Needle exchange

A needle and syringe programme (NSP), syringe-exchange programme (SEP), or needle exchange program (NEP) is a social service that allows injecting drug users (IDUs) to obtain hypodermic needles and associated paraphernalia at little or no cost. It is based on the philosophy of harm reduction that attempts to reduce the risk factors for diseases such as HIV/AIDS and hepatitis. While NSPs provide most or all equipment free of charge, exchange programmes require service users to return used syringes to receive an equal number of new syringes. A comprehensive 2004 study by the World Health Organization (WHO) found a 'compelling case that NSPs substantially and cost effectively reduce the spread of HIV among IDUs and do so without evidence of exacerbating injecting drug use at either the individual or societal level.' WHO's findings have also been supported by the American Medical Association (AMA), which in 2000 adopted a position strongly supporting NSPs when combined with addiction counseling. Needle-exchange programmes can be traced back to informal activities undertaken during the 1970s. The idea is likely to have been rediscovered in multiple locations. The first government-approved initiative (Netherlands) was undertaken in the early to mid-1980s, followed closely by other initiatives. While the initial programme was motivated by an outbreak of hepatitis B, the AIDS pandemic motivated the rapid adoption of these programmes around the world. Harm reduction begins with the assumption that it is not reasonable to assume that individuals make healthy decisions. Advocates hold that those trapped in dangerous behaviors are often unable and/or unwilling to break free of them, and should at least be enabled to continue these behaviors in a less harmful manner. A tendency in the medical profession has been to treat drug dependency as a chronic illness like diabetes, hypertension and asthma, to be treated, evaluated and even insured in like manner. NEPs typically support the health and well-being of people who use drugs through awareness, education, and empowerment; for example, programs in Australia use the community development (CD) discipline as a basis for their work. NEPs treat recreational drug use as a health issue and neither condemn nor condone the practice. Some US states ordinarily require a prescription to buy needles and syringes, as they are considered drug paraphernalia rather than medical equipment. NEPs provide access in such areas. National District Attorneys Association (NDAA)'s view is that denial of human agency offends common sense as well as criminal statutes, in that adults are responsible for their actions. Where individual decisions impact public health and welfare, criminal sanctions are appropriate and necessary. Catholic Church doctrine asserts that harm reduction protocols treat persons as objects not in control of their own actions and gives the impression that certain types of irresponsible behavior have no moral content.Former US President George W. Bush wrote: 'Drug use in America, especially among children, increased dramatically under the Clinton-Gore Administration, and needle exchange programs signal nothing but abdication, that these dangers are here to stay. Children deserve a clear, unmixed message that there are right choices in life and wrong choices in life, that we are responsible for our actions, and that using drugs will destroy your life.' It is estimated that the average annual cost of HIV care per person in the United States is US$15,745. Those with advanced HIV had an annual estimated cost of US$40,678. Depending on when infection is detected and when the treatment process begins, it is estimated that, as of November 2006, the total lifetime healthcare costs of HIV care are between US$303,000 and $619,000. In addition to sterile needles, syringe-exchange programmes typically offer services such as HIV and Hepatitis C testing; alcohol swabs; bleach water and normal saline (often as eye drops); aluminium 'cookers'; citric acid powder (an imperative agent that enables heroin to dissolve in water); containers for needles and many other items. A survey conducted by Beth Israel Medical Center in New York city and the North American Syringe Exchange Network, among 126 surveyed SEPs that 77% provided material abuse therapy, 72% provided voluntary counselling and HIV testing, and more than two-thirds provided supplies such as bleach, alcohol pads and male and female condoms.