Community Response to the Opioid Crisis: The Case for Needle Exchange Programs

When the first needle exchange program (NEP) appeared in Amsterdam, The Netherlands, in 1983, law enforcement officials in the U.S. were not impressed with the idea.

The differences of opinion between the Dutch health officials who initiated the program and members of U.S. law enforcement were straightforward. They’re described in detail in this article published in the American Medical Association’s Journal of Ethics in 2016.

In a nutshell, the Dutch proposed that offering IV drug users access to clean needles in exchange for dirty needles would decrease the spread of infectious diseases, give users access to first-line counseling and education, and decrease criminal activity. In the long run, they also hoped the programs would decrease overall IV drug use.

Here in the U.S., law enforcement believed exactly the opposite would happen. Officials were sure increased drug use, increased criminal activity, and increased spread of infectious disease would follow. They also believed that conceptually, NEPs contradicted and undermined The War on Drugs. Still, in its early stages, the war focused on the crack epidemic. It prioritized a tough on crime approach that was, conceptually, in direct opposition to the harm-reduction approach espoused by the Dutch.

In the ensuing 36 years, we’ve learned a lot.

One thing we’ve learned is that NEPs do everything Dutch officials thought they would.

They work.

The Benefits of NEPs

We listed the initial goals of the first NEP above. Since then, three decades of research, catalogued meticulously in this article published by the American Civil Liberties Union, show that across the U.S., the presence of an NEP/SEPs in a community:

  1. Decreases drug activity in the community
  2. Decreases risky sexual activity by IV users
  3. Offers participants access to substance use disorder education
  4. Offers participants access to testing and treatment for IV-drug related diseases
  5. Decreases rates of new HIV and hepatitis infection
  6. Offers participants first-line drug counseling
  7. Offers participants referrals to substance use disorder treatment
  8. Protects law enforcement, first responders, and health care workers from accidental infection due to accidental needle pricks
  9. Decreases overall financial burden on society for the treatment of infectious diseases and substance use disorders

These exchange programs originally existed only in large urban centers. In Europe, Amsterdam and Lisbon had programs. In the U.S., only New York City and San Francisco had programs. They’re now appearing in smaller towns and communities across the U.S. Their presence is a direct response to the opioid crisis. They’re an example of the power of community action in the face of a public health crisis that affects all citizens, regardless of race, gender, cultural heritage, origin, or socioeconomic status.

Case in Point: Mayfield, Kentucky

Mayfield is a community of just over 10,000 residents in Western Kentucky. It’s located about two hours northeast of Nashville, TN, three hours southwest of St. Louis, MO, and three hours west of Louisville. A quick look at the town’s website shows upcoming events like The Mayfield Food Fest, a Rodeo at the Mayfield-Graves County Fairgrounds, an Antique Tractor show, and Religious Art Show hosted by the Mayfield-Graves County Art Guild.

At first blush, Mayfield is not the type of town you’d associate with IV drug use. Nor is it the type of town you’d expect would need something like a syringe exchange program. But that’s the nature of the opioid epidemic in 2019.  It reaches into every corner of our society, from tough inner cities peaceful country towns. And it’s changing our country.

We recently shared this article on our Facebook Page about the new needle exchange program in Mayfield, which is the first of its kind in Western Kentucky. In the article, Mayfield Chief of Police Nathan Kent believes the program is a good thing for the community. He does not believe it will increase IV drug use in Mayfield.

In his words, “People that are using needles for intravenous drug use are going to do that anyway. So the program is about harm-reduction – trying to keep those used, dirty needles from ending up in places that would be harmful to our kids, such as in parks, or harmful to our city employees.”

People who take advantage of the exchange program can also get free testing for hepatitis C and HIV and find out about treatment if they test positive. Also, a drug counselor is on-hand at the exchange sites to offer advice about and assistance in finding treatment for opioid or other substance use disorders.

A New Crisis Means New Approaches

While needle exchange programs are not a new idea, they’re certainly new to areas of the rural Midwest like Mayfield, Kentucky. They’re part of a movement across the U.S. that employs both a by any means necessary and an all hands on deck approach to battling the opioid crisis.

They’re also the result of a grassroots movement begun by a joint task force formed in 2016 by the National Association of Counties (NaCO) and the National League of Cities (NLC). The task force, which included representatives from Western KY, created an action plan for addressing the opioid crisis, called “A Prescription for Action,” and presented it to Congress. Elements of the plan – including funding for programs like the NEP in Mayfield – became law in October 2018 as The SUPPORT (Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities) Act.

We still have a long way to go before we recover from the opioid crisis. The needle exchange program in Mayfield, however, is an example of the power of communities – now matter how large or small – to make their voices heard on a national level, and create real change that helps people struggling with opioid addiction find a way forward to a new, better life.