P revention Point Philadelphia, tucked away in a basement space at 2nd and Lehigh, has been quietly offering services to the Injection Drug User, or IDU, population of Philadelphia since 1991. PPP is one of 203 syringe exchange programs, or SEP, operating in 34 states. Today is Friday, and about 175 people will come through to exchange their used syringes for new, clean ones. These men and women are saving their own lives.
Nationwide, there are an estimated 50,000 new cases of HIV infection each year, 14 percent of which are attributed to the sharing of used injection equipment between IDUs. Given the choice, an IDU would prefer the safety that comes with using a clean needle. It is easy to underestimate the incredible physical and mental need that an IDU experiences when the beginnings of withdrawal take effect.
Drug addiction is an irrational affair, leading people to engage in all manners of behavior that their former clean selves could not have dreamed of. Syringe exchange is a rational response to the real dangers of blood borne pathogens, such as HIV and hepatitis, that affect not only the IDU, but their sexual partners and children as well.
There is a mountain of evidence showing that SEPs are highly effective in lowering the instances of new HIV infections. In Philadelphia, for example, the percentage of new HIV cases attributable to injection drug abuse dropped from 47 percent in 1991 to 8 percemt today. Not only that, but there are ample studies showing that SEPs do not increase drug use or crime, that they reduce the number of discarded needles left on the street, that they reduce the number of “needle sticks” experienced by police and that they are often an IDU’s only point of access to health care and drug treatment. The economic figures are staggering as well. The average cost of servicing an individual at a SEP for a year is $4,000 compared to the lifetime cost of medically treating HIV, which is conservatively estimated at $488,000. With all of this evidence in mind, President Obama lifted the 21-year ban on federal funding for SEPs in 2009. Two years later, in a stunning example of morally charged politics trumping science, economics and public health, the ban was reinstated by Congress.
An IDU will inject drugs an average of 1,000 times per year. That is 1,000 opportunities to contract HIV or HCV. Multiply that by the 620,000 people who reported injecting drugs in the United States last year, and the health dangers are startling. SEPs have been able to make a substantial impact in reducing the transmission of blood borne pathogens, but operating at times in a legal gray area and on shoe-string budgets limits what they are able to accomplish.
I have not stuck a needle in my arm in four-and-a-half years and it is due to a miracle of luck and my own fastidiousness that I am not living with HIV or any other blood-borne disease. Heroin addiction took me to places and had me doing things that my former, sober self would never have dreamed of doing. I am an educated man, and was well aware of the dangers that come with sharing needles. I avoided the practice whenever I could, but when that need would take hold of me, I would use whatever was available. I was very secretive about my addiction, did not know about places like Prevention Point and did not even think to ask because I was so afraid of being found out, judged, punished. Prevention Point serves about 7,000 people, but I wonder how many others they have not reached because, like me, they did not know where to go for help.
Drug addicts have long been a stigmatized population, not valued by lawmakers or much of society as a whole. One argument against SEPs is that, because they were already engaged in such high-risk behavior, IDUs had no concern for their health and well-being and would not use SEPs anyway. IDUs are not self-harming lunatics to be forgotten and abandoned by the larger society. They are children and parents, co-workers and friends. They are our neighbors, and they have found themselves in a cycle of behavior that is dangerous, scary and very difficult to break away from. Congress must lift the ban on allowing federal dollars to be spent on SEPs. Congress must do this to keep people caught in the trap of addiction, make the communities they live in safer and offer them exposure to treatment when they are ready to pursue it. Please stand on the side of compassion and reason and urge Congress to lift the ban.
Sam Janney is a first-year student in the School of Social Policy & Practice. His email address is firstname.lastname@example.org.
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