Tomorrow, March 21, is the National Day of Action for Syringe Exchange. Since the Reagan administration, Congress has expressly prohibited any federal funds from going to syringe exchange programs. This ban on federal funding is an outgrowth of the ineffectual War on Drugs, the theory being that preventing injection drug users from accessing clean syringes will cause them to stop using drugs. (A more nefarious justification: they’ll just use dirty needles, contract Hepatitis C or HIV, and die. Except they don’t just die and they cannot be denied treatment because they’re horrible drug users.)
For the first time, in last year’s budget, Congress lifted the prohibition on federal funding of syringe exchanges, providing a valuable and effective service to those in need. Then, at the end of last year, Congress reinstituted the ban in this year’s budget.
The prevailing face of syringe exchange is not one that lends itself to advocates. Many injection drug users are poor, homeless, or both; this is the demographic with which people most associate injection drug use. But many injection drug users are also people with homes and jobs who happen to use drugs. The harm reduction philosophy of public health doesn’t care why people use drugs, or for that matter, that people quit their addictions. Harm reduction is judgment-neutral in the sense that it concerns itself with people using drugs as safely as possible, which includes using sterile syringes.
Despite its proven efficacy in reducing the spread of blood-borne diseases like Hepatitis C and HIV, and the fact that syringe exchanges do not increase the use of injectable drugs, syringe exchange is one public health plank that remains largely undefended. Safe sex education is easily defensible on the ground that everyone has sex, so everyone should use condoms. That is to say, the middle class will invariably end up having sex. Not true with injection drugs. In this way, syringe exchange can remain the pariah of the public health world because it appears to affect the dirty, downtrodden masses (though you would probably be surprised to know that this is not the case; middle class people inject drugs, too!).
The loss of — or rather, the prospect of another year without — federal funding for syringe exchange does a disservice to a swath of society. As a social justice issue (or, rather, a justice issue), those without access to clean syringes should not bear the burden of lifelong, chronic disease as a result of their lifestyles, some parts of which they chose, and others of which they did not. In other words, people should not be judged or punished for the decisions they make that don’t affect others. Want to inject heroin? No problem: just do it safely. This is the moral argument.
“But why should I pay for some junkie to get high? It’s his fault he’s using drugs, so he should bear the consequences, including chronic disease and/or death.” So I see you’re not a fan of the moral argument. Consider, though, that the lifetime cost of care for an HIV patient can be as high as $600,000 per person. For an indigent user, that’s money coming out of your taxes that isn’t going to pay for something else. Contrast this with the cost of a citywide syringe exchange program, which can be contracted out for as little as $100,000 per year. Couple this figure with the fact that the War on Drugs has neither saved money nor decreased drug use, and we arrive at this simple conclusion: abstinence inducements are expensive to begin with and increase the risk of contracting (and spreading!) disease by encouraging such behaviors as using dirty needles and sharing needles with others. These behaviors, in turn, result in more collateral costs, like HIV treatment and emergency room care.
By taking a judgment-neutral approach; i.e., not allocating blame and making value judgments (the latter of which can get very dicey, very personal, and can easily be reflected back to the judger in some form), harm reduction — and syringe exchange, its subsidiary — foster both dignity, for those concerned with morality, and cost effectiveness, for those concerned with money. When a syringe exchange ban is lifted, everyone wins: injection drug users, tax payers, and cash-strapped state governments, which have shuttered many public health programs — including syringe exchanges — due to lack of money. Moreover, a comprehensive, federal syringe exchange program could go a long way in curbing the spread of Hepatitis C and HIV, ultimately saving money in the long run.
Full disclosure: the author is a member of the Board of Directors of Needle Exchange Emergency Distribution, a California nonprofit corporation devoted to reducing the spread of HIV and Hepatitis C by distributing clean syringes and providing outreach and education using the harm reduction philosophy.