In 2011, PreventionWorks!, a needle exchange program in the District of Columbia, closed down after 12 years of helping people who struggled with drug use.
When its workers tried to contact the 3,000 clients to let them know the news and refer them to other programs, it became clear how much this clinic — which was really just a syringe exchange van — meant.
“For many of these folks, this was the only source of care that they had known in the last 10 years of this program’s existence. This is the only place they felt comfortable for any sort of care,” Monica S. Ruiz, Ph.D., M.P.H., an associate research professor at The Milken Institute School of Public Health at The George Washington University, told Healthline.
Use of programs increases
Over the past decade, the number of people accessing programs like this has grown.
According to a new report from the Centers for Disease Control and Prevention (CDC), in 2015 more than half of people who inject drugs reported using a syringe services program —compared to about one-third in 2005.
The new report included data from 22 U.S. cities with a high number of HIV cases.
The success of PreventionWorks! and similar programs around the country lies in the fact that they offer more than clean syringes.
Many of these programs, said Ruiz, provide HIV and hepatitis C testing, condoms for safe sex, blood pressure testing, wound care, and referrals to drug treatment programs, HIV care, and social services.
But their success is as much about how they provide the services as what they offer.
“Syringe services programs are so tremendous because they meet the person where they’re at in the course of their addiction,” said Ruiz, “doing so without judgment, and trying to create a trusting, safe environment where people can feel comfortable about reaching out to these services.”
Even today, drug use is highly stigmatized. But so, too, is mental illness, which occurs in higher rates in people who use drugs.
Which is why programs work hard to build trust with people needing their services.
This kind of trust is critical, said Ruiz, along with staff who “try to help you preserve your dignity, and offer you things to help yourself.”
“I think that is huge,” she explained. “That is why more people are using the programs and why people keep coming back.”
More work is needed
In spite of the success of these programs, more work is needed to reduce the risk of infection from sharing syringes.
“There have been increases in the number of people who have been using these services, but it’s still not perfect,” said Ruiz.
The CDC report found that in 2015 one in three injection drug users reported sharing a needle in the past year — about the same as in 2005.
According to the researchers, 9 percent of HIV infections diagnosed each year in the United States are among injection drug users. Also, in recent years this population has contributed to a 150 percent increase in hepatitis C infections.
There are many reasons that people don’t use sterile needles, but one stands out from the rest.
“There are so many barriers to people using these programs,” said Ruiz. “And the biggest one, I think, is access.”
The programs may not exist in rural areas. Cities and towns may also have bans or restrictions against them. Other programs may not have enough money or staff to reach everyone.
“We need to expand these services in order to really increase the coverage,” said Ruiz, “so that everyone has access to these programs, and that ideally every injection is with a new needle.”
Benefits of syringe exchange
Making the case for expanding the number of syringe services programs is never easy.
In the 1980s while the United States was embroiled in a war on drugs, some people were concerned that providing sterile needles for injection drug use would only encourage people to keep using.
Some of this mentality remains today. But the CDC report and other studies show the benefits of these kinds of programs.
In a study published last year in the scientific journal AIDS and Behavior, Ruiz and her colleagues looked at what happened in the District of Columbia after a ban on the use of municipal funds for syringe services programs was lifted in 2007.
The city quickly set up a program that included needle exchanges and referrals to HIV testing and addiction treatment programs.
In the study, Ruiz and her colleagues saw a 70 percent drop in newly diagnosed HIV cases over two years, which amounted to 120 infections avoided. This saved millions of dollars that would have been spent for treatment if those people had become infected.
“HIV treatment is not cheap and it’s not easy,” said Ruiz. “If we can prevent people from getting infected, this is saving the taxpayers money.”
The benefits of these programs, though, extend well beyond the cost savings.
“It’s really a way of empowering drug-using communities to do what they can to lead healthier lives,” said Ruiz.