The Case For Needle Exchanges

Needle exchanges are organizations that allow injection drug users to receive free or reduced cost hypodermic needles with no prescription. To the dissenters, the first word that comes to mind when discussing these programs is “enabling.” Due to such opposition, needle exchanges remain illegal in many states. Even in cities like Pittsburgh and Philadelphia, where needle exchanges are legal and provide a myriad of additional resources, public funding is disallowed. When evaluating needle exchanges, it is often hard to define the line between support and collusion, but the best way to do so would be to look at the overall benefits provided to the communities these programs are a part of.

Although there are many needle exchanges throughout the country, the one most near and dear to Jefferson - and one of the five locations JeffHOPE caters to - is located just a few miles away. Prevention Point’s main headquarters is located in the heart of Kensington, which remains the neighborhood with the most heroin usage and sales in Philadelphia. So why would a program want to provide needles to individuals in an area of problematic drug usage? The short answer: a clean needle supply does not contribute to increased usage and, in many ways, can be beneficial to the population it serves. In other words, the people who are using heroin will do so independently of the presence or absence of a supply of clean needles. The real question, then, is what the supply of clean needles accomplishes.

In addition to ranking as one of the top cities in opiate usage, Philadelphia also has one of the nation’s largest city-wide populations of hepatitis C and HIV-infected individuals. The connection between these two statistics is well-studied; usage of dirty needles can overwhelmingly increase the risk of contracting HIV and hepatitis C. In cities like Philadelphia that are already grappling with a staggering number of new hepatitis C and HIV infections each year, these numbers are likely many times higher than those reported. This is where programs like Prevention Point come in.

  Figure 1 . Injection drug user with hypodermic needle.

Figure 1. Injection drug user with hypodermic needle.

Needle sharing is a common practice among injection drug users that have no means of securing clean needles and comprises one of the largest risk factors for hepatitis C and HIV transmission. Oftentimes, these individuals are unaware of the risk associated with used needles. For those who are educated on the dangers of needle sharing, the scarcity and price of an unused needle is prohibitive of safe injection practices. Although Pennsylvania legalized over-the-counter dispensation of syringes in 2009, there is a limit to the number of syringes that can be purchased at one time, and the price can still sometimes be prohibitive. Additionally, there are reports of pharmacists disobeying this mandate by prohibiting the sales of syringes presumably based on appearance. For some, Prevention Point is the only consistently non-judgmental and free source of clean needles.

Beyond reducing the transmission of blood-borne infections like hepatitis C and HIV, clean needles also reduce dermatological and vascular problems associated with the utilization of used needles. Figure 2 shows a picture of a needle after 0,1, and 6 uses. The amount of erosion after each use is easily apparent, and the insertion of a blunt needle tip can cause unnecessary damage to the skin and veins. Many injection drug users develop abscesses and collapsed veins as a result of re-using needles, and these issues can be avoided with increased availability of clean needles, decreasing the healthcare burden of preventable medical procedures. Many patients with collapsed veins require more complicated means of drawing blood, including various vein illumination techniques and access through the femoral artery. Additionally, abscesses obtained through the use of blunt needles can sometimes require surgery and antibiotics, and, if left untreated, can result in endocarditis and even death. By providing clean needles to injection drug users, programs like Prevention Point are able to reduce all these harms done by old, potentially disease-harboring needles.

  Figure 2 . Hypodermic needle tip after no uses, after one use, and after six uses.

Figure 2. Hypodermic needle tip after no uses, after one use, and after six uses.

Prevention Point not only supplies clean needles to reduce transmission of infectious diseases, but also offers prevention in the way of training seminars on safe injection use, needle disposal (even going so far as to supply each client with their own mini-sharps bin, Figure 3), and Narcan use. The number of opiate-related overdose deaths has grown considerably over the past number of years, and Prevention Point recognizes this as an intolerable statistic. The organization has advocated successfully in city health policy to allow over-the-counter Narcan sales and for the requirement that police officers be trained in proper Narcan usage. This organization, therefore, not only advocates for the right to access to clean needles, but the right to secure life-saving overdose prevention materials and training on how to use them.

  Figure 3 . Personal size sharps bin container with hypodermic needles.

Figure 3. Personal size sharps bin container with hypodermic needles.

Prevention Point is a strong advocate for its clients and actively aids in acquisition of stable housing, clothing, food, and medical treatment. By existing as a needle exchange, Prevention Point is able to reach out to the people who enter their doors primarily for new needles and offer services that greatly exceed the basic practice of exchanging needles. This outreach to a vulnerable population helps to build stability in a community plagued with opiate addiction and helps to guide people through an immensely difficult time in their lives. 

The primary purpose of Prevention Point is not to cure people of their addictions, but to meet individuals where they are and focus on harm reduction, which entails minimizing the harmful consequences of a behavior rather than the behavior itself. Through this method, Prevention Point establishes a community-focused approach, building people better opportunities in all aspects of their lives and thus a foundation to work their way through addiction.

Needle exchanges function as much more than what the name suggests. Their staff are experts in the realm of advocating for injection drug users and are helping to change the landscape of addiction in communities where drug addiction is a symptom of larger problems. By focusing on the more dire, immediate necessities their clients present with, like food, housing, and clean needles, organizations like Prevention Point are able to alleviate addiction from the outside-in. In this way, needle exchange programs have a multi-faceted approach to grappling with addiction in communities that includes aspects of public health, policy, advocacy, and harm reduction. The case for needle exchanges, therefore, lies in their ability to support individuals struggling with addiction on many fronts and to actively engage each person with resources that can provide comfort and humanity within a society that sometimes lacks both. It is for this reason that we must strongly advocate for their existence in the face of stringent restrictions, so that they can continue to advocate for vulnerable, hard-to-reach populations in desperate need of care.

About the Author

Brenda French is a medical student in the Sidney Kimmel Medical College Class of 2020.

Citations

1. http://www.post-gazette.com/news/state/2015/05/10/PA-law-prohibits-needle-exchanges-that-can-save-lives/stories/201505100067

2. http://www.malverninstitute.com/the-loved-ones-guide-to-heroin-other-drugs-in-kensington-philadelphia/

3. Hagan, H., McGough, J.P., Thiede, H., Hopkins, S., Duchin, J., & Alexander, E.R. (2000). Reduced injection frequency and increased entry and retention in drug treatment associated with needle-exchange participation in Seattle drug injectors. Journal of Substance Abuse Treatment. 19(3): 247-252.

4. https://www.justice.gov/archive/ndic/pubs0/670/heroin.htm

5. https://hip.phila.gov/DataReports/Hepatitis

6. https://aidsvu.org/state/pennsylvania/philadelphia/

7. https://www.cdc.gov/hiv/risk/idu.html

8. Zule, W.A., Oramasionwu, C., Evon, D., Hino, S., Doherty, I.A., Bobashev, G.V., & Wechsber, W.M. (2016). Event-level analyses of sex-risk and injection-risk behaviors among nonmedical prescription opioid users. The American Journal of Drug and Alcohol Abuse. 42(6): 689-697.

9. http://www.pabulletin.com/secure/data/vol39/39-37/1681.html

10. Koester, S.K., Bush, T.W., and Lewis, B.A. (2002). Limited access to syringes for injection drug users in pharmacies in Denver, Colorado. Journal of the American Pharmacists Association. 42(6): S88-91.

11. http://i.imgur.com/Rh7RY.jpg

12 Binswanger, I.A., Kral, A.H., Bluthenthal, R.N., Tybold, D.J., & Edlin, B.R. (2000). High Prevalence of Abscesses and Cellulitis Among Community-Recruited Injection Drug Users in San Francisco. Clinical Infectious Diseases. 30(3): 579-581.

13. Rhodes, T., Briggs, D., Kimber, J., Jones, S., & Holloway, G. (2007). Crack-heroin speedball injection and its implications for vein care: qualitative study. Addiction. 102(11): 1782-1790.

14. Larney, S., Peacock, A., Mathers, B.M., Hickman, M., & Degenhardt, L. (2017) A systematic review of injecting-related injury and disease among people who inject drugs. Drug and Alcohol Dependence. 171: 39-49.

15. http://www.phila.gov/health/pdfs/chartv1e1.pdf