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Congress must restore federal funding for needle exchange

In 2009, Congress passed legislation reversing the decades-old ban on the use of federal funding for syringe exchange but, for unclear reasons, in late 2011, it reversed this decision, again withholding federal funding from programs that provide drug users with sterile needles and syringes. This month, Congress approved the health spending budget for the rest of this fiscal year without lifting the ban. This lack of action worsens public health problems, makes our communities less safe, and increases future financial burdens on taxpayers.

Although syringe exchange programs were controversial when they first appeared in the 1980s, this is no longer the case. Many communities across the country have actively embraced syringe exchange, recognizing that such programs create healthier, safer and more productive communities.

Since Baltimore's syringe exchange program began in 1994, health officials have exchanged nearly half a million needles each year and have served more than 14,000 clients. The percentage of HIV diagnoses attributable to drug use in Maryland has fallen from 53 percent to an all-time low of 16 percent in 2010. In large measure, Maryland has been able to dramatically reduce drug-related HIV transmission due to the availability of sterile injecting equipment in Baltimore.

Maryland's record is consistent with experience across the U.S. and the rest of the world, as dozens of studies have confirmed that syringe exchange represents the most effective tool available to prevent drug-related HIV transmission. These same studies have also consistently found that syringe exchange programs do not result in an increase in drug use.

Syringe exchange also helps curb the growing epidemic of hepatitis C, which is closely linked with needle sharing during drug use. Up to half of all people who inject drugs in Maryland are infected with hepatitis C, which is much easier to transmit than HIV. Syringe exchange interrupts the cycle of hepatitis C transmission by providing the clean equipment that enables drug users to avoid needle sharing.

Although the public health benefits of syringe exchange would be enough to warrant robust government support for this life-saving approach, the benefits extend much further. In an era of budget austerity, syringe exchange helps conserve taxpayer dollars by averting substantial future medical costs associated with preventable infections. Every case of HIV infection leads to lifetime treatment costs that exceed $600,000, and a single liver transplant resulting from chronic hepatitis costs more than $300,000. With much of these costs absorbed by the public sector, taxpayers have an important fiscal reason to support programs that prevent new HIV and hepatitis infections from occurring in the first place. Every dollar invested in syringe exchange saves an estimated $3-$7 in future HIV-related medical costs.

Baltimore's syringe exchange program serves as a vital bridge to drug treatment for many clients by maintaining close linkages with local drug treatment programs, with studies indicating that syringe exchange clients in Baltimore have high levels of retention in drug treatment.

Syringe exchange also helps combat Maryland's severe drug overdose problem. Nationally, drug overdoses cause more than 30,000 deaths annually, and drug overdose is the leading cause of death among homeless people. Unfortunately, Maryland is a leader in drug-associated mortality, as the state's death rate from drug overdose is surpassed by only 10 states. Syringe exchange helps prevent drug overdose by providing health counseling and support services and by linking clients to stable housing and drug treatment.

Syringe exchange programs also help make communities safer by stabilizing lives that were once chaotic. They have been shown to help increase employment and safe housing and decrease legal involvement in participants. By exchanging contaminated needles for sterile ones, syringe exchange also keeps used injecting equipment from being discarded in our communities. This diminishes the likelihood that children or others will encounter contaminated needles in a park or other public space. This public safety benefit of syringe programs is of special importance to police officers and medical first responders, who are especially likely to suffer needlestick injuries during their regular duties.

The case for syringe exchange is overwhelming. Efforts to burden or extinguish syringe exchange are undoubtedly well-intentioned. But what these measures have actually done is make our communities less safe, undermine a vital bridge to drug treatment, contribute to higher medical costs, and hinder national efforts to prevent the spread of HIV, hepatitis and other blood borne diseases. Work will begin shortly on the 2014 budget. Congress needs to work to lift this shortsighted ban on funding for an essential health service and not make the same mistake yet again.

Dr. Christopher Welsh is an associate professor of psychiatry at the University of Maryland Medical School, focusing on alcohol and drug abuse. His email is cwelsh@psych.umaryland.edu.

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