Prior to hearing about this needle-exchange program, my preconceived thoughts did not agree with needle exchange programs. My understanding of these programs at the time was that an individual was able to exchange dirty needles for clean needles and that, if wanted, programs to help wean the patient from substance use are offered. I liked the idea of offering programs to individuals to help them with their struggle with substance-use. However, I did no like the idea of needle-exchange because I believed that it promoted the use of substances and allowed more circulation of potentially dirty needle access around cities and towns with drug-use problems.
Though I understand the point of the program and fully respect what Kerri Barton spoke to us about and what she does, I still do not agree with the use of needle-exchange programs. I like the idea of providing health care options to those who are in need and encouraging the stoppage of harmful substance use, but I cannot help but believe that providing clean needles, though it certainly decreases circulating needle-borne issues (i.e. HIV, AIDs, hepatitis, etc.), does not necessarily help the individual who is seeking the needles in the key way that maybe it should. As someone who has close family members who struggle with substance use disorders, I think that the exchange for needles encourages the use of drugs as exchanges will lower the perception of risk of injection drug use and thus attract more users to inject illegal substances. Or, if there is no increase in the use of drugs among the community, it remains stagnant.
If I were to propose a different program, the only thing I would get rid of would be providing clean needles and using the funding to support further healthcare efforts to train every healthcare professional on substance-use disorders and how to use motivational interviewing to guide the patient to treatment. If clean needles are used, they should only be used by healthcare professionals and under a controlled environment. I would also use the funding that would have otherwise been used for clean needles to further substance use and mental health efforts in the community and provide affordable, high-quality healthcare practices for those who are a part of this population. Though there are a lot of positives of needle-exchange programs and there is no evidence that the use of these programs increases the use of drugs, there is also no evidence that these programs necessarily decreases the use of drugs in these communities.
Thank you, Jordan, for sharing your thoughts on what has always been a controversial topic – and being honest about what you feel the drawbacks of NEPs are. There is no doubt that more mental health providers, substance use providers, affordable rehabilitation centers, and insurance coverage of all of these services would positively impact the population of people with substance use disorder. I would challenge what you wrote in your last sentence, about how there is no evidence that NEPs decrease the use of drugs. I haven’t reviewed the literature myself, so I couldn’t say – but what I will say is that maybe that isn’t necessarily the goal of NEPs, to decrease drug use. And so if that isn’t a direct goal of their programming, then we shouldn’t expect that measure to change dramatically one way or the other, nor should their success or relevance be judged by that metric. Just some food for thought!