Worth Every Penny?

Compare this legitimate injection kit obtained...

Compare this legitimate injection kit obtained from a needle-exchange program to the user-compiled one above. (Photo credit: Wikipedia)

Preventing HIV is a very good thing.

The Atlantic has a post about the role of needle exchanges in preventing HIV. It makes a pretty compelling case that needle exchanges reduce HIV infection rates among injection drug users. I don’t doubt this. And, provided it serves as an engagement point for recovery, I have no objection to needle exchanges.

However, there are a few things that bug me about these stories.

First, there’s not a single mention of addiction treatment or recovery. Not one word.

Second, one would walk away from this article assuming that injection drug users make up a huge portion of HIV infections. Not true. CDC numbers suggest that, nationally, injection drug users make up around 8% of all new infections.

Third, there’s not a single mention of overdose. The article focuses on LA as a success story, and they have been successful in reducing infections. In 2005, they had 83 new infections among injection drug users. How many overdose deaths? 508. Not a single mention of overdose. We’re busy bragging about the success of the surgery while the patient has died.

Fourth, while I don’t doubt that needle exchanges reduce infection rates, what else also reduces infection rates? We don’t really know. The only research that’s done on the matter focuses on methadone.

Finally, the story was prompted by a new report about infections in Washington DC. The writer says:

According to the department’s research, the repeal of a decade-long ban that prevented D.C. from using local funding for clean needle exchanges led to a major reduction of needle-caused HIV infections. The city is now reporting an astonishing 80 percent decrease in the number of newly diagnosed HIV cases where the reported mode of transmission was injection drug use. In 2007, the year Congress lifted the 1998 ban on D.C.’s needle exchanges, there were 149 cases of needle-caused HIV. In 2011, there were just 30.

That’s pretty great, right? Fewer infections is a great thing. However there’s one very big problem with the way this story frames the data. In 2007, injection drug users made up 29% of new infections. In 2011, they made up 27% of new infections. The big story is that new HIV infections dropped dramatically. Injection drug users are a slightly smaller portion of new infections.

It took me two minutes of googling and reading his own source documents to find this data. Why do so many of these stories fail to provide this context? Why didn’t a reporter spend a couple minutes with a search engine before submitting this? There are lots of stories like this every year. I don’t understand it.

“Giving Drug Addicts Free Clean Needles Is Worth Every Penny” is a good headline, but what’s the rest of the story? There’s more to HIV and addiction than an accounting exercise.

5 Comments

Filed under Controversies, Harm Reduction, Policy, Research

5 responses to “Worth Every Penny?

  1. Has the HIV community done a better job reducing stigma compared to the recovering community?

    • I’m speculating, but I think people are scared of disease and anything that reduces the chances of them or a loved one getting sick is good news and people look no further.

      Also, this kind of program gives a nice, clean metric.

  2. I’ve worked at a needle exchange and your post raised a few thoughts for me:

    a) I think they are, at least in my experience, very recovery-oriented environments that emphasize health empowerment and make available a number of resources that add to a person’s recovery capital. The case for creating and funding them, however, is usually the prevention of infection, not–I don’t think–because the people who run the programs don’t care about recovery, but that society at large so stigmatizes the injection drug-using population that this sort of heartless argument makes more sense to the general public.

    b) Many needle exchanges also distribute naloxone, which is absolutely a case of the surgery keeping the patient alive. In the city where I live, it’s one of the few places a citizen can access naloxone. As a result, hundreds of lives have been saved. I don’t know the story in L.A., but if they also offer information about safer injection practices and perhaps naloxone, they may have kept the overdose number lower than it would have been otherwise.

    • Thanks for the comment. I’m short on time at the moment, so please forgive any terseness in my response.

      a) I just wonder what the reaction would be if we were celebrating preventing MRSA infections among cardiac patients when the cardiac patients are dying in large numbers. I suspect there would be a lot of outrage.

      b) I support naloxone distribution, but I’m not sure I’d go as far as you.

      It certainly reverses the OD. But, what happens afterward? It’s like using one of the defibrillators that are now in grocery stores and everywhere else. A critical question is what happens next. Does the person go home, or do they go and get treatment for the condition that caused the cardiac emergency?

      Our local outreach program recently announced 26 successful naloxone rescues, but said that none of them resulted in a treatment admission. That troubles me, but it didn’t appear to trouble anyone else in a room full of public health people and physicians. (I asked the question. It didn’t seem to come to anyone else’s mind.)

  3. What a tragic wasted opportunity to provide a meaningful intervention besides temporarily saving their lives.