By Priyanka Surio
Our generation’s War on Drugs…
Prescription painkillers, including opioids, are the nation’s fastest growing drug problem. There are 7 million injection drug users in the U.S. and a strong correlation exists between opioid abuse, injection of drugs, and the transmission of Hepatitis C (HCV) and HIV. What’s even more alarming is the sharp increase in the number of young persons who inject drugs. Data collected from the Centers for Disease Control and Prevention revealed that the majority of reported cases of HCV from 2006-2012 were from adolescents and young adults, ages 30 and younger.
Now that I’ve got your attention…
There is a solution to mitigate the spread of new cases of HIV and HCV. Syringe Exchange Programs (SEPs) target the problem by providing access to free sterile syringes and drug equipment, which reduce the likelihood of users sharing drug injection equipment. There is strong evidence based data to show that sterile syringes can reduce the emergence of new cases of HIV/HCV.
But how do people use these programs?
Acute HCV is often asymptomatic and hard to identify, especially among injectors who might not seek medical care, and co-infection with HIV is high in this population. Engagement in prevention and care is particularly challenging for young and nonurban injectors, who may even be uninterested in drug or HIV/HCV treatment. As such, there are a number of programmatic approaches to provide new and sterile syringes to young persons who inject drugs. Some SEPs operate as an exchange where participants are required to return used syringes for new, sterile ones. Others function by providing participants with as many sterile syringes as requested, without conditions. Many SEPs offer a package of services related to prevention and care, which are vital reducing the risks of acquiring or transmitting HIV or HCV and help individuals maintain and improve their health. These services can include medication assisted therapy to prevent overdose/ support drug treatment, on-site medical care, screening and counseling of HIV, hepatitis C, and STI’s, distributing condoms and items such as food or clothing, and referrals to substance abuse treatment.
If they’re so great, why don’t we have them everywhere?
Public funding of SEPs has been limited since 1988, when a ban on the use of federal funding for such programs was first enacted by Congress. For a short period from December 2009-2011, Congress lifted the ban of federal funds to support SEPs. However, it was reinstated as part of a partisan package proposed by the Republican majority in the House. In DC, the banning of federal funding for SEPs has been used as a political provision between Congressional Republicans and Democrats to strike a budget deal. In June 2015, the Senate and House congressional members issued a report accompanying the FY 2016 Labor-Health and Human Services Appropriations bill. The report included guiding language for syringe exchanges that allows use of federal funds if the implementation of an SEP is essential for mitigating the spread of HIV/HCV and reducing associated healthcare costs.
What’s the take-away?
The resounding recommendation from federal agencies and public health practitioners today is to support evidence-based and best practices in policy, including SEPs as an effective intervention in reducing infectious disease transmission of HCV and HIV. SEPs have shown the most efficacy when integrated with already existing HIV/AIDS or viral hepatitis prevention program. SEPs can also be an injection drug user’s first access point to the healthcare system, which work to increase access to care and linkage to treatments and services including substance abuse treatment. A comprehensive approach is not possible without involvement from all relevant stakeholders across the spectrum of federal, state, local, community, and patient organizations. A comprehensive approach not only promotes transparency and enhanced awareness and understanding of the issues, but it will also pool collective resources and surveillance mounting to an increased capacity to address prescription drug abuse and HIV/HCV transmission.
Priyanka Surio is a second year Master of Public Health student and a Healthcare Legislative Assistant at the Health and Medicine Counsel.