The Pump Handle

Congress (finally) allows use of federal funds for needle exchanges

USA TODAY’s Laura Ungar highlights an important measure in the omnibus spending bill Congress passed last month: It lifts the ban on the use of federal funds for needle-exchange programs. State and local needle-exchange programs still can’t use federal money to purchase needles, Ungar explains, but they can use it for staff, vans, outreach, and other expenses that typically cost far more than the syringes themselves.

Needle exchanges — also called syringe service programs (SSPs) — allow injection drug users to avoid sharing needles, a practice that can spread HIV, hepatitis C, and other diseases. CDC explains that most of these programs do much more than hand out clean needles:

SSPs are an effective component of a comprehensive approach to HIV prevention among PWID and their sex partners, and most SSPs offer other prevention materials (e.g., alcohol swabs, vials of sterile water, condoms) and services, including education on safe injection practices, counseling and testing for HIV and hepatitis C infections, and screening for other sexually transmitted infections. Many SSPs also provide linkage to critical services and programs, thus promoting integration among drug treatment programs, HIV care and treatment services, hepatitis C treatment programs, and other medical, social and mental health services.

The World Health Organization commissioned a review of 200+ studies on needle exchanges and concluded:

There is compelling evidence that increasing the availability and utilization of sterile injecting equipment for both out-of-treatment and in-treat- ment injecting drug users contributes substantially to reductions in the rate of HIV transmission. … There is no convincing evidence of major unintended negative consequences of programmes providing sterile injecting equipment to injecting drug users, such as initiation of injecting among people who have not injected previously, or an increase in the duration or frequency of illicit drug use or drug injection.

Despite the compelling evidence that these programs are good for public health, Congress began prohibiting the use of federal funds for needle exchanges in 1988. They briefly lifted the ban in 2009 (when Democrats controlled both houses of Congress), then restored it in 2011. What’s changed since then? Laura Ungar reports:

The latest change came at the suggestion of U.S. Rep. Hal Rogers, R-Ky., and Sen. Mitch McConnell, R-Ky., ensured the language remained in the Senate version of the spending bill, their spokespeople say.

“The opioid epidemic is having a devastating effect on communities throughout Kentucky and the nation,” McConnell’s office said in a statement. “As more people inject drugs like heroin, rates of Hepatitis C and HIV have been on the rise.  To help address this issue, Senator McConnell worked with Chairman Rogers to pass legislation to provide flexibility so that certain counties in Kentucky may be able to access federal funds for their treatment and education efforts.”

“Congressman Rogers supports efforts in Kentucky and elsewhere to mitigate the spread of devastating diseases, like HIV and (hepatitis) C, and the associated health care costs,” says Danielle Smoot, communication director for Rogers. Though he still doesn’t want federal money going to the needles themselves, she says, “he believes federal resources can effectively be used for needle exchange programs that focus on education and treatment to help end the cycle of dependency and curb an outbreak of needle-related diseases.”

Ungar notes that more than 1,000 drug overdose deaths now occur in Kentucky each year, and nearby Indiana is home to a new HIV outbreak centered in the town of Austin, Indiana, which now has a higher HIV incidence rate than any country in sub-Saharan Africa.

The issue of Congressional bans on needle-exchange funding is especially salient in Washington, DC, where Congress also blocked the city’s government from using local tax dollars for needle-exchange work between 1998 and 2007. (Yes, Congress can veto the District’s decisions about how to spend our own local funds.) Finally, legislation lifted the ban and DC was able to launch a needle-exchange program in 2008.

In a recently published study, researchers at the George Washington University Milken Institute School of Public Health (where I also work) analyzed data from before and after the DC program began. They estimate that in its first two years, it averted 120 new cases of HIV and saved $44 million — compared to a cost of just $650,000 per year during the program’s first two years. The savings figure includes public money that would have been spent on care for injection drug users who would have been infected with HIV in the absence of the program.

I hope the availability of federal funds will help more jurisdictions launch and strengthen their needle-exchange programs. The research clearly demonstrates that they reduce the spread of some of the worst diseases.