Each individual IV drug user injects approximately 1000 times yearly, adding up to millions of injections and creating a tremendous need for reliable sources of clean needles (Syringe Exchange Programs, 2005.) Needle exchange programs offer a way for IV drug users who continue to use substances to safely dispose of used needles as well as being able to obtain clean syringes that are given to them at no cost. This paper will discuss the social history of how these programs developed, including the health costs and benefits of syringes exchange programs as well as the application of public health nurse principles linked to such programs.
Long before needle exchange programs were formally established, health professionals and grassroots activists considered distributing clean needles to IV drug users as a way to curtail the spread of infections (Lane.) In San Francisco in 1970, the idea of giving sterile needles to IV drug users was suggested as a way to combat both yellow jaundice and abscesses that were caused by using heroin.
When the HIV epidemic first became clearly identified as a problem of tremendous scale, doctors and nurses in San Francisco began leaving 10 packs of syringes near people that they knew were injecting drugs, and would then leave the area to provide anonymity. In addition, in the mid-1980s, a growing number of IV drug users in New York City were worrying about becoming infected with the HIV virus because of sharing needles, and more than 50% of those users who were studied were attempting to find different ways to prevent infection. Because of the tremendous need for clean needles, an underground market sprang up; initially, used needles and syringes were washed and then repackaged in order to appear sterile before being sold on the street to unsuspecting customers (Lane.)
In 1984, a drug users’ advocacy group in Amsterdam began a needle exchange program in partnership with the Municipal Health Service, although purchasing clean syringes were legal in Netherlands. Still, there was a concern that because at least one pharmacist in that city refused to sell needles to drug users, there might be an outbreak of hepatitis B. A main purpose for that program was harm reduction, an approach that recognizes that realistically, many drug users will not abstain from using so that the best possible outcome is reducing the risk to which addicts expose themselves and others. In addition, a goal was to provide accessible service anonymously, and the program became publicized internationally at conferences attended by healthcare professionals, researchers, and activists. In particular, health advocates in North America led the fight for needle exchange programs, because of the ever-increasing rate of patients with AIDS.
The services can also help people who are actively using drugs to maintain and improve their overall health (Syringe Exchange Programs, 2005.) The additional programs may include HIV and AIDS counseling and education, distribution of condoms, information and referral for substance abuse treatment, HIV testing and counseling as well as crisis intervention on-site, and screening for TB, hepatitis B and C, as well as other infections.
There has been a great deal of research examining the costs of needle exchange programs, and the conclusions are that they are indeed cost effective. Each syringe costs on the average $.97, so that needle exchange programs are able to save money in all IV drug populations where the yearly HIV sero-incidence rate is more than 2.1 per 100 people per year (Syringe Exchange Programs, 2005.) This is compared with the cost for each instance of HIV prevention when needle exchange programs are used, which is calculated at $4000-$12,000. This amount is significantly lower than the approximately $190,000 in medical costs that are incurred when treating a person who is infected with the HIV virus. In addition, there are costs to the criminal justice system and healthcare that are saved. Frequently, drug addicts will commit crimes in order to pay for drug paraphernalia, including needles, so that needle exchange programs reduce one level of law enforcement activity (although there are certainly many more crimes associated with drug use.) In addition, the costs of treating infectious diseases that are caused by using dirty needles are extremely high as well.
The ethical principles of public health nursing are certainly relevant to healthcare professionals’ involvement with needle exchange programs. For example, respect means treating people as unique and equal to others, and distributing syringes to people that are clearly using IV drugs is a way of communicating that their lives are worth saving; in addition, there is no judgment about their behaviors, only concern about their health and that of others in the community. Autonomy is the recognition that people have freedom of choice, and the needle exchange program sends the message that although people may choose to engage in a harmful lifestyle that includes using IV drugs, this is their choice and it must be acknowledged. The principle of fidelity is relevant, because it indicates that nurses who are participating in needle exchange programs are true to the concept of confidentiality, i.e. that they will not reveal the identities of drug users to anyone, including and especially law enforcement. Finally, beneficence means acting to benefit others, and the needle exchange programs allow nurses to engage in harm reduction by distributing needles to people who are choosing to be involved in behaviors that are self harming, but the nurse is willing to provide help to the user that will ultimately increase the chances that they will stay healthy.
- Lane, S. (n.d.). Needle Exchange: a Brief History. Retrieved from Henry J Kaiser Family Foundation: http://hpcpsdi.rutgers.edu/
- Syringe Exchange Programs. (2005, December). Retrieved from Centers For Disease Control And Prevention: http://www.cdc.gov/