Needle Exchanges

I posted yesterday about Hepatitis B and C.  As I said, one way to become infected with either virus that causes these diseases is through reusing needles (syringes).  The contact to infected blood can transmit the virus easily. In fact, most hepatitis C infections around the world occur through unsafe injecting drug use. (1)


Each injected drug users inject about 1,000 times a year. (2)  Many of these users, because they don’t have access to clean needles, reuse the ones they have and share them with others thus spreading hepatitis viruses and HIV

As of 2004, injection drug use accounted for about one-fifth of all HIV infections and most hepatitis C infections in the United States. (3, 4)

One way to decrease the risk of being infected by dirty needles (needles used over and over again) is through implementing needle (or syringe) exchange programs (SEPs).

What is a syringe exchange program (SEP)?

SEPs provide a way for those illegal drug users who continue to inject to safely dispose of used syringes and to obtain sterile syringes at little or no cost.  In conjunction with this service, many SEPs provide information about these diseases, counseling, and can direct users to programs that may help them quit.

The first organized SEPs in the U.S. were established in the late 1980s in Tacoma, Washington; Portland, Oregon; San Francisco; and New York City. By 2002, there were 184 programs in more than 36 states, Indian Lands and Puerto Rico. These programs exchanged more than 24 million syringes. (5)  As of 2008, 77 countries worldwide had SEPs. (1)

And the effects prove promising both for decreasing the risk of exposure and decreasing drug use.  Researchers found that in 1998 half of syringe exchange program clients referred for substance abuse treatment actually entered treatment. (6)  Others reported reduced frequency of injection drug use among current and former users of a needle exchange program. (7)


There are a lot of myths about syringe exchange:

  • People believe that these programs encourage drug users to keep using – they do not encourage drug use.
  • Some believe these programs don’t work – they do work to help decrease the spread of hepatitis B and C and HIV and help users find treatment.
  • Others worry that these programs will mean more dirty needles in the community – providing clean syringes do not increase dirty needles in the community.
  • Syringe exchange programs will mimic Zurich’s needle parkThey won’t look anything like Zurich.
  • People who use illegal drugs deserve the consequences.  They do not.

The Right to Health:

The Right to Health is a moral responsibility as well as a tenant of many international human rights documents including Article 25 of the Universal Declaration of Human Rights and Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR).  As aptly stated by the International Harm Reduction Association

Individuals who use drugs do not forfeit the right to the highest attainable standard of health. The prohibited legal status of the drug(s) in question does not remove from states parties their obligations to respect, protect and fulfil this right for all persons within their jurisdiction, including people who use illegal drugs. (1)

Part of ensuring a right to health is implementing measures such as syringe exchange programs. SEPs are crucial locally and worldwide to improve personal health of users, to protect the public health from spread of the disease, to decrease the financial burden of these diseases, and simply to fulfill moral obligations under human rights laws.


In Texas’s 81st legislative session, I and other staffers (the people putting in the grunt work for the Congressmen and women and Senators) worked hard to pass a bill to legalize syringe exchange programs in Texas (one of the few states without such programs).  This bill had support by both parties.  The session before, Texas passed a bill for a pilot project to allow syringe exchange programs in San Antonio area, but due to a flaw in the bill, those exchanging needles could still be prosecuted.  In the 81st session, due to political motives that were much more selfish than in the best interest of their constituents, the democrats in the House of Representatives chose to block this and other legislation fighting a bill on voter registration.  I don’t agree with the voter registration bill personally, but the fight it led to was pointless because the bill was one of the first passed this 82nd legislative session (soon to be signed by Governor Perry) and did not protect the legislators who voted for it (ie many democrats were voted out of office).  However, the resulting impact on public health issues that should have been addressed is substantial.  The syringe exchange bill was lost.

Watching this play out was heartbreaking and infuriating.

In Texas, syringe exchange programs are still illegal, leaving Texas as the only state in the country without some sort of program.  Syringes are considered drug paraphernalia.  Here’s hoping that in the 82nd legislative session House Bill 117 will pass.  Unfortunately, seeing as session is winding down in 11 days and the bill hasn’t even had a hearing, the likelihood is nil.


(1) International Harm Reduction Association, Global State of Harm Reduction 2008: Mapping the Response to Drug-Related HIV and Hepatitis C Epidemics 12 (2008).

(2) Lurie P, Jones TS, Foley J. A sterile syringe for every drug user injection: how many injections take place annually, and how might pharmacists contribute to syringe distribution? Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998;18(Suppl 1):S45-S51.

(3) Glynn M, Rhodes P. Estimated HIV prevalence in the United States at the end of 2003. 2005 National HIV Prevention Conference; June 12–15, 2005. Atlanta, GA. Abstract T1-B1101.

(4) Centers for Disease Control and Prevention (CDC). Hepatitis C fact sheet. Accessed December 22, 2005 from

(5) Centers for Disease Control and Prevention (CDC). Update: syringe exchange programs— United States, 2002. Morbidity and Mortality Weekly Report 2005; 54(27);673-676 .

(6) Brooner R., Kidorf M, King V, Bielenson P, Svikis D, Vlahov D. A Drug Abuse Treatment Success among Needle Exchange Participants. Public Health Reports, 113; Supplement 1: pp. 130-139, June 1998.

(7) Hagan H, McGough JP, Thiede H, Hopkins S, Duchin J, Alexander ER. Reduced injection frequency and increased entry and retention in drug treatment associated with needle‐exchange participation in Seattle drug injectors. Journal of Substance Abuse Treatment. 2000;19(3):247‐252.

Other research support can be found by looking up these articles listed by the US Substance Abuse and Mental Health Services Administration.


3 Responses to Needle Exchanges

  1. Carol Troyer says:

    That was a very good article.
    good references.

  2. […] year San Francisco established what is now the largest needle exchange program (see my post about the importance of these programs and the Texas politics keeping the state from implementing […]

  3. A commenter on my post about the New England Journal of Medicine turning 200, asked how to get involved in Texas politics to get syringe exchange program legislation passed. I thought it would be worth sharing my response to him. The general advice about getting involved applies to any bill. If you are interested in supporting a specific cause – contact your legislators, contact local organizations, learn the legislative history, and get involved now even though the next legislative session seems far away.

    My response:
    In 2009 legislative session, much progress was made in attempting to create syringe exchange programs. When I worked in the that session, Senate Bill 188. This bill had bi-partisan support and only failed for lack of coming to a vote on the House floor.

    Unfortunately, only one bill was filed in the 2011 legislative session and it was not even heard in committee.

    The next chance to establish SEPs in Texas will be the 2013 legislative session. Though it seems quite a long ways off, bills will actually start being drafted this fall. Bills will start to be filed on November 12, 2012 for the 2013 session.

    You can do several things to get involved – first contact your state representative and senator and tell them you want to see legislation on SEPs pass next year. To find out who your representative and senator are go to – Of course elections are this fall so this may change come November. But you can get involved in any campaigns going on in your district and advocate for SEPs.

    You can talk to the authors of the 2011 bill – Ruth McLendon, John Zerwas, Garnet Coleman, Susan King, and Elliot Naishtat. You can also talk to the co-authors Luna Hernandez, Donna Howard, and Eric Johnson. You can get their contact information by going to which is also a helpful place to track bills when the session begins or look up bills filed in past sessions.

    Finally, you can contact The Access Project ( I worked closely with them in 2009 on the bills in the House and Senate. Several other organizations have supported this issue in the past like the Texas Medical Association, the Texas Hospital Association, the Texas Nursing Association, and a host of others (but those are three pretty major players). You can contact them and ask their legislative lobbyists their interest in pursuing this legislation again.

    I do think a SEP bill will appear next session. How far it gets in the legislative process depends on many things – who is elected, who runs the committee the bill is referred to, other bills that have high popularity that session, and general politics. I was sad to see last session’s bill fail so entirely after the progress made in 2009. But that doesn’t mean it won’t pass someday. Many bills are proposed year after year – some finally make it, others try again the next session. I could not tell you the likelihood of its success in the future, but I can tell you that having a lot of support from individual constitutents and organizations can make a difference. Speaking about the issue to those you know and getting them involved, contacting organizations and politicians that already support the idea, even getting involved with press can impact a bill’s advancement in the legislative process.

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