Securing State Funding for Syringe Exchange Programs

Shelby Elizabeth Rash

Spring 2012

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Injection Drug Use

• Drug injection is a method of introducing a drug into the body using a syringe that pierces the skin

• Usually heroin, amphetamines, barbiturates, cocaine, methamphetamine

• It is estimated than an individual IDU injects about 1,000 times per year

• As of 2004, injection drug use accounted for one-fifth of all HIV infections and most Hepatitis C infections in the U.S.

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What is a Syringe Exchange Program (SEP?)

• Provides individuals with sterile syringes and sterile injecting equipment (i.e., clean cookers, sterile water, sterile cotton)

• Ancillary services--HIV testing and education, condom distribution, referrals for medical/social services

• A harm reduction intervention

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The Syringe Exchange Process

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Early SEPs

• The first organized SEPs in the US were established in the late 1980s in Portland, San Francisco, and NYC

• By 2002, there were 184 programs in 36 states exchanging more than 24 million syringes annually

A mobile SEP in Bronx, NY

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A mobile SEP in Bronx, NY

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Chicagoland SEPs• Two SEPS in Chicago

– Chicago Recovery Alliance (private NGO)– Community Outreach Intervention Project (operated

by UIC SPH)

• SEPS in Chicago have helped reduce HIV infections stemming from shared needles by 67% in the last 10 years

• In Illinois, new HIV cases among IDUs have dropped by nearly two-thirds since 2001, averting 650 new HIV cases and preventing $200 million in health care costs

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Notable Quotables• “I believe needle exchange is another important method of the prevention

of HIV/AIDS transmission.”--President Barack Obama, 2008• “An exhaustive review of the science in this area indicates that needle

exchange programs can be an effective component in the global effort to end the epidemic of HIV disease.”--Department of HHS press release

• “[Syringe exchange] programs are wise public-health ventures, often providing the only link between abusers, health-care providers, and treatment programs.”--Massachusetts Commissioner of Public Health, 2002

• “A growing body of evidence indicates that needle exchange reduces the HIV risk, leads participants to avoid needle sharing and practice safer sex, and encourages them to enter treatment.”--NYC Health Commissioner, 1991

• “Clearly needle exchange programs work. There is no doubt about that.”--Testimony before U.S. House of Representatives Committee on Oversight and Reform, 2008

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Current SEP Legislation• Illinois: IL Public Act 093-0392 allows individuals

to purchase and possess up to 20 syringes without a prescription; provides pharmacies with information about safe syringe disposal and drug treatment programs to disseminate to individuals purchasing syringes

• Federal: 1988 ban on the use of prevention dollars for funding needle exchange activities, overturned in 2009, ban reinstated in 2011

• Federal dollars hardly had a change to trickle down before the funding was taken away

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Dollars and (Common) Cents• Lifetime cost of medical care for each new HIV

infection = $385,200• The equivalent amount of money spent on SEPS

would prevent at least 30 new HIV infections• The cost per HIV infection prevented by SEPs =

$4,000 to 12,000• IL SEPs have reduced the rate of infection by

two-thirds since 2001, saving $200 million in medical costs

• SEPs are very cost effective!

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Policy Action Plan

• Amend SB 1701 (the IL Controlled Substances Act and the Methamphetamine Control and Community Protection Act)

• Reallocate federal funds for preventative methods that are covered under the federal appropriation bill (such as smoking cessation programs)

• Use state and local funds for SEPs• No additional funding is necessary!

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Proposed Amendment to SB 1701

• “The State of Illinois recognizes the importance and necessity of syringe exchange programs in and around the Chicagoland metropolitan area. As such, the State of Illinois will fund SEPs as long as their effectiveness and cost-effectiveness are documented.”

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Federal Policy Support

• Congressman Dan Brady• Congressman Danny Davis• Congresswoman Jan Schakowsky• Congressman Luis Gutierrez• Congressman Jesse Jackson Jr.

The IL delegation wouldn’t vote for state legislation but their support is still very valuable

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State Policy Support

• Representative Mary E. Flowers– Honored by Illinois Alcoholism and Drug

Dependence Association for her continued support

• Representative Greg Harris– Serves openly as a person with AIDS; lists public

safety and HIV as legislative priorities

• State Senator Mattie Hunter– Majority Caucus Whip; Vice-Chairperson of Public

Health Committee; member of the Illinois Advisory Council on Alcoholism and other Drug Dependency

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Governmental Stakeholders

• Illinois Senate Public Health Committee• Illinois House Health and Healthcare

Disparities Committee• Center for Disease Control and Prevention• Illinois Department of Public Health• Illinois Department of Human Services• Cook County Department of Public Health• Chicago Department of Public Health

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Non-Governmental Stakeholders• Injection drug users• Families of IDUs• Communities surrounding SEP facilities• Employees of SEPs and drug treatment facilities• Healthcare providers and hospitals

• AIDS Foundation of Chicago• North American Syringe Exchange Network• Chicago Recovery Alliance• Community Outreach Intervention Projects• Test Positive Aware Network

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Marketing Campaigns

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Questions and Comments

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Sources• Burris S, Finucane D, Gallagher H, Grace J. The legal strategies used in operating syringe

exchange programs in the United States. American Journal of Public Health 1996; 86(8 Pt 1): 1161-1166

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

• Centers for Disease Control and Prevention (CDC). Syringe exchange programs fact sheet—December 2005.

• 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

• Ramchandani, Ariel. "Federal Cuts Won’t Hurt Chicago Needle-exchange Programs." Medill Reports, Northwestern University [Chicago, IL] 17 Jan. 2012. Print.

• Vlahov D Junge B. The role of needle exchange programs in HIV prevention. Public Health Reports 1998; 113(Suppl 1): 75-80

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