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Indiana Suddenly Needs A Needle Exchange Program

Gov. Mike Pence of Indiana declared a public health emergency Thursday over an outbreak of HIV in the southeastern part of the state. He also did something fairly surprising for a traditionally tough-on-drugs Republican, authorizing a 30-day program that allows drug users to trade in used needles for sterile ones.

All 79 cases of HIV identified since December of 2014 in a rural area just north of Louisville, Kentucky, have been linked to intravenous drug use. Pence has long been a vocal opponent of needle exchanges, but said the temporary program was needed in the face of the current crisis.

The data on the effectiveness of needle exchanges, however, suggests the governor should not have waited until the last minute. The programs work.

The Substance Abuse and Mental Health Services Administration, the U.S. Surgeon General’s office and the World Health Organization all have published evidence showing needle exchanges help prevent the spread of HIV. The Surgeon General’s notice also points to evidence the programs can reduce drug abuse by promoting entry into treatment programs.

A review of existing research published in the journal Addiction in 2010 found “tentative” evidence that the programs reduce HIV transmission, but said there wasn’t enough evidence to say whether they could prevent the spread of Hepatitis C. They blamed the limitations on the study design, pointing out that most studies have been observational and based on existing programs, instead of controlled trials comparing selected communities with and without a program. But the authors also note that there is very strong evidence the programs prevent the sharing of dirty needles, and urge that the programs should continue. “The findings of this review should not be used as a justification to close NSPs (needle and syringe programs) or hinder their introduction,” they wrote.

As in so many issues regarding drugs, the reasons why needle programs are not more widespread involve politics.

No state has explicit laws banning needle exchanges, according to Scott Burris, a professor of law at Temple University who has studied the issue since 1996. But anti-drug policies in many states, often written before the identification of HIV, consider syringes to be drug paraphernalia or make it illegal to possess even trace amounts of controlled substances without a prescription. Carrying a needle used for illicit use of prescription pain medications, like the ones linked to many of Indiana’s recent HIV cases, is often illegal.

A review of state laws curated by Burris for the Public Health Law Research program at the Robert Wood Johnson Foundation shows that, with the exception of a handful of states, the presence of these laws fall along party lines, with blue states significantly more likely to have decreased barriers to syringe distribution.

There were at least 194 needle exchange programs in 33 states in 2014, according to the Foundation for AIDS Research (amfAR), and almost all were in states that have explicitly lifted or modified their laws. All of those programs are paid for by states, local governments or other organizations, since federal funding for needle exchange programs has been banned since 1980 (the ban was briefly lifted in 2009 by President Obama, and reinstated by Congress in 2012).

Pence’s order allowing the exchange program lasts for only 30 days. But it’s a start.

Anna Maria Barry-Jester reports on public health, food and culture for FiveThirtyEight.

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