A recently released Surgeon General’s report, “Facing Addiction in America,” paints an alarming picture of substance abuse in the United States. The yearly cost to society is estimated at almost $250 billion. In addition to the huge economic cost, there is a human cost. Communities are suffering with increased crime and violence and child neglect and abuse. Alarmingly, the rate of premature deaths among white women has increased, in part due to a big increase in overdoses, particularly of opioids.
Among infections that can be transmitted by sharing needles are HIV and hepatitis B and C. HIV causes AIDS, which if not controlled with medication leads to death. Hepatitis B and C can both cause liver disease, including cancer. We do have effective treatments against all three of these viruses but they are very expensive — and in the case of HIV, must be taken for life.
There is, however, a risk-reduction strategy for injecting drug users that prevents infection. Syringe service programs (SSPs) are community-based programs that provide access to sterile needles and syringes free of cost and facilitate safe disposal of used needles and syringes. This not only helps prevent transmission of these infectious diseases through dirty needles, but also diminishes the possible exposure to others of needles and syringes that are thrown in the garbage or in the environment. Most SSPs offer other prevention materials and services, such as education on safer injection practices, treatment for infectious diseases, immunizations, referral to substance use disorder treatment programs, and other medical, social, and mental health services. Interestingly, where SSPs have been established, it’s been found that diabetics and others who use syringes for medical purposes appreciate the availability of safe places in which to dispose of used needles.
Questions commonly come up when discussing SSPs. The first is, do they work? The answer is yes. Overwhelming, research has shown that SSPs are associated with positive health outcomes, including declines in needle sharing and injection frequency, reductions in new HIV and hepatitis infections, and increased entry into drug treatment programs. New York City saw a dramatic decline in new HIV infections, essentially reversing an epidemic, after establishment of an SSP. It’s not just drug users who are affected by SSPs; other studies have found fewer environmental used needle exposure by firefighters and police in their work.
The second question is do SSPs lead to increased drug injection use? The answer is no. According to research cited by the Institute of Medicine, SSPs neither encourage the initiation of drug use nor do they increase the frequency of drug use among current users. Studies have also established that SSPs do not increase crime and indeed neighborhoods with SSPs show a decrease in break-ins and burglaries.
Lastly, are the programs cost-effective? Studies have found that SSPs offer an extremely good return on investment as new syringes are cheap and treatment for HIV and viral hepatitis is very expensive.
Currently there are over 225 SSPs in 35 states, the District of Columbia, Puerto Rico, and the Indian Nations. While some states that allow SSPs may not be surprising (California and New York), others might be (Louisiana and Georgia). Governor Pence of Indiana, a staunch opponent of SSP, finally recognized the need for a program to slow down the terrible HIV epidemic in his state because of opioid addicts sharing contaminated needles and signed a law lifting the ban on SSPs last year.
As in the rest of the country, opioid abuse is a serious problem in Texas, but we have an opportunity to get ahead of the problem of associated infectious diseases spread by dirty needle use. While the best strategy would be to stop drug abuse, addiction is a powerful disease and there are many barriers to getting into treatment, including a shortage of trained staff and treatment beds. We can, however, immediately decrease the risk of an injecting drug user becoming infected with a life-threatening illness. It’s time for Texas to consider, as Indiana did, a cost-saving program that saves lives by giving people who inject drugs the opportunity to reduce their risk of HIV and hepatitis B through access to clean syringes and needles.
Troisi is an infectious disease epidemiologist at the University of Texas Health Science Center School of Public Health.