highly regarded federal HIV/AIDS program, Ryan White Comprehensive AIDS Resources Emergency Act [23]. Seelye KQ.
The WADA Policy Group supports needle exchange. New York Times. 27 June 1997. www.nytimes.com/1997/06/27/us/ama-policy-group-backs-needle-exchanges.html. Retrieved 19 January 2016. Justice Stanton After decades, Congress effectively lifts the ban on state-funded needle exchange. In: BuzzFeed. 5 January 2016. www.buzzfeed.com/johnstanton/after-decades-congress-effectively-lifts-ban-on-federally-fu#.yeLaGdJxVQ.
Retrieved 19 January 2016. In March 2015, Indiana Governor Mike Pence declared a public health emergency. This call came amid recognition that after months of rising cases, there was an HIV epidemic in the southeastern part of the state [1]. The outbreak in this predominantly rural community resulted in a final tally of 185 cases [2], largely due to needle sharing by injecting drug users abusing the painkiller Opana [3]. What made it a notable public health crisis was how the state government finally responded. In hopes of stopping the spread of HIV in this part of the state, Governor Pence has called for the opening and funding of temporary needle exchange programs (NEPs) in which people who inject drugs could dispose of used needles and receive sterile needles, despite his previous opposition to such programs [1]. South Dakota has one of the highest rates of acute hepatitis C infections reported in the country. According to a 2021 HIV/AIDS surveillance report conducted by the South Dakota Department of Health, 13 of the state`s 66 counties have been identified as highly susceptible to opioid overdoses and blood-borne infections. About 18% of South Dakota residents diagnosed with HIV reported injecting drugs, nearly three percentage points higher than the national average.
However, needle exchange programs are illegal in South Dakota. In addition, the use or possession of drug paraphernalia, including syringes, may result in a misdemeanor charge. There are currently no legislative proposals to legalize needle exchange programs. 10. Paone D, Clark J, Shi Q, Purchase D, des Jarlais DC. Exchange syringe in the United States, 1996: A national profile. Am J Public Health 1999 Jan; 89(L):43-6. Many people who abuse drugs choose to inject because they produce a faster and more intense effect. But this method of delivering drugs into the body, especially for people who share needles or syringes, is also associated with an increased risk of transmission of blood-borne diseases such as hepatitis and the human immunodeficiency virus (HIV). According to one study, new participants in Seattle`s needle or syringe exchange programs were up to five times more likely to be treated for a substance use disorder than people who did not use these resources. Regular program participants are about three times more likely to reduce or stop injection drug use than people who have never participated in a needle and syringe program.
More than 50% of people who inject drugs receive PHC injections, effectively reducing needle release rates in communities. Barr S. needle exchange programs are facing a new federal funding ban. Kaiser Health News. December 21, 2011. khn.org/news/needle-exchange-federal-funding/. Retrieved 19 January 2016. There are currently 44 states and DC, 1 tribal nation, 1 territory and with a needs assessment. Across the country, an increase in the abuse of injectable opioids and heroin means that more people are at higher risk of contracting infectious diseases from contaminated needles. Needle sharing is a direct route of transmission of blood-borne diseases such as hepatitis C virus (HCV), hepatitis B virus (HBV) and human immunodeficiency virus (HIV). Symptoms may not occur for years, meaning people who inject drugs can share needles and unknowingly transmit diseases to others. Using a sterile syringe for each injection can reduce the risk of contracting and transmitting diseases, but legal barriers often prevent people from accessing clean needles.
Advanced policies that allow the possession, legal sale and replacement of sterile syringes can significantly reduce infection rates.