Published in the Huffington Post, October 22, 2015
Talking about injection drug use is not comfortable for many people. Yet nearly 7 million U.S. citizens inject drugs every year. For those who suffer from debilitating addictions, our silence is deafening. The majority of injection drug users are infected with either HIV or hepatitis C, both devastating illnesses with life-long consequences. Medically, they are at high risk for overdose and a multitude of diseases. Socially, they face enormous stigma, homelessness and violence. Each of them is someone's family. All of their lives matter.
What is there to be done? The good news is that for decades, both injection drug users and doctors have been advocating for harm reduction, a rational and proven way to reduce infections. The idea is simple: lower the risks associated with using drugs. Doctors use these principles every day in the clinic, such as when they encourage patients to use condoms and birth control. We've learned the hard way that abstinence-based methods actually increase risky sexual activity. By instead providing knowledge and safer-sex supplies, they make the behavior safer. Drug use is no different.
The main example of harm reduction for injection drug users is needle exchange, and like harm reduction in general, it's easy to understand. A needle exchange provides a safe, anonymous way for needle users to throw away old syringes, thus keeping them out of public parks and trash cans, where they may wind up otherwise. Next, needle exchanges provide a way to obtain clean injection supplies, so that clients are protected from disease. These simple operating principles have incredible, proven results among clients: a 33% reduction in the risk of contracting HIV, a 61% reduction in hepatitis B, and a 65% reduction in hepatitis C. If needle exchange was a prescription, it would a blockbuster.
But there's more to needle exchange than syringes. Programs provide HIV testing, hepatitis C testing, health education, and referrals to drug treatment and medical services for clients who want them. Studies show that needle exchanges decrease drug use and injection frequency among clients, and some programs report that 49% of their referrals result in successful admission to programs, an unbelievably high number in a world where drug treatment facilities often close their doors to poor, uninsured clients. Furthermore, research has proven that programs don't increase crime or connections among injection drug users. To understand why, try the following thought experiment: how many free needles would someone need to offer you before you used them? Most people would find that having access to syringes does nothing to increase the appeal of injecting.
Thanks to the hard work of activists and public health advocates, needle exchanges have growing acceptance, but the challenges are far from over. There remains a federal funding ban for needle exchanges in all states. Orange County, California, is the 6th largest county in the United States, but has no needle exchange. My colleagues and I have been working hard for the last 18 months to establish a program, but have been mired with bureaucracy and a lack of empathy. It is easy for politicians and officials to forget about their constituents if they are voiceless. This means that we, citizens, have the responsibility to demand the implementation of harm reduction programs or our families will continue to face the consequences of the addiction epidemic.
Fortunately, we know what steps we need to take. The federal ban on funding needle exchanges must be lifted. Public health authorities must stop obstructing these essential services, instead finding the courage to lead their communities and help organizers build harm reduction programs. We must put pressure on public health departments and governments to make harm reduction a priority. In Orange County, our program is presently in a 90-day public comment period. We encourage all of you to contact the California Department of Public Health and tell them that harm reduction is not optional, but an essential public health service that everyone in Orange County and elsewhere deserves access to. This process might not be easy, but if we do not overcome our reluctance to speak out now, we will continue to find our communities damaged by the endless consequences of drug addiction.