Harm Reduction through Syringe Access Programs

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Article Overview:

The opioid crisis in America has taken on such drastic proportions that the political and medical communities are taking unprecedented steps to stem the tide of overdoses and deaths. One such method to reduce the harm of heroin abuse is the use of syringe access programs, also known as needle exchange programs or a syringe exchange program. The thought of giving heroin addicts a safe place to inject themselves may seem counterproductive, but if the end result is that more users are introduced to treatment and fewer people die, then many healthcare workers believe it’s worth the risk.

One Day: 50 or 60 Syringes

The National Institute on Drug Abuse explains that intravenous heroin use increases the risk of exposure to HIV, viral hepatitis, and other infectious diseases and agents through contact with infected blood or body fluids (such as semen or saliva) when users share needles and other drug paraphernalia.[1] The risk of infection extends beyond other drug users; “thousands” of discarded needles used in heroin intake were left discarded in public parks in Boston, and dozens of other cities across the country have struggled with how to deal with the problem of heroin addicts leaving contaminated needles in bus stops, parking lots, and on beaches.[2] In Sacramento, for example, city employees pick up 50 or 60 syringes “on a typical day” in the same parks where children and their parents play catch.[3]

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City employees pick up 50 or 60 syringes “on a typical day”

According to the Centers for Disease Control and Prevention, syringe services programs (under which syringe access programs would fall) and pharmacies can greatly reduce the risk of drug users contracting HIV and other bloodborne infections, as well as minimizing the risk of contaminated needles being handled or stepped on by non-drug users in public places.[4]

Syringe access programs are based in and led by local communities that provide drug users with access to clean needles and syringes without cost. These programs can then arrange for the used drug paraphernalia to be safely disposed. The CDC and the Department of Health and Human Services both advocated syringe access programs for being an “effective component” of the goal to prevent HIV and hepatitis C among people who are going to inject drugs. Most programs also offer other prevention materials and services, including education on how to prevent an overdose, vaccinations, referrals to addiction and mental health treatment programs, counseling, and onsite testing for HIV, hepatitis C, and other bloodborne illnesses. Still others have alcohol swabs, sterile water, and condoms available to users, and they may offer a range of medical, social, and mental health services to drug users.

The United States’ Needle Problem

With the United States gripped by an opioid crisis that leads many victims to using heroin and leaving needles in their wake, Congress moved in January 2016 to open up federal funding for needle exchange programs. One of the lawmakers who helped overturn three decades of policy was Kentucky’s Hal Rogers, a Republican who used to support a total ban on funding syringe access programs, but came around when he learned the scope of the crisis.

Rogers told NPR that his local district has been devastated by OxyContin abuse, overdose deaths, and the rise of heroin as an alternative to prescription opioid abuse. “We’ve got a needle problem,” he said, so he worked to ensure that CDC-approved programs based on counseling and treatment will receive federal money.

Even though scientific research has turned up no evidence that syringe access programs encourage drug users to continue their habit, Rogers acknowledged that, politically speaking, that’s the impression given by those programs. But the problem of heroin use being so widespread, and the other health issues that discarded needles can cause, “woke a lot of people up to the problem that the nation faces,” Rogers said, and something needed to be done.


NPR also spoke with the policy director for the Harm Reduction Coalition who explained that the people who come to syringe access programs are not new users who are looking to start injecting. Instead, the people the programs see are those who have been fighting their addictions for years, and they are grateful for the opportunity to talk about getting help for their problems.

Crucially, the help entails the understanding that those users still need to have heroin; the pull of the drug is too psychologically and physically strong to break, and syringe access programs create a connection to users that many other treatment and rehabilitation centers will refuse to do. It is those people, said the Harm Reduction Coalition policy director, who ask the syringe access programs for help.[5]

Needles in New Jersey

In New Jersey, the problem of opioid addiction giving way to heroin abuse is one that has affected every corner of life in the Garden State. Almost 50 percent of the residents of New Jersey who sought substance abuse treatment did so for heroin and prescription painkiller abuse. At 128,000 people, that number is enough to make what would be New Jersey’s fourth largest city, a place NJ.com calls “Herointown,” an urban dystopia of people who were plied with an endless supply of OxyContin and Vicodin. The connection is not a theory; the Monmouth County Prosecutor laid the blame of New Jersey’s heroin problem at the feed of pharmaceutical companies and greedy doctors for wastefully marketing and overprescribing powerful, addictive medicine to consumers. Heroin is so plentiful and widespread that using it becomes a simple question of economics. A bag of heroin can go for less than an order at McDonald’s, and when OxyContin dries up, the transition to needles is done without any second thoughts.[6]

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128,000 NJ residents sought treatment for opiate abuse

This has made heroin “the dirty secret” of suburbs in New Jersey, said North Jersey News, taking use of the drug out congested inner city slums and into the same neighborhoods and parks where people walk their dogs and children play after school.[7] A government-assembled drug task force to address the plague of heroin and opioid abuse in New Jersey attributed the “significant diversion of prescription drugs” (away from legitimate medical uses, and toward recreational and/or abusive consumption) to the number of heroin users increasing across the entire state.[8]

The result is “a heroin epidemic plaguing New Jersey,” says Vice News, helped in part by drug smuggling rings targeting the massive Port Newark-Elizabeth Marine Terminal, the state’s legendary population density, and the vast network of highways and roads that allow for chemically untainted heroin to disappear across New Jersey, supplementing, and eventually supplanting, the prescription opioid addiction that was already in place.[9]

Reducing Harm in New Jersey

Even as New Jersey struggles with so many of its people falling under heroin’s sway, thousands are responding to treatment overtures. In 2008, state government authorized a pilot syringe access program, and 4,482 people took part. Official figures determined that 998 of those people then moved on to drug treatment.

Reception to syringe access programs was tepid. The pilot program was meant to start in six locations, but only five of New Jersey’s municipalities (Atlantic City, Camden, Paterson, Newark, and Jersey City) stepped up to host programs, and the state of New Jersey itself offered no funding for the operation of the needle exchanges. Nonetheless, thanks to private community agencies, 295,736 syringes were properly disposed of, instead of being left in parks and at bus stops.

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Private community agencies properly disposed of 295,736 syringes

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In a 2 year period, over 300 participants of the needle exchange program went on to enroll into treatment

The Division of HIV/AIDS Services and the School of Public Health at the University of Medicine and Dentistry of New Jersey praised the “excellent start” to the needle exchange program, pointing out that a population that has been traditionally hard to reach is now able to access medical care that can protect them from HIV and hepatitis. The report issued by the department recommended that the program continue.

The sentiment was echoed by the Drug Policy Alliance of New Jersey, which said that an expansion to more sites across the state was next on the agenda, since the trial program proved effective.

How effective? In Newark, the North Jersey Community Research Initiative opened its site in February 2008 and worked with 1,250 users over the next two years. From that population, 25 percent enrolled in a treatment program, a statistic that a director of the institute called “phenomenal.”

In Paterson, the local counseling center took in 988 intravenous drug users who came to the site three days a week to exchange their used syringes for new ones. From that 988, 259 then checked into a treatment program.

The former New Jersey Health and Senior Services Commissioner said that, as a doctor, she supported the work of syringe access programs. Not only do they minimize the risky behavior that (intravenous) drug users engage in, such programs also reduce the risk posed by dirty needles.[10]

Fearing for the Future

But when the one-time federal grant dried up, the ambitious program ran out of steam, with NJ.com saying in August 2016 that operators of the five sites across New Jersey were “strapped for cash and fearing for the future.”[11] Organizers resorted to an online funding campaign to continue the work of their syringe access programs, which collectively served 5,979 people and collected over 1,015,840 contaminated needles in 2015.

The director of Camden’s Syringe Access Program told NJ.com that a single visit to a needle exchange site is one less chance of a user contracting HIV, one less needle that can be left in a parking lot or on a street, and one more chance that the user can get access to substance abuse treatment, mental health counseling, and other social services.

But without money, municipalities like Atlantic City did not have the funds needed to contribute city employee time to work with the program. Camden itself faced running out of supplies, a fate that befell Paterson earlier in 2016. The Drug Policy Alliance of New Jersey stepped in to ensure that the program could continue, although organizers still feared that Paterson’s reprieve would be short-lived.

“The state needs to provide adequate funding to these programs” if it is serious about addressing heroin abuse and the dangers of discarded needles, the state director of the Drug Policy Alliance said. Syringe access programs are the only ones equipped and empowered to work with the most at-risk and hardest-to-reach communities. If they were to be shuttered, New Jersey would go back to square one on how to combat the heroin plague.

‘Over the Moon Excited’

The funding problem hits at the heart of what needle exchange programs set out to do. All five of New Jersey’s sites didn’t have enough clean needles to keep up with the demand that came their way, simply because they couldn’t afford them. While the sites gave out more than 1 million needles in 2015, they only managed 314,931 in the first six months of 2016. The private donors who helped get the program off the ground expressed concern and reservations about continuing their contributions, because New Jersey refused to fund the programs out of its own coffers, despite syringe access sites being both legal and effective.[12]

Things changed at the end of August 2016 when Governor Chris Christie signed legislation that “saved” New Jersey’s needle exchange program. Christie’s bill directed New Jersey’s Health Commissioner to raise $200,000 to provide the five sites in Atlantic City, Camden, Paterson, Newark, and Jersey City with clean needles and other resources (such as “lifesaving education, treatment and testing”), but it also opened the door for other cities to develop their own programs.

Christie touted his administration’s “continued efforts” to hit back at the wave of substance abuse sweeping across his state, while also helping eliminate the side effect of HIV and hepatitis C being transmitted through contaminated needles. Those efforts were very well received by the people in the field. The chief operations officer for the South Jersey AIDS Alliance, and one of the people who created the online funding drive to try and keep her needle exchange program afloat (raising just $2,713 of the desired $95,000) told NJ.com that she was “over the moon excited.”[13]

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Christie’s bill directed New Jersey’s Health Commissioner to raise $200,000…

Not just her, she said, but her colleagues and clients as well. There will no longer be the fear of not knowing whether there will be enough syringes to keep users free from bloodborne diseases. “This will definitely keep the transmission rate of HIV and hepatitis C down in the state of New Jersey,” she said.

Chris Christie and New Jersey’s Drug Problem

Christie’s intervention came at a key time for New Jersey’s harm reduction programs. In 2011, the number of people who contracted HIV through the use of sharing dirty needles was 7,592; in 2015, it was 6,805, when nearly 6,000 intravenous drug users were given over a million clean needles to use. The change in fortunes was no coincidence; even in 2012, New Jersey’s State Health Department wrote that the program had helped put a dent into the spread of HIV and hepatitis C cases, and encouraging 2,160 drug users to get treatment.

Advocates feared that with New Jersey’s syringe access programs running out of money, valuable ground that had been gained in the public health battle was in danger of being lost.

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6,000 intravenous drug users were given over a million clean needles to use

It didn’t go without notice that New Jersey supported municipalities by allowing them to operate the controversial needle exchange programs, but refused to allocate any money for the services until the situation was dire. NJ.com writes that the reluctance to fully embrace the work of syringe access programs goes back to the mid-1990s, when then-governor Christie Whitman argued that such methods condoned drug use.

Chris Christie, on the other hand, “has very complicated views on drugs,” in the words of the Washington Post. Christie rose to fame as a tough-on-crime federal prosecutor in a state that has long struggled with organized crime and drug trafficking. While smashing crime rings and pushing zero-tolerance policies toward most forms of law-breaking, Christie’s approach to nonviolent drug users has been remarkably progressive for an otherwise staunch Republican and conservative. Ahead of the curve, Christie pushed for offering more treatment services to heroin and prescription drug abusers instead of incarceration (while still adamantly refusing to consider any kind of marijuana reform).


Slamming the 40-year-long War on Drugs for not working, Christie instead argues that giving nonviolent drug offenders and addicts the tools to recover and heal themselves is what will make the ultimate difference in saving his state (and many others) from the devastating effects of the epidemic. To that point, Christie has expanded drug courts (signing a bill that opened up $2.5 million to fund such programs) and made treatment courses mandatory for many people who are arrested on drug-related offenses. He also put his name on a “Good Samaritan” law that offers legal protection to people who call 911 to report a drug overdose.[14]

A ‘Get out of Jail Free Card’

But even as Christie is an unlikely champion of drug courts and needle exchange programs, his unflinching opposition to marijuana decriminalization (even of the medicinal kind) has raised eyebrows, and it speaks to reservations many in his own state have – reservations that extend to the programs Christie himself has championed. The Ocean County Prosecutor told the Press of Atlantic City that he welcomes syringe access programs in his county, while still saying he would rather divert money toward more prevention methods, such as a program that encourages users to turn in their drugs and paraphernalia to the police, no questions asked, no risk of arrest.

Similarly, senators in Warren and Hunterdon counties voted down a measure to establish permanent programs across New Jersey. One of them expressed his concerns about the perceived paradoxical nature of the programs: on the one hand, “drugs are bad”; on the other, “providing needles to facilitate drug use.” Even taking into account that the sites offer more than just needles (in terms of treatment for substance abuse, education, and other services), the senator said that alternative methods, that are not “essentially a get out of free jail card,” should be looked at.[15]

The senior team leader at a site in Ocean County argues that the presence of needle exchange programs does not encourage drug use. Advocates identify other challenges even with Christie’s support of their efforts. One community health worker explained that local communities are uneasy about having designated injection sites in their areas, not wanting to call attention to the drug users and addicts who live in their neighborhoods. Even as the effectiveness of needle access sites becomes more publicized, residents of municipalities where the sites are set up would rather talk about more palatable forms of gentrification and revitalization.


In “Why NJ Doesn’t Have More Needle Exchange Programs,” the Press of Atlantic City breaks down the numbers: An addict who picks up HIV from using a contaminated needle might costs New Jersey taxpayers around $618,000 for treatment, according to needle exchange program directors. A syringe, on the other hand, costs 10 cents.[16]

The Only Syringe Exchange Program in Camden County

Syringe access programs in New Jersey are “the most important harm reduction tool we have,” said Senator Joe Vitale, but there still remains a lot of ground to cover. The editorial board of the Star Ledger pointed this out in an editorial, curtly thanking Chris Christie for signing a bill that “would have been welcome six and a half years ago,” and mentioning that many thousands of people fell through the cracks when needle exchange sites had to turn them away or even shut their doors.[17]


While a number of sites were boosted by Christie’s bill, some were not so lucky. In Camden, the Camden Area Health Education Center (the only syringe exchange program in Camden County) was forced out of its premises by a company that designs and produces components used in nuclear reactors.

The Observer discovered that the company has run afoul of the Federal Election Commission for not paying taxes on its political action committee, but was nonetheless granted a $260 million tax subsidy by the congressman who represents the district where the Camden Area Health Education Center – the only syringe exchange program in Camden County – used to be.[18]

The executive director of the program told the Philadelphia Inquirer that even though the work she did was to prevent the spread of a disease that has reached the levels of an epidemic across the city and across the country, “someone doesn’t want the needle exchange program in Camden. But I don’t know who,” she lamented, “and I don’t know why.”[19]

Citations

[1] “Why Does Heroin Use Create Special Risk For Contracting HIV/AIDS And Hepatitis B And C?” (November 2014). National Institute on Drug Abuse. Accessed October 11, 2016.

[2] “Thousands of Discarded Heroin Needles Found In City.” (December 2010). WCVB. Accessed October 11, 2016.

[3] “Drug Addicts Leave Parks Stuck With Discarded Needles.” (September 2016). Sacramento Bee. Accessed October 11, 2016.

[4] “Syringe Services Programs.” (May 2016). Centers for Disease Control and Prevention. Accessed October 11, 2016.

[5] “Congress Ends Ban on Federal Funding For Needle Exchange Programs.” (January 2016). NPR. Accessed October 11, 2016.

[6]Welcome to Herointown, New Jersey’s 4th Largest City.” (n.d.). NJ.com. Accessed October 12, 2016.

[7]Heroin: Suburbia’s Deadly Secret.” (April 2015). North Jersey News. Accessed October 12, 2016.

[8] “New Jersey’s Heroin Crisis: State Report Calls For Major Reforms.” (March 2014). NJ.com. Accessed October 12, 2016.

[9] “A Heroin Epidemic is Plaguing New Jersey.” (April 2014). Vice News. Accessed October 12, 2016.

[10] “Needle Exchange Pilot Programs in N.J. Are Successful, Health Department Finds.” (April 2010). NJ.com. Accessed October 12, 2016.

[11] “Desperate N.J. Needle Exchange Programs Plead For Cash.” (August 2016). NJ.com. Accessed October 12, 2016.

[12] “N.J. Needle-exchange Programs For Addicts Running Out Of Clean Needles, Report Says.” (August 2016). NJ.com. Accessed October 12, 2016.

[13] “Christie Saves N.J. Clean Needle Program For Addicts.” (August 2016). NJ.com. Accessed October 13, 2016.

[14] “Chris Christie Has Very Complicated Views On Drugs.” (June 2014). Washington Post. Accessed October 13, 2016.

[15] “New Jersey Needle Exchange Program Expansion Awaits Review.” (August 2012). Lehigh Valley Live. Accessed October 13, 2016.

[16] “Why N.J. Doesn’t Have More Needle Exchange Programs.” (August 2016). Press of Atlantic City. Accessed October 13, 2016.

[17] “At Long Last, Christie Delivers On Needle Exchange Funding | Editorial.” (September 2016). NJ.com. Accessed October 14, 2016.

[18] “Avoiding Toxic Pricks.” (September 2016). Observer. Accessed October 14, 2016.

[19] “In Clash Between Old And New Camden, Business Development Forces Out Community Health Program.” (September 2016). Philadelphia Inquirer. Accessed October 14, 2016.