Currently, the number of injection drug users has increased considerably. Researchers note that “even more alarming is the 109% rise in use among those who are 18–25 years old and live in the United States” (Vidourek, King, Yockey, Becker, & Merianos, 2019, p. 111). Consequently, this growth affected the spread of blood-borne infectious diseases, such as HIV, Hepatitis B and C, syphilis, and others. Over 60% of the people injecting drugs have become infected with these diseases (Vidourek et al., 2019).
Therefore, it is essential to establish and develop some efficient strategies and programs that would help to reduce the speed of the blood-borne infections spread and its risks. One of the vivid examples of such policies is the needle exchange programs (NEPs). The primary function of this strategy is to offer clean needles to injection drug users in exchange for used ones. During the past years, NEPs have been an utterly disputable social health program in the US with changeable attitudes towards them among authorities and the public. This paper aims at determining the resultant benefits and drawbacks of these programs and analyzing them.
To start with, it seems significant to delve deeper into the history of the issue. According to Weinmeyer (2016), NEPs first appeared in Amsterdam in 1983 as a means to decrease infection transmission, causing considerable public controversy. In the US, the most popular and supported point among people who were against the implementation of NEPs was a concern that it would contribute to increased drug use.
In addition, the opponents of NEPs claimed that it would contradict the US’s efforts in terms of “war on drugs,” and, moreover, would adversely influence children. Nevertheless, researchers note that NEPs were officially endorsed in 1998 by the US Department of Health and Human Services (Levinthal, 2014). In addition, it was proved that NEPs could remarkably reduce the spread of HIV (around 30%) without raising the use of drugs.
In spite of the fact that the implementation of NEPs was officially endorsed, the public and government attitude was not entirely in favor of their development. According to Levinthal (2014), “although the ban on federal funding for needle-exchange programs was lifted in 2009, it was reinstated in 2011” (p. 45). The primary cause for the ban was a misgiving that NEPs would undermine an ideological political message about drug consumption being morally wrong and against the law.
Only around 2017 did the US Congress lift the ban and allowed NEPs to be federally funded. What is more, NEPs were finally approved by such medical organizations as the American Medical Association and the World Health Organization. In addition, NEPs provide various drug treatments, such as group therapy, lectures on drug consumption and abuse, and different ways of curing drug addiction.
Currently, there are many NEPs working around the world, including such countries as India, Australia, Ukraine, and 33 US states. It is possible to note that there is a large US organization called the North American Syringe Exchange Network (NASEN) that has registered approximately 400 NEPs around the US by 2018 (Davis et al., 2018). The NASEN is currently sponsored by various federal funding, donations, and sometimes by start-up grants. According to its data, the activity of the NASEN has helped to drastically reduce the spread of various blood-borne diseases starting from a declined outbreak of HIV in 1988 (Dave Purchase Project, 2020).
Although the activity of NEPs is apparently helpful and does not correspond to negative concerns, there are many opponents of the increasing and development of NEPs. Mostly, they are directed by moral misgivings and lack of understanding of the issue core. Therefore, it is essential to learn how to understand this moral basis of NEPs opponents in order to raise public awareness and correctly promote NEPs among society. According to Christie et al. (2019), the moral foundation prevails over scientific pieces of evidence when people who are against NEPs explain and support their point. However, the study showed that more educated people tend to be slightly more favorable in terms of implementation and development of NEPs.
As for health professionals’ attitudes, there is one study that was conducted on pharmacists. The results show that at least one in three pharmacists was firmly against NEPs, one was supportive, and another third were undecided (Vidourek et al., 2019). Interestingly enough, the majority of pharmacists reached an agreement that NEPs reduced HIV. In spite of accepting that NEPs provoke positive health outcomes, there is a lack of support for NEPs. It may suggest that pharmacists tend to hold stigma-related attitudes toward such public health strategies.
What is more, another study of pharmacists revealed some reasons for contradicting NEPs. Among other reasons, there are theft, safety concerns, disheveled appearance, and anxiety about insecure needle disposal. Therefore, regrettably, it is possible to note that not only ordinary people are mostly against NEPs, but also a considerable number of medical professionals do not regard it as a beneficial public health strategy.
In my opinion, such public health strategies as NEPs have their particular benefits and drawbacks. Firstly, not only are NEPs useful, but they are even essential as a means of stopping and preventing the spread of blood-borne diseases. Secondly, NEPs also provide people with resources helping to fight off drug addiction. For instance, there are many information promoting campaigns originated by NEPs that help to raise public awareness and clarify the issue of drug consumption and abuse. What is more, NEPs organize various therapy for drug-addicted people, such as group therapy, psychological meetings, and others. Last but not least, NEPs provide people with different drug treatments and all the connected information about it.
However, NEPs also have some disadvantages that need to be dealt with. In spite of being studied and proved to be useful, NEPs still provoke public doubts and misgivings. It is impossible to deny that the activity and development of NEPs can cause increased drug consumption and abuse since it can be seen as a contradiction to the US laws created against drugs. Nevertheless, society witnessed the implementation and work of NEPs during adverse outbreaks of blood-borne diseases, and the results were remarkably impressive. For instance, during the HIV outburst of 1998, NEPs contributed to a considerable reduction of infected people that equaled approximately one-third of the whole amount of the ill (Levinthal, 2014). What is more, it did not lead to an increase in drug consumption or abuse.
Moreover, as for the drawbacks of NEPs, there can be a danger for the medical and volunteering staff working here. There were some cases when non-users, such as police and medical workers, were infected by uncontrollable violent drug users (Weinmeyer, 2016).
Approaching people with drug addictions is mostly risky, therefore, special precautions are necessary. However, this drawback is not something that cannot be fixed. Such precautions as a developed security system and more advanced equipment should be implemented as parts of NEPs. Therefore, it will probably become safer for the staff to perform their work and more complicated for violent people to commit their crimes.
To sum everything up, NEPs have caused controversial attitudes among the public and authorities over the past decades. While the benefits of such public health strategy are undeniable, people, especially conservative ones, solely cannot accept the core idea of NEPs. Skeptics, conservative people, and other opponents ignore scientific proofs and actual results of the activity of NEPs and stick to their emotional-based attitude. However, various public opinions on the issue depend on every particular person’s values. Thus, people who consider care as a more robust moral value, treated NEPs more positively, since, above all, it is a harm-reduction program. On the contrary, people who treat other moral values as more significant, tend to be less tolerant towards NEPs.
What is more, official organizations, such as the World Health Organization (WHO), the Centers for Disease Control (CDC), and the National Institutes of Health (NIH) claim that needle exchange programs are essential and utterly useful. Therefore, it is possible to note that public attitudes towards NEPs are a matter of life or death. Thus, it is utterly significant to raise public awareness and understanding of the issue. In addition, further studies, developments, and implementations of NEPs are essential and must be conducted.
References
Christie, N. C., Hsu, E., Iskiwitch, C., Iyer, R., Graham, J., Schwartz, B., & Monterosso, J. R. (2019). The moral foundations of needle exchange attitudes. Social Cognition, 37(3), 229-246.
Dave Purchase Project. (2020). Pioneering harm reduction strategies since 1988. Web.
Davis, S. M., Davidov, D., Kristjansson, A. L., Zullig, K., Baus, A., & Fisher, M. (2018). Qualitative case study of needle exchange programs in the Central Appalachian region of the United States. PloS One, 13(10), e0205466.
Levinthal, C. F. (2014). Drugs, behavior, and modern society. (8th ed.). Bergen, NJ: Pearson.
Vidourek, R. A., King, K. A., Yockey, R. A., Becker, K., & Merianos, A. L. (2019). Straight to the point: A review of the literature on needle exchange programs in the United States. Journal of Behavioral Health, 8(3), 111-121.
Weinmeyer, R. (2016). Needle exchange programs’ status in US politics. AMA Journal of Ethics, 18(3), 252-257.