In these programs those involved in illicit Injection Drug Use (IDU), i.e. abusers, exchange syringes which have been contaminated by use for new syringes. Typically, the process of exchange is accompanied by counseling on proper use of syringes including administration and safety concerns revolving around contamination and sterile technique.
Often, counselors are also able to provide information on safe sexual practices (particularly condom use to prevent Sexually Transmitted Infections (STIs) such as Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV)), on-site screening for infectious disease, drug abuse rehabilitation programs, and supplies for sterile injection technique (alcohol swabs, bleach).
To evaluate the pros and cons of these programs one must approach the topic from two perspectives.
First, to protect the safety of the innocent public (the larger of the two populations involved) the effect on the non-IDU cohort should be considered. Perceived risks of SEPs for non-IDU population include increased exposure to contaminated syringes and concomitantly infectious disease, elevated crime rates committed by the IDU population on non-IDU residents in the vicinity of the SEP and a higher risk of new onset drug use among the non-IDU population.
Second, the IDU citizens should be assessed for changes in rates of drug use, changes in rates of infection, rates of criminal activity if possible and changes in IDU technique. Although, there are outliers on either end of the spectrum, studies have shown that these programs in general do not increase drug use; either recurrent or new onset use. They also do not increase the amount of improperly discarded needles.
Quite the opposite has been shown in many studies, if not simply remaining at similar rates. Probably most important to some is the fact that no appreciable increases in crime rates have been shown in areas contiguous to these centers. With the correlation between intravenous drug abusers and transmission of infectious diseases such as HIV and HCV one could obviously see the benefit that providing clean needles to the abusing population could have.
These benefits include not only decreasing the rates of transmission among users but also to someone who may be unfamiliar to the person and simply exposed to some contaminated needle or syringe that was cast off into a parking lot or alley way.
Scientific evidence exists showing increase d transmission of infectious disease and rates of risky behaviors among IDU groups following the closing of a similar program. According to the CDC in 2004, approximately one-fifth of all HIV infections and most hepatitis C infections were due to IDU.
Beyond the medical issues surrounding SEPs, financial incentives also exist. Estimates show a cost of between $4000 and $12000 for every prevented cases of HIV. These figures seem extreme until one considers the average cost of treating one case of HIV which is typically in the multiple hundreds of thousands of dollars.
The idea of SEPs originally was unsettling based on presumptions regarding the risks of possible increases in drug use and exposure to contaminated syringes. This prejudice was not founded in fact, logic or objective study but was nonetheless present.
Upon further research of the topic including information from Centers for Disease Control and Prevention, Government Accountability Office, National Institutes of Health, World Health Organization, scientific literature and other published resources, I concluded that these programs offer a benefit to society as a whole and particularly to both groups involved; those that do and do not partake in illicit IDU.
The legality of SEPs has been an issue historically for their implementation particularly with state and local laws across the country. Also, debate of appropriate means of funding (public vs. private/charitable giving) has also been discussed.
I implore each member of our community to consider the evidence discussed above as well as independent research that they may synthesize their own conclusion regarding the subject of SEPs and their utility for our area.
Jared Scott Compton, PharmD