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Syringe exchange demand spikes while funding drops

November 23, 2018

Syringe exchange programs are on the frontline of the nation’s ongoing opioid epidemic, yet as demand for these services increase, the amount of funding is less available, according to a recently published report.

AIDS United, a nonprofit that gives funding grants to programs working to end the spread of HIV, says in its “Syringe Access Fund Round 9” report that its groups working in needle exchange say the opioid epidemic, the increase of deadly fentanyl in the drug supply and lack of money has strained available services and reduced their impact.

“Access to sterile syringes is a proven public health tool to prevent the transmission of HIV and [hepatitis C],” Jesse Milan Jr., president and CEO of AIDS United, said in a statement.

“Despite longstanding, clear scientific evidence, the federal government continues to hedge its support for syringe services by prohibiting the use of federal dollars to procure sterile syringes,” Mr. Milan said. “And, too many state and local authorities continue to oppose these programs, even as their residents’ need for them grows.”

Since 2004, AIDS United has provided $20 million in grants to programs that work with drug users and provide clean needles, free condoms, HIV and STD testing, access to health services and connection to treatment.

About 1.1 million people in the U.S. are living with HIV, and while new diagnosis rates are in decline, there were an estimated 40,000 new cases in 2016.

In some cities and states, syringe exchange programs are specifically credited with decreasing the number of new HIV transmissions.

In the District of Columbia for example, the scale-up of syringe exchange programs between 2007 and 2017 resulted in a 95 percent drop of new HIV cases, from 150 to seven. Further, the number of new HIV cases attributed to injection drug use reached an all-time low of 1.9 percent.

In 2011, about 6.6 million Americans injected drugs, according to the Centers for Disease Control and Prevention. In 2016, the federal government made funds available for syringe exchange programs through the Department of Health and Human Services and the CDC provided money going to these programs weren’t used to purchase needles or paraphernalia for drug use.

At least 35 states, the District of Columbia, New York City, seven counties and Puerto Rico have secured federal funding for syringe exchange programs.

The organizations that benefit from the Syringe Access Fund have distributed 66 million syringes to more than 350,000 people, AIDS United said.

Between 2016 and 2018, the organization has distributed seven policy grants across 18 states. The latest AIDS United report covers the experiences and reflections of these programs, notably that workers have had to scale up their purchases of naloxone, the overdose reversal medication and fentanyl test strips, which can detect if fentanyl is present in a drug found to be present in nearly every illicit drug including counterfeit pills, heroin, cocaine, methamphetamine and synthetic marijuana.

“Many grantees report that an overdose involving fentanyl requires more Naloxone and so they are having to spend additional funds on Naloxone and overdose prevention kits,” the researchers wrote.

One grantee, the report cites, dispensed more than 2,300 doses of Naloxone between 2016 and 2018. While more than 1,300 lives were saved, the report notes, 192 people in their program died from an overdose.

Spending more money on naloxone, fentanyl test strips and syringes have led to a scaling down of other services, including counseling, disease testing and connecting people with additional health services and treatment.

“These factors have led to unintended negative consequences,” the researchers wrote. Programs that must demonstrate success in connecting people to treatment to qualify for local or state funding can’t provide those resources because they’re cash-strapped.

“Staff spend less time with participants, removing the relationship building aspect, a crucial component for access and linkage to care,” the report says.

Further, some organizations had to place a cap on the number of syringes distributed, “creating a situation that could increase the likelihood of syringe sharing,” the report states.

Although there are some bright spots, that increased attention on the opioid epidemic has created a shift in public perception and partisan politics.

“The depiction of a person who uses drugs has changed in the media,” the researchers said. “The opioid crisis has introduced the nation to the suburban white drug user.”

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