Improving public health

Injection drug use is associated with 75% of hepatitis C cases and 10 – 12% of HIV cases when risks are identified. 1 2 3 As this enormous disease burden is due to sharing contaminated supplies, providing clean equipment can reduce the risk of contracting disease. It's that simple — and many studies have proven that this technique is highly effective. 4 5 6 7 8 9 10 11 12 Direct measurement shows that needle exchanges can lead to a 33% reduction in overall HIV rates (and a 70% reduction in the HIV rate attributable to injection drug use), 61% reduction in hepatitis B rates, and 65% reduction in hepatitis C rates among clients. 13 14 15 16

Orange County has the fourth-highest number of HIV+ patients in California (doubling in less than 10 years) and has nearly 1,000 cases of hepatitis C. 17 18 19 Based on the above evidence, establishing a needle exchange program is essential to reduce these infections and improve the public health of our community.

Needle exchanges are about more than just syringes. Most new cases of hepatitis C are caused by sharing supplies other than needles. 20 Providing HIV testing and safer sex supplies is essential to reducing the spread of HIV and other sexually-transmitted diseases, as are connecting people to medical, social, psychological, and housing services if clients desire them. More than 3/4 of injection drug users receive all of their health services from needle exchanges when they are available. 21 Available data shows that 49% of needle exchange referrals result in successful admissions. 22 Programs such as OCNEP are thus critical social safety nets as well as being effective public health interventions.

Making communities safer

Wherever a needle exchange exists, dirty syringes are being safely removed from the community. Without such programs, these needles would otherwise be in the public trash, parks, and beaches. Improper disposal can be more than halved in areas with needle exchanges. 23 24 25 26 This has a demonstrable improvement in safety, with reported reductions in needlestick injuries around 67%. 27 In cities without a needle exchange, improper disposal can be 800% higher. 28

Needle exchanges decrease drug use and improve access to services. 29 14 30 31 Needle sharing decreases and even injection frequency decreases when a needle exchange is operating. 32 The explanation for this is simple: by treating injection drug users with respect and compassion while providing needed health services, enrollment in those services dramatically increases and many harms are prevented. 33

The presence of a needle exchange doesn't increase crime. 34 35 36 Needle exchanges don't encourage drug use in children. 37 No negative outcomes have ever been shown to come from needle exchange programs, making them incredibly safe, effective ways to combat infectious diseases and benefit communities.

Highly cost-efficient

Every case of HIV costs over $300,000. 38 Hepatitis C treatments cost $1,000 for a single pill and average $65,000 per case. 39 40 Opiate overdose costs $20.4 billion nationally. 41 Each of these figures demonstrates costs many times the annual budget of our needle exchange — syringes cost only 9¢. Based on the statistics above, this means that conservative cost savings from programs like OCNEP are in the tens of thousands of dollars.

Needle exchanges are capable of preventing up to an estimated $538 million in national preventable HIV cases. 42 This enormous cost does not include prevented cases of hepatitis A, B, or C, reduced emergency department visits, overdose prevention, reduced abscesses, skin infections, needlestick injuries, or other harms that needle exchanges lessen. This also does not include the societal benefits associated with better access to social services and drug treatment when people seek them. It is thus of no surprise that needle exchanges generate high value per dollar. 43 44

Our research

We are an evidence-based program and are committed to improvement and the actual needs of Orange County drug users. Accordingly, we are studying the outcomes of our program and the needs of the people who use it to be as effective as we possibly can. In conjunction with faculty from UC Irvine and USC — experts in sociology, public health, and needle exchanges — we are developing a research protocol that by 2016 will improve the publicly-available data on injection drug use, quantify our impact, and suggest improvements for infectious disease and drug treatment strategies in Orange County.

References

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  2. Centers for Disease Control and Prevention (2012). HIV Surveillance Report, 2012; volume 24. Accessed December 14, 2014. ↩

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  18. Orange County Health Care Agency (2013). 2013 HIV Disease Fact Sheet. Accessed December 14, 2014. ↩

  19. California Department of Public Health, Sexually Transmitted Diseases Control Branch, Office of Viral Hepatitis Prevention (2011). California Local Health Jurisdiction Chronic Viral Hepatitis Data Summaries. Accessed December 14, 2014. ↩

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  26. Doherty MC, Garfein RS, Vlahov D, Junge B, Rathouz PJ, Galai N, Anthony JC, Beilenson P (1997). Discarded needles do not increase soon after the opening of a needle exchange program. American Journal of Epidemiology, 145(8): 730 – 737. ↩

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  44. Lurie P, Gorsky R, Jones TS, Shomphe L (1998). An economic analysis of needle exchange and pharmacy-based programs to increase sterile syringe availability for injection drug users. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 18(Suppl 1): S126 – S132. ↩