On Dec. 18, Congress passed a $1.1 trillion omnibus spending bill filled with numerous additions and addendums, including, somewhat surprisingly, a rider that might be really important to drug addicts. It restores the possibility of federal funding for needle exchange programs. For both drug users and those who advocate for them, this is a huge step—but there’s still more to be done.
The first ban on federal funding for needle exchanges was implemented back in the late 1980s. We’ve been relying on stigma to dictate our public health policies for almost three decades. In 2009, legislators briefly relented and lifted the ban, only to reinstate it with a spending bill in December 2011.
I was an IV drug user for nine years and, during that time, sometimes lived in areas with needle exchanges and sometimes in areas without them. Not having access to needle exchanges certainly didn’t stop me from using needles. Instead, I took risks, used the same needles for months on end, and bought theoretically clean needles from sketchy corner dealers. In that situation, it’s what most addicts will do.
To me, it’s fairly obvious that a lack of needle exchanges does not deter addiction. Literally no would-be heroin addict says, “Oh darn, there’s no needle exchange? Well then I guess I won’t become a heroin addict after all.” (Conversely, no one says, “Oh there’s a needle exchange?! Perfect time to become a drug addict!”)
It’s well-documented that needle exchanges reduce HIV and hepatitis transmission rates among IV drug users. This 1998 study found that one needle exchange in Connecticut reduced the HIV infection rate among participants by 33%. Also, it’s worth noting that a 2000 study–conducted by the same two scientists—found that needle exchanges did not correlate with any increase in crime. In other words, they’re not making your neighborhood unsafe. And from a public health perspective, they’re actually making it safer.
Essentially, needle exchanges help keep people as healthy as possible until they finally reach a point where they’re able to stay clean. Until we find the silver bullet to solve addiction instantaneously, that’s the best we can do: Keep people alive until they can manage to stay clean.
If we really want to do that, though, we need to take public-health efforts a step further. Clean needles can help prevent the spread of disease, but they don’t prevent overdoses. Right now, the US is facing a growing crisis when it comes to opiate overdose deaths. For the fourth year in a row, 2014 saw an increase in heroin deaths in New York City. That’s not an anomaly; it’s just part of a larger trend. Nationally, the number of heroin deaths per year increased six-fold from 2001 to 2014.
While the US has struggled with the growing epidemic, some countries have found a better way.
Ten countries—including Australia, Norway and Canada—have decided to allow supervised injection facilities. SIFs, as they’re also known, provide a safe place for drug users to shoot up, a place where they can get clean needles, learn about safe injection practices, and know that someone is around with the anti-overdose drug naloxone in case anything goes wrong.
It’s a radical approach. But so far it seems to be working. The only SIF in North America—InSite, founded in Vancouver in 2003—has been the subject of a number of studies with some encouraging results.
InSite has dramatically decreased the number of overdose deaths. And, although there have been thousands of overdoses at the facility, none of them were fatal—because medical staff was on hand with naloxone, a potentially lifesaving drug that can block and even reverse the effects of an opioid overdose. Last year, a study found that SIFs largely achieve their harm reduction goals without an increase in drug use. The facilities also result in fewer people shooting up in public and fewer used needles on the ground. Perhaps surprisingly—almost counterintuitively -—a 2011 study found that people who went to the Vancouver SIF regularly were more likely to seek treatment and more likely to stop using.
Basically, SIFs might sound like a crazy idea, but they’re working. And yet, politicians have consistently avoided making them legal in the US. It’s possible that a state or municipality could pursue founding a SIF anyway—just as states have been legalizing marijuana despite federal laws criminalizing it. But in order for SIFs to really take root, we need to see legislative support at a federal level.
For me, this all feels very personal right now. One of my friends overdosed and died this week. Amid the loss, I feel anger—anger that as a country, we’re still stuck pursuing drug policies that just aren’t working. Instead of relying on strategies that are shown to work, we stigmatize and incarcerate and let people die, all while failing to really address the problem.
Would a safe injection facility have saved my friend? I don’t know, but it might have. What I do know for sure is that we owe it to her—and millions of others like her—to find out.