Las Vegas is installing three vending machines to dispense free, unused needles to users — a technological twist on the longstanding idea that it is better to protect addicts from disease than to leave them to their own devices.
The machines, which will come online in May, are funded through a pilot program that could eventually expand. Backers hope that by using machines instead of requiring addicts to interact with a human being, as is typical of other needle exchanges around the country, they will reach users who might shy away from having to discuss their addiction in order to get a clean spike.
Of all the consensus-driven policies aimed at reducing the cruel failures of America’s War on Drugs, perhaps none has as much support from public health and economics researchers as needle exchanges.
Efforts to put sterilized, clean injection kits into addicts’ hands contravene the puritanical streak in American culture. The drug war mindset reflects that old Calvinist idea that drug users are bad people who must face stiff consequences for their behavior — jail cells and familial isolation — in order to change.
The logic of needle-exchange programs runs the opposite direction: If addiction is hard to escape, then even those trying to escape it will at times continue to use, even if it means risking their freedom or health. Rather than imposing even higher risks of disease, poverty, and incarceration upon addicts, society should look for ways to protect them even as they struggle to get clean — or decline treatment that might help them do so.
Hard-line anti-drug crusaders might see this as enabling addiction. If a heroin junkie knows she can come downtown and get a free needle, why would she even think about stopping?
While needle exchanges now exist in 35 states, they still face skepticism in some corners. Utah just suspended plans to launch an exchange after police officials criticized it as a way to encourage drug use. A Republican state senator in Washington is asking the Department of Justice to stop Seattle from establishing safe injection sites; he’s pledged to “fight until the very end.” Vice President Mike Pence long resisted needle exchange proposals as governor of Indiana, only relenting after his obstinacy helped drive a spike in HIV rates there.
Such moralistic approaches to addiction are also myopic. Infectious diseases are expensive; clean needles are cheap.
It costs tens of thousands of dollars to treat a single person for Hepatitis C (in part because of the predatory behavior of drug manufacturers). It costs close to $400,000 to treat just one HIV patient. The intravenous drug kits that will be free to Vegas users cost $10 a pop to stock.
Needle exchanges drastically reduce the spread of infectious disease among intravenous drug users. In 1990, half of all drug-injectors in New York tested positive for HIV. A dozen years later, after a needle exchange program was launched, that number was one in six. Additional analysis of that program found the exchanges saved the state between $1,300 and $3,000 per client per year in reduced treatment costs. The Centers for Disease Control and Prevention has estimated that needle exchanges nationwide would return $7.58 in public health savings for every dollar spent, based on a combination of research studies into the New York program.
The exchanges also help health providers establish contact with users and encourage them to get treatment. One of the new machines in Vegas will be located inside the Community Counseling Center of Southern Nevada, bringing users closer to resources and professionals they can lean on if they do want to get clean.
Despite nearly 20 years of science illustrating the societal and individual benefits of needle exchange systems, states and local governments have had to operate almost entirely on their own. Federal funds could not be used for such programs until early 2016, when Congress allowed a ban on the programs to lapse.
The role of middle-road Republican lawmakers in lifting the funding ban seemed to mark a turning point in the old battle between hardheaded moralistic thinking and pragmatic, research-backed approaches to addiction. But with President Donald Trump’s election, every corner of the policy consensus on drugs and drug users is back in play.
Trump never took a position on needle exchanges during the campaign, despite frequently discussing the opioid epidemic in other contexts. His position toward the idea is a mystery. But as the ongoing resistance in Utah and Washington illustrates, there are still plenty of public officials who hate the idea. And Trump’s broader position toward the War on Drugs is notoriously retrograde in other contexts.
“I’m not very hopeful for the future based on what I’ve seen so far,” Dr. Steffanie Strathdee of the UC-San Diego School of Medicine told POZ magazine in December.
“If we just trust people to do the right thing, we’re going to see not just inaction but barriers to the implementation of services.”