Why Do Needle Exchanges Keep Getting Shut Down Despite Evidence of Their Effectiveness?

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Kate Harveston

Kate Harveston is originally from Williamsport, PA and holds a bachelor's degree in English. She enjoys writing about health and social justice issues. When she isn't writing, she can usually be found curled up reading dystopian fiction or hiking and searching for inspiration. If you like her writing, follow her blog, So Well, So Woman.

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30 Responses

  1. Avatar Oscar Gordon says:

    Few will say it out loud, but the resistance is because people still think junkies deserve their fate, and we shouldn’t be doing anything that makes their plight less desperate until they step into the rehab facility.

    I wonder how successful the conversation would be if needle exchanges or safe injection sites were sold as a stop gap until we can get these folks the help they want?

    Also, why are syringes only available via Rx?Report

    • Avatar Em Carpenter in reply to Oscar Gordon says:

      I’m not sure a prescription is required; I think it is just one of those “kept behind the counter” things.Report

    • Avatar Jaybird in reply to Oscar Gordon says:

      I’m not sure that it’s “they deserve it” as much as “is there honestly not something else we could spend this money on?”

      Which would you rather spend money on: Needle exchanges for heroin addicts or the pothole on Main and 3rd?

      Well, the pothole is still there.

      Also, why are syringes only available via Rx?

      When our sweet little Chumky got diabetes, we put her on insulin and were able to purchase needles and insulin from the Safeway pharmacy. After we ran out of the first box, I got asked to pick up some on the way home and I apologetically told the pharmacist that I didn’t have my prescription with me but I needed needles for the insulin that I had a prescription for in the computer. She told me “oh, you don’t need a prescription for needles.” I expressed surprise (because, seriously, we have to jump through so many dang hoops to get cold medicine that works) and she sadly said “nope, anybody can just buy them.”

      So there’s that.Report

      • Avatar Em Carpenter in reply to Jaybird says:

        Read the comments section of any random needle exchange article (I know, comments sections…) and you will very clearly see the sentiment is “they deserve it”. Yes, it may be financial too… as in, “why are we wasting money on these junkies who chose to use drugs?” i.e., don’t waste money trying to save them because they brought it on themselves.Report

      • Avatar Morat20 in reply to Jaybird says:

        Which would you rather spend money on: Needle exchanges for heroin addicts or the pothole on Main and 3rd?

        Except that, of course, needle exchanges free up money.

        A heroin addict who doesn’t have Hep C isn’t spending about 40 potholes a year worth of ER time just for his Hep C. All for about 1/1000th a year worth of a pothole in needles.Report

        • Avatar Jaybird in reply to Morat20 says:

          Oh, I understand the ounce of prevention/pound of cure calculus.

          There’s a lot of utilitarian calculi to be made that gets us to agree that needle exchanges are a good idea.

          Only a couple that don’t.

          It’s that the couple that don’t make a handful of deontological assumptions that seem to be common and pervasive that is the root of the problem.

          And that particular problem is one hell of a gordian knot.Report

    • Avatar dragonfrog in reply to Oscar Gordon says:

      Oh, they’re not that quiet about it.

      I mean, read any newspaper story where a conservative politician is dogwhistling “damn dirty junkies deserve to die of preventable diseases”, then read the comment section below it – half the comments will be angrily pointing out the dogwhistle, the other half will be enthusiastically and overtly agreeing with it. But nobody is really fooled by it.

      I mean, maybe don’t actually read the comment section on any newspaper article about addiction unless your mental health is particularly robust right now. But you know what I mean.

      (…) and we shouldn’t be doing anything that makes their plight less desperate until they step into the rehab facility.”

      Heck, half the rehab programs seem designed to make their plight desperate after they step in – I can’t recall where I read it, but it was well put – addiction is the only disease where you are likely to be kicked out of treatment if you have symptoms that demonstrate that the diagnosis was accurate.Report

    • I had to look into it once and it varied by state. Some states require pharmacies to sell w/o a prescription; some states neither forbid nor require non-prescription sales; at that time one or two states still required a prescription. Some states still had syringes on the list of “drug paraphernalia”, more so that they could still charge people when the search for drugs proper came up empty than anything, I think. The prescription-only and drug-paraphernalia laws might get tossed if challenged on the right grounds: I know a guy who does restoration work on clockwork mechanisms who uses medical syringes with very fine needles to apply small amounts of solvents or lubricants in hard-to-reach places.Report

    • You’ve heard of talk radio? Lots will say it out loudReport

  2. Avatar Em Carpenter says:

    Charleston, WV had a needle exchange, and the mayor and the cops fought so hard against it that it was shut down. They insisted that the homeless were busing in to town on needle exchange day. They insisted that more needles, not fewer, were being found on the streets. They insisted the exchange wasn’t following “best practices”, though they failed to outline what those were. They did a sham investigation and report which was full of misrepresentation and outright falsehoods. They set up “stings” to catch the exchange workers violating the rules of the program (the program’s own self-imposed rules).
    Now we have a Hep A outbreak.

    I’m afraid Oscar is correct about the motivation- they think junkies deserve it. Take Narcan for example. Every time it’s discussed, they don’t even hide it. The overwhelming response is “why waste the money to save them, it is their choice!”Report

    • @em-carpenter Up here, we have a needle exchange, and a needle exchange bus, and we’ve had parts of this county insist that they don’t want the needle exchange bus setting up shop, because if it does, then people there will start using. The implication being that they are not currently using. It’s absolutely ridiculous and it is going to get people sick and dead.Report

      • Avatar Em Carpenter in reply to Sam Wilkinson says:

        Ridiculous.
        As is the line of thinking that the exchange programs are the same as condoning and encouraging continued use. As if without the programs, the users would stop using, (rather than share dirty used needles and spread diseases.)Report

    • Avatar dragonfrog in reply to Em Carpenter says:

      Eugh, horrible.

      I don’t know about needle exchanges, but around here there are a couple of newly minted supervised consumption facilities – which have already reversed several overdoses, even in their first few months in action, and which are connecting people with addiction treatment opportunities.

      And of course there are folks up in arms about them, and populist politicians are stoking those fires because there are both federal and provincial elections coming up next year.Report

  3. The easy answer is because some people believe – very wrongly – that things like needle exchanges create usage, mostly because these same people prefer to believe that problems which definitely do exist in their communities actually don’t.

    The harder answer is because those same people are assholes.Report

    • Avatar North in reply to Sam Wilkinson says:

      There’s also a strong NIMBY element both literal and psychological to it. Creating or allowing needle exchange sites is feared as a draw for users and is viscerally disliked as a very visible sign that the problem exists. People very much prefer to pretend that it doesn’t exist in their communities. Even if money wasn’t a concern a lot of neighborhoods and communities would vehemently oppose needle exchanges.Report

  4. Avatar Oscar Gordon says:

    People don’t think about alcohol abuse the same way they think about opiate abuse, and I think that stems from the fact that alcohol is very much a social drug. Consuming alcohol is socially accepted and expected. So people see the path from having a few drinks to being an alcoholic, and they can see themselves following that path under the right circumstances, and so the alcoholic gets a certain amount of public sympathy.

    People don’t understand the path from normal person to opiate addict. They default to this idea of a person looking for the high, then getting addicted. And even though the news is busy with stories about how the current epidemic is the result of prescription opiates, I think people still have this idea that opiate abuse is all about the person wanting to get high, and using pain as an excuse to get drugs.

    Hell, once upon a time, I thought that. Then I got hit by a car, and spent a week on Morphine. And ten years later I had my ACL repaired, and spent another week on Morphine. I enjoy an alcoholic beverage every now and again, but I’ve never enjoyed the feeling of being drunk, so I’ve never worried about becoming an alcoholic. Morphine… That shit scares the hell out of me, because I LOoOoOoOVED it. Loved it so much that after my ACL repair, I stopped taking it as soon as the Rx was done, and I never used a refill. I have a disturbingly high tolerance for pain, so I can live with pain. I know how to manage it without drugs. I’m also very much aware I’m on the right side of the bell curve in that regard, and I’m not going to think less of people to the left of me because they want release from the pain.

    The public in general has no idea what chronic pain is*, nor what an opiate high feels like, and if they did, they’d be much more sympathetic.

    *Many think they do, but they really don’t.Report

    • Yeah. The summer I was 16 I had a nasty case of pleurisy (infection of the lining of the lung cavity) and spent three days high on some sort of don’t-care drug. It didn’t do a whole lot for the pain, but I just didn’t care that breathing hurt. Scary, as we’ve all either been, or known people who have been, in situations where not having to care for a while is enormously attractive. Compounded by whatever it was they gave me being physically addictive after you took it long enough.Report

      • Avatar Oscar Gordon in reply to Michael Cain says:

        That’s the difference between alcohol and opiates. Alcohol lets you feel numb. The pain is still there, just muted. I can still feel a thousand knives jabbing into my knee, but it’s more like 500 fingers.

        With opiates, the thousand knives are still there, I just don’t care. I can eat, I can relax, I can sleep, and I can otherwise function, because the part of my brain that cares about the pain has been shut off. It’s way more liberating that being drunk, where you still care about the pain, and you are utterly useless except for sleeping (and the sleep insn’t that great, and you have a hangover, etc…).Report

    • @oscar-gordon You’re right on about alcohol. You can see that both in the broader culture – we have alcohol advertising on television, and we still have politicians who melt all the way down about the availability of marijuana, which is by every imaginable measure a far safer substance – and here (don’t even think about asking a “Drugs are bad!!!” warrior if they drink alcohol). The absurdity of our cultural relationship to these things is on full display whenever anybody proposes extending the same decency to somebody else that has previously only been enjoyed by one group.

      And it ends up both prolonging and worsening the problem itself without achieving anything beyond those recalcitrant individuals’ smug satisfaction at having resisted doing something better and more substantive. Em’s example about Charleston WV is a perfect one.Report

    • Avatar Em Carpenter in reply to Zac Schwartz says:

      Interesting. I’ve never heard of that.
      I doubt such a thing would stand a chance where I live; there is currently a big anti-suboxone push in the works. If they disapprove of that, no chance they’d consider heroin.Report

      • Avatar dragonfrog in reply to Em Carpenter says:

        Anti suboxone? Good grief.

        This basically confirms my suspicion – needle exchanges and supervised consumption sites are not opposed despite their effectiveness in saving lives and reducing disease, addiction, and misery – they’re opposed BECAUSE of their effectiveness.Report

        • Avatar Em Carpenter in reply to dragonfrog says:

          Yes, anti-suboxone. Judges and courts demand defendants stop taking it if they are on probation because it’s “just another drug”. And law enforecement says that wherever they find heroin/opiates they find suboxone so obviously that must mean its abused (as opposed to addicts having it in their possession because it eases their cravings and withdrawal). So they have gotten into the ears of law makers and word is there will be a big push to reclassify it as a higher schedule drug and put more restrictions on its use in treatment.
          And a bigger reason? Vivitrol. It’s the “new” thing and it has a strong lobby working to make it the more favorable option.Report

  5. Avatar Fred says:

    Corrolary question: since sex education classes lower teenage pregnancy and abortion rates why do many favor abstinence education which does not change behavior.Report

    • Avatar DavidTC in reply to Fred says:

      A related question: Wouldn’t it be easiest to just build some places for homeless people to sleep?Report

      • Avatar Jaybird in reply to DavidTC says:

        The Parable of the Prodigal Son is surprisingly rich. Here (this is the RSV):

        And he said, “There was a man who had two sons; and the younger of them said to his father, ‘Father, give me the share of property that falls to me.’ And he divided his living between them. Not many days later, the younger son gathered all he had and took his journey into a far country, and there he squandered his property in loose living. And when he had spent everything, a great famine arose in that country, and he began to be in want. So he went and joined himself to one of the citizens of that country, who sent him into his fields to feed swine. And he would gladly have fed on[a] the pods that the swine ate; and no one gave him anything. But when he came to himself he said, ‘How many of my father’s hired servants have bread enough and to spare, but I perish here with hunger! I will arise and go to my father, and I will say to him, “Father, I have sinned against heaven and before you; I am no longer worthy to be called your son; treat me as one of your hired servants.”’ And he arose and came to his father. But while he was yet at a distance, his father saw him and had compassion, and ran and embraced him and kissed him. And the son said to him, ‘Father, I have sinned against heaven and before you; I am no longer worthy to be called your son.’But the father said to his servants, ‘Bring quickly the best robe, and put it on him; and put a ring on his hand, and shoes on his feet; and bring the fatted calf and kill it, and let us eat and make merry; for this my son was dead, and is alive again; he was lost, and is found.’ And they began to make merry.

        “Now his elder son was in the field; and as he came and drew near to the house, he heard music and dancing. And he called one of the servants and asked what this meant. And he said to him, ‘Your brother has come, and your father has killed the fatted calf, because he has received him safe and sound.’ But he was angry and refused to go in. His father came out and entreated him, but he answered his father, ‘Lo, these many years I have served you, and I never disobeyed your command; yet you never gave me a kid, that I might make merry with my friends. But when this son of yours came, who has devoured your living with harlots, you killed for him the fatted calf!’ And he said to him, ‘Son, you are always with me, and all that is mine is yours. It was fitting to make merry and be glad, for this your brother was dead, and is alive; he was lost, and is found.’”

        Anybody who sat through a sermon on this knows that the preacher has to spend a good five minutes on the older brother. Specifically on the question: “Does the older brother have a point?”

        I submit to you: the older brother has enough of a point to get all of the people out there who always served their proverbial fathers, always did what their proverbial fathers commanded, and never got so much as a kid with which to make merry with their friends to nod their heads and say something like “What the hell?”

        And without the ability to promise something similar to a proverbial inheritance, the proverbial father will find himself with a fairly pissed off elder son.

        Which might not be a big deal in a paternalist authoritarian system but, in a democracy, you’re going to find yourself wondering why pointing at how good it is to provide “bunks for drunks” doesn’t resonate with a huge chunk of the electorate.Report

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