Roosevelt Institute | Cornell University

The Politics of Syringe Exchange

By Nethan ReddyPublished March 23, 2016

Despite legislators' awareness of syringe exchange as an effective method to reduce disease transmission, there are concerns as to how permanent the recent lifting of the federal ban on these programs is. The reform could be seen as an urgent, short-term response to recent HIV outbreaks instead of a recognition for the benefits of syringe exchange as a practice.

Congress recently lifted a ban on federal funding for syringe exchange programs. Syringe exchange programs operate under the principle of harm reduction, allowing users of intravenous drugs to trade used needles for new needles in order to minimize the transmission of diseases like HIV and Hepatitis C. Harm reduction proponents' reactions to the news, however, have not been so enthusiastic. For more than twenty years, congress members have neglected the extensive research that shows syringe exchanges are both effective in preventing the spread of disease and not shown to increase drug abuse.
HIV outbreaks in Indiana have forced lawmakers' hands when it came to the policy on syringe exchanges. One particular and striking example would be the outbreak in Scott County, Indiana. In early 2015, the small town was hit with 150 new cases out of a total county population of 4,000. Rural areas, like Scott County often lack the protocols to address disease outbreaks, and there were concerns that the outbreak would spread throughout Indiana and across state lines. Many of the states that could have been affected and are still at risk are notoriously conservative states that have a number of rural communities. Consequently, it was republican congressmen from these states that led the reform with the support of senate majority leader Mitch McConnell and House Appropriations Committee Chairman Hal Rodgers who both represent the state of Kentucky, a state that lies on the border of Indiana. The concern is that lifting the ban is only being used as an emergency measure to combat the HIV outbreaks, and will eventually be reversed once congress returns to being unsupportive of harm reduction programs. Such an outcome seems likely in light of past events, in which President Obama lifted the ban on federal funding for syringe exchange programs in 2009 only to have the ban reinstated by Congress in 2012. Since 2012 it has been used as a "trading chip" in democrat and republican negotiations, it status only being elevated by the nationwide opioid epidemic. Another caveat of the bill is that the ban is still placed on the syringes themselves. However, what partly motivated Congress to act (besides the urgency of the public health need) was the fact that many syringe exchange programs offer other services like HIV testing, referrals to drug treatment programs, and Medicaid and other forms of healthcare management. With 56% of Louisville, Kentucky participants on Medicaid and another 24% without health insurance at all, the need for syringe exchange programs is not trivial/should not be ignored.
Despite efforts to undermine the recent lifting of the ban, it can still be considered a step in the right direction. Harm reduction specialists will continue to ask lawmakers to change their attitudes towards the practice, and recognize the public health and economic benefits that programs like syringe exchange have to offer. According to the Civil Liberties it costs a city about $160,000 a year to operate a syringe exchange program, and a staggering $120,000 to treat a single HIV patient. With an estimated $350,000 and a growing number of injecting drug users in the United States, it is imperative that Congress works not only to offset HIV outbreaks, but also to confront the systemic heroin and opioid epidemic with proven public health policies.