Needle exchanges can help save lives in fentanyl fight
It can seem counterintuitive to provide clean syringes to individuals who inject drugs. After all, why make it easier to consume illicit substances that are increasingly resulting in overdoses?
In the fight against fentanyl, however, a clean syringe can be a lifesaving connection. We might not be able to stop every overdose, but if we can provide a tool to forge those connections and make illicit drug use safer, then we should.
Colloquially known as syringe services programs, SSPs aim to reduce infectious disease transmission acquired from shared needles.
In this regard they are undeniably effective, yielding a 50% reduction in HIV and hepatitis C transmission.
Syringe exchange programs are certainly not without controversy, but having been around for more than three decades in America, SSPs are neither novel nor lacking in evidence of their public health efficacy and societal cost savings.
A growing number of conservative states – often concerned that overdoses are increasing year over year – are moving to restrict or close down needle exchange programs.
We’ve seen this in Idaho, Nebraska and West Virginia.
Skepticism is understandable, as we are all frustrated by an ever-evolving opioid epidemic that now is dominated by fentanyl.
Even so, it is critical to follow the facts and use every tool at our disposal to fight this unrelenting enemy.
One of us is a former commissioner of the Indiana Health Department and knows from working on the ground with vocal opponents of SSPs – ranging from local law enforcement to community members – that contrary to what some skeptics claim, these programs have long contributed to community safety.
An SSP in Indiana had a lifetime syringe return rate of 92%. One in Florida reduced public syringe litter by nearly half. Being uncomfortable with a solution, or frustrated with what seems like a lack of progress, is not a reason to stop using tactics proven to save lives and advance public safety.
Opponents of SSPs argue that they enable drug use and make neighborhoods less safe. However, when implemented according to best practices, there is actually plenty of evidence to the contrary.
Public health and public safety
As the overdose epidemic accelerates due to synthetic opioids (like fentanyl), which are behind nearly 9 out of every 10 opioid-related overdoses, loud voices shout that syringe programs are not bringing down this spike. However, they misunderstand the scale of the overdose crisis and the various roles SSPs play in mitigating its harms.
If we’re going to create connections to those who often feel separated from society, and protect individuals and communities, we have to stop pitting public health against public safety.
We can accomplish both, which is reto flected in how SSPs have evolved to address this crisis. They offer not just sterile syringes but also overdose prevention education and tools, community support services, and pathways to treatment and recovery.
SSP participants are five times more likely to enter drug treatment than nonparticipants – and three times more likely to stop using drugs.
In other words, contrary to inflammatory rhetoric about these programs “enabling drug use,” they are one of the most effective gateways to treatment we have.
Despite these successes, misguided policies can hamstring the ability of needle exchange programs to meet the pressing needs of vulnerable communities, especially as the opioid epidemic worsens. Since the 1990s, SSPs have had to take legal risks just to distribute the opioid overdose reversal medication naloxone or nalmefene.
As such, these lifesaving interventions have been insufficiently accessible people who are most likely to experience, witness and respond to an opioidrelated overdose.
It is only recently, as states have implemented laws to reduce prescription barriers to naloxone and as intranasal formulations have become available over the counter, that the antidote has started to become truly accessible.
As one of us said when he was surgeon general, having the knowledge and tools to respond to an overdose can save a life. We’ve made progress in spite of the increasingly prevalence of fentanyl, so why would we go backward?
Front-line work
The nation’s stubbornly high overdose rate is not a sign of SSPs’ failure; it is a sign of fentanyl’s success. We must do more, not less.
Syringe services programs do the tireless, front-line work of grappling with the realities of the opioid crisis in our communities.
Yes, they can make us uncomfortable, despite the fact that it’s exactly this work that curbs the spread of disease, keeps people alive and connects them with treatment, and makes communities safer – all while being extremely cost-effective.
These are outcomes every American can agree are the right ones.
Dr. Jerome Adams, a licensed anesthesiologist, is the executive director of Purdue University’s Health Equity Initiatives. He served as the 20th U.S. surgeon general from 2017 to 2021, and as commissioner of the Indiana Health Department 2014-17.