Needle Exchange Program: A Case Study

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Franks, Eric 7/27/16 WST 320 Gender, Drugs and Alcohol Arizona State University Professor Herson Putting People first: Substance use treatment and public health How do we put people first when dealing with substance use and treatment, how does this effect public health, and where do people who use fit into these as it relates to gender? How do these converge into a public health option? One such treatment option to mitigate public health risks is a Needle Exchange Program, also referred to as a Needle Syringe ¬¬¬¬¬Program (NSP). What is the current medical approach to this health option? It is not a uniform practice in the US, this being, a directly federally funded and nationally implemented option, and is
relegated to state or county health authorities in some places, and community organized volunteer programs in others. According to a report from University of California, San Francisco, treatment for Injecting Drug Users (IDU’s) in the US began as early as 1988, with the first comprehensive program being established in Tacoma, WA. (School of Public Health & Institute of Health Studies, 1993) This comprehensive NSP not only provided IDU’s with access to needles and syringes, but a wide array of services, which paved the way for other NSP programs. What is a NEP? According to the City of Ottawa, Ontario, Canada “The City of Ottawa’s Clean Needle Syringe Program is an effective mandatory health program, which has been in operation since 1991. The availability of these programs have been deemed a necessary public health measure to prevent the spread of communicable diseases, primarily HIV and Hepatitis-C virus, and to minimize the risks associated with substance use in society.” (Ottawa, 2016) this treatment seeks to reduce the prevalence of “dirty needles” being used to inject drugs, particularly Heroin, but also to mitigate the spread of blood borne illness, such as AIDS/HIV, Hepatitis C, which are often transmitted while sharing needles for use of illicit drugs. Although needle exchange programs have been in place at some level for just over twenty-five years, particularly in many parts of North America, these programs vary from state to state, even municipality to municipality, and of course, from one nation to the next. What is involved in such an option for a drug user?
Apart from providing safe spaces to inject, and clean equipment to utilize their drug, there has been a shift in public health accessibility of NSP’s, this is to state that the institutional attitude towards people who are injecting drug users or IDU’s, is changing, for example in Lexington-Fayette County Kentucky, people who utilize the established program can remain anonymous, and in exchange for using clean needles, the user faces no criminal penalties. (Needle Exchange Program , 2016) According to North American Syringe Exchange Network, as of May of 2015, “there are currently 228 of these programs in 35 states, The District of Columbia, The Commonwealth of Puerto Rico, and the Indian nations.” (Directory-Facts, 2015) To date, there is still no direct federal funding, according to research done by Society for the Study of Addiction, it found some major problems with existing NEP’s, which they call, operational issues, “The most common problem was ‘lack of funding/lack of resources’, reported by 56% of the programs. Staff shortages (47%)… Despite these problems, the two guiding principles of utilizing secondary exchange to increase the diffusion of sterile syringes in the IDU population and utilizing the programs to provide multiple other health and social services have provided an excellent basis for the development of SEPs in the country.” (Des Jarlais, 2009) So who is most likely to
utilize these services based on gender?. One study quantified the demographics who tend to take advantage of harm reduction programs like NEP’s, the vast majority are male, (72%) and over the age of 35, the other (28%) percent were female, and these figures also showed a disproportional number of African Americans (89.9%) (Valente, 2001) Existing evidence shows that there is a lack of Gender Sensitive and Harm reduction treatment protocols designed for women. This is problematic due to the fact that women IDU’s are more likely than men not to utilize the treatment options available, according to one report, women who inject drugs experience much higher rates of death, increased potential for injection related problems, higher rates of HIV, due largely to higher risk factors for risky actions, such as sexually, or while injecting. Throughout the research I perused, I would propose a nationwide implementation of Harm Reduction protocols, and include with them a mandate to require federal funding be specifically allotted for the creation and maintenance of a comprehensive NEP-NSP that includes a full spectrum of health care services, for both men and women based upon existing state and local examples, like those overseen by North America Syringe Exchange Network (NASEN) based in Tacoma WA, as well as a federal framework similar to Canada, like the programs in Vancouver, BC, and Ottawa, ON, and those in other European nations. In order to accomplish this, we need to establish a uniform NEP, and one that could become nationwide. Sheway, in Vancouver, Canada, is a specific program that offers more than NEP, they also provide gender specific services for women, such as child care and housing assistance, pre-natal and post-natal care, counseling and advocacy, even transitional housing. They are known as Common Sense for Drug Policy (CSDP) and they call it the Effective National Drug Control Strategy. Within their proposals they have two major recommendations “1. Repeal all State and Federal laws to prevent access to and prevention of possession of sterile syringes and injection equipment and 2. Make prevention of Hepatitis-C a high public health priority.” (Common Sense for Drug Policy, 1999) There have been strides made since the initial NEP-NSP’s came about, and a large portion of health authorities and organizations in the US back such changes including, but not limited to the National Association of Social Workers (NASW), American Psychological Association, National Association of County and City Health Officials, the American Medical Association, World Health Organization and many others. (Common Sense for Drug Policy, 1999) The aim of CSDP and many other organizations can be summed up with the philosophy and framework of harm reduction. According to an interview with Daniel Raymond, Policy Director for the Harm Reduction Coalition, in an interview on January 8, 2016, with NPR, Congress has now allowed existing federal funds to aid with established NEP’s functionality, in the interview, Mr. Raymond clarifies, “It's a shift in funding policy, it's not an addition of new funds. But what that means is that if you're a state that receives federal treatment dollars then you suddenly have more options. The absence of federal funds - especially in the rural areas, smaller cities, suburban areas - has meant that a lot of good intentions have never been able to get off the ground. So my hope is that this is going have a transformative effect outside of the bigger cities which were often the first to move and spread better programs into areas that have been hard-hit by the heroin and opioid crisis.” (Rogers & Raymond, 2016) This is a major win for public health options in America.
The shifting of Federal funding policy is a step towards a more cohesive practice of harm reduction, which will benefit both IDU’s health options, as well as relieve the strain on public health in general. References Common Sense for Drug Policy. (1999). The EFFECTIVE NATIONAL DRUG CONTROL STRATEGY 1999. Retrieved from Common Sense for Drug Policy: http://www.csdp.org/edcs/page19.htm Des Jarlais, D. C. (2009). Doing harm reduction better: syringe exchange in the United States. Addiction, 104(9), 1441-1446. Retrieved from https://nasen.org/site_media/files/nasec2010/ddj_2009DoingHarmReductionBetterSEPintheUS.pdf Exchange, N. A. (2015, May). Directory. Retrieved from North American Syringe Exchange: https://nasen.org/ Needle Exchange Program . (2016). Retrieved from Lexington-Fayette County Health Department: http://www.lexingtonhealthdepartment.org/ProgramsServices/NeedleExchangeProgram/tabid/263/Default.aspx Ottawa. (2016, July 28). Retrieved from Site Needle & Syringe Program: http://ottawa.ca/en/residents/public-health/healthy-living/clean-needle-syringe-program Rogers,
H., & Raymond, D. (2016, January 8). Congress Ends Ban On Federal Funding For Needle Exchange Programs. All Things Considered. (A. Cornish, Interviewer) Retrieved from National Public Radio: http://www.npr.org/2016/01/08/462412631/congress-ends-ban-on-federal-funding-for-needle-exchange-programs Valente, T. W. (2001, June). Needle-exchange participation, effectiveness, and policy: syringe relay, gender, and the paradox of public health. Journal of urban health, 78(2), 340-349.