After nearly three decades of entrenched opposition to funding programs that allow drug users to obtain free sterile syringes, the U.S. Congress in January finally unlocked access to the federal funding, giving states that receive federal treatment money more options for preventing HIV and hepatitis C.
There’s a catch. The money can’t go toward the needles, but for everything else that a needle exchange relies on: bigger costs like staff salaries, transportation and facilities.
Daniel Raymond is policy director for the Harm Reduction Coalition, an organization that helps communities establish and expand needle exchanges. He’s been advocating for this change in law for many years and he told A&U the new policy is a compromise he can live with.
“The funding ban has starved programs of access to resources. In some progressive environments, states and cities have contributed their own dollars and we have benefited from the generosity of private foundations. But the lack of access to federal funding means a huge stream of resources that has been completely cut off, and it’s left these programs with a precarious position.”
Raymond points out that states go through budget fluctuations. During the last recession, many states cut back on health budgets, leaving syringe exchange programs vulnerable to cuts, without the anchor of federal funds to fall back on. He also says that the CDC got the message over the years that Congress didn’t like these federal needle exchanges and therefore took a hands-off approach to exchanges. It was barely mentioned in the last National HIV/AIDS Strategy.
“This has pushed these programs to the margins of the HIV response when we realize they should be integrated a part of a continuum.”
Needle exchanges are not yet part of a broader continuum of harm reduction and there will be incremental changes starting with the modification of Congress’s policy. Raymond says that immediately health departments and community groups and states will have more options.
“They can say, ‘we have this federal grant to provide outreach to people with substance abuse disorders, maybe we can use this to fund a counselor at the syringe exchange program,’” Raymond says.
But because there are no new dollars attached by Congress, states will have to move money around, maybe from HIV testing money, for example. Or they could wait until it’s time to renew their grants.
Scott County’s wake-up call
In the U.S., HIV rates associated with injection drug use declined substantially over the last twenty years. But the number of new cases of HCV has been rising as more opioid users began injecting the drugs.
Last year Indiana was ground zero in the new wave of infections from IV drug use. Almost 200 people were diagnosed with HIV and HCV in the rural community of Scott County, largely due to residents sharing needles to get high with Opana, also known as oxymorphone, which became the drug of choice for a heroin-like high after OxyContin was changed in 2010 to make it more difficult to snort or inject.
That outbreak was a wake-up call for lawmakers with districts similar to Scott County’s, largely rural or suburban. There is a new sense of urgency in addressing the IV drug use problem in the U.S. is coming from lawmakers who had previously opposed needle-exchange funding when drug use was a big city problem. The thinking goes, last year’s opioid-based crisis in Scott County could be this year’s crisis in Anywhere County, USA.
In fact it was two powerful Kentucky Republicans, House Appropriations Chair Hal Rogers and Senate Majority Leader Mitch McConnell, both previously staunch opponents to federal needle-exchange funding, who pushed to end the funding ban in large part, they admit, because of the HIV and HCV crisis in neighboring Indiana and the heroin epidemic nationwide.
Rep. Rogers told National Public Radio that his district has seen the impact of unsafe needles.
“In my own district, we’ve have a severe problem with OxyContin abuse and overdose deaths, and I’ve been in those emergency rooms and seen these young people die of overdose of OxyContin and other opioids. But now it’s shifting toward heroin. And that brings us to a different problem. And that is needles are used. We’ve got a needle problem.”
A bigger boost to HCV prevention?
Raymond tells A&U that preventing HCV becomes a bulwark against HIV infections.
“Rates of new HIV infections attributable to injection drug use have been on the decline and are at their lowest point in the last twenty years. They are already trending in the right direction. HCV infections are going up. If we can reverse that trajectory, if we can bend that curve, it will be easier to show an impact on HCV faster.”
Larry Buhl is a radio news reporter, screenwriter, and novelist living in Los Angeles. His podcast on employment issues, “Labor Pains,” can be found at www.laborpainspodcast.com.