Danae Bixler, MD1; Greg Corby-Lee2; Scott Proescholdbell, MPH3; Tina Ramirez4; Michael E. Kilkenny, MD5; Matt LaRocco6; Robert Childs, MPH7; Michael R. Brumage, MD4; Angela D. Settle, DNP8; Eyasu H. Teshale, MD1; Alice Asher, PhD1 (View author affiliations)
Opioid overdose, human immunodeficiency virus, and viral hepatitis have increased among persons who inject drugs in the United States. Comprehensive syringe services programs (SSPs) reduce risks associated with injection drug use (IDU); however, access to SSPs has been limited.
What is added by this report?
SSPs have increased dramatically in Kentucky, North Carolina and West Virginia with support from government officials, community advocates, and healthcare providers.
What are the implications for public health practice?
Comprehensive SSPs can mitigate the health effects of IDU. With appropriate authorization and support, agencies can successfully implement SSPs in underserved areas.
The Appalachian region of the United States is experiencing a large increase in hepatitis C virus (HCV) infections related to injection drug use (IDU) (1). Syringe services programs (SSPs) providing sufficient access to safe injection equipment can reduce hepatitis C transmission by 56%; combined SSPs and medication-assisted treatment can reduce transmission by 74% (2). However, access to SSPs has been limited in the United States, especially in rural areas and southern and midwestern states (3). This report describes the expansion of SSPs in Kentucky, North Carolina, and West Virginia during 2013–August 1, 2017. State-level data on the number of SSPs, client visits, and services offered were collected by each state through surveys of SSPs and aggregated in a standard format for this report. In 2013, one SSP operated in a free clinic in West Virginia, and SSPs were illegal in Kentucky and North Carolina; by August 2017, SSPs had been legalized in Kentucky and North Carolina, and 53 SSPs operated in the three states. In many cases, SSPs provide integrated services to address hepatitis and human immunodeficiency virus (HIV) infection, overdose, addiction, unintended pregnancy, neonatal abstinence syndrome, and other complications of IDU. Prioritizing development of SSPs with sufficient capacity, particularly in states with counties vulnerable to epidemics of hepatitis and HIV infection related to IDU, can expand access to care for populations at risk.
CHARLESTON, W.Va. — To its critics here, the needle exchange was an unregulated, mismanaged nightmare — a “mini-mall for junkies and drug dealers” in the words of Danny Jones, the city’s mayor — drawing crime into the city and flooding the streets with syringes. To its supporters, it was a crucial response to an escalating crisis, and the last bulwark standing between the region and a potential outbreak of hepatitis and H.I.V.
When Charleston closed the program last month after a little more than two years of operation, it was the latest casualty of a conflict playing out in a growing number of American communities. At least seven other such exchanges have closed in the past two years, even as dozens of others have opened.
Needle exchanges dispense sterile syringes to drug users and give them somewhere to discard their used syringes safely. Often, as in Charleston’s case, an exchange will offer supporting services, too: on-site medical care, hepatitis/H.I.V. screening, counseling and connections to drug treatment.
HAZARD, Ky. (WYMT) Three Eastern Kentucky counties now have needle exchange programs thanks to an expanded initiative by the Kentucky River District Health Department.
Perry, Letcher and Wolfe Counties have just added the new programs hoping to stunt the drug epidemic and spread of Hepatitis C and HIV.
“Needle exchange is an evidence-based intervention designed to prevent the spread of a communicable disease,” said Scott Lockard the Public Health Director at the Kentucky River District Health Department.
This latest round of funding comes at a critical time, as the nation struggles to address the opioid epidemic and disease outbreaks resulting from injection drug use.
NEW YORK, Feb. 1, 2018 /PRNewswire/ — The Syringe Access Fund today announced nearly $2.4 million in grants awarded to 62 organizations that are driving efforts to prevent HIV and viral hepatitis by providing injection drug users with access to sterile injection equipment and related health messaging. The funding will support syringe service programs and advocacy efforts to increase access to these programs in 32 states, the District of Columbia, Puerto Rico, and the US Virgin Islands through 2020, many of which serve the very same communities impacted by increased injection drug use stemming from the opioid epidemic that currently rages across the country.
“Injection drug use has always been a primary mode of transmission for both HIV and viral hepatitis, and the sharing of needles continues to result in thousands of new HIV transmissions each year,” said Elton John, Founder of the Elton John AIDS Foundation. “In light of recent HIV outbreaks linked to injection drug use, which threaten to curb the progress we’ve made toward ending HIV, this is a critical time to continue resourcing programs that provide clean needles and other equipment to injection drug users, because these programs are proven to help prevent the spread of the disease.”
Public health officials fear that removing the item from the kits may lead to more outbreaks of hepatitis C and HIV.
Under pressure from community critics and law enforcement, Indiana’s Madison County Board of Health voted to remove “cookers” from harm reduction kits distributed by a local syringe exchange program.
Cookers are metal bowls slightly larger than the size of a quarter. People who inject drugs typically pour powder into them, then add water and apply heat to turn the substance into an injectable solution. It’s a key ingredient in reducing the spread of blood-borne disease, which can be transmitted when people share cookers.
The harm reduction law aims to curb the transmission of hepatitis C and other blood-borne infectious diseases.
Health agencies throughout the state of Virginia have been given the green light to distribute clean syringes to intravenous (IV) drug users. The new law allowing syringe access programs was signed in February by Governor Terry McAuliffe, and went into effect July 1st.
After declaring the state’s opioid crisis a public health emergency back in November, the governor and state officials are hoping to reduce the transmission of blood-borne infectious diseases such as hepatitis C and HIV.
Cherokee hopes to combat the high Hepatitis C rates resulting from the heroin epidemic with a needle exchange program, aiming to have the program in place by Oct. 1.
“We’ve sat here and we’ve talked about ways to assist and help our communities. Talk is talk is talk. It’s time for action,” said Councilmember Teresa McCoy, of Big Cove, as she introduced legislation June 1 authorizing the tribe’s Public Health and Human Services Department to seek funding for a needle exchange program.
The program would give drug addicts a place to dispose of their used needles and leave with a clean needle, as well as instructions for how to avoid contracting diseases as a result of drug use. The center would also provide direct referrals to treatment and behavioral health for participants who are ready to seek help.
Despite reports of expanding rates of injecting drug use in a new list of countries around the world, no new countries have established needle and syringe programmes in the last three years.
This is one of the headline findings of an exhaustive review of the state of harm reduction services around the world conducted by international NGO Harm Reduction International, presented at the 25th International Harm Reduction Conference (HR17) in Montréal last week.
The absence of any increase in the number of countries that report starting needle and syringe programming is significant. Katie Stone, Research Analyst with Harm Reduction International describes this problem: