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Health Care

New Data on Syringe Exchanges

(George Frey/Reuters)

Syringe Exchange Programs (SEP’s) are a popular policy prescription to manage the opioid crisis. Cities and towns, faced with the spread of blood-borne diseases like HIV from addicts sharing needles, will provide a site to pick up clean needles (sometimes free, sometimes not) and connect users to drug treatment and rehabilitation programs. It’s a classic case of “harm reduction” policy, which isn’t an unhelpful sentiment. Jailing drug users doesn’t do much good. Better to treat them, minimize health risks, and avoid driving them away through punitive processes, the thinking goes.

But a recent National Bureau of Economic Research paper by Analisa Packham, an NBER fellow and economics professor at Miami University, calls that conventional wisdom into question. Titled “Are Syringe Exchange Programs Helpful or Harmful? New Evidence in the Wake of the Opioid Epidemic,” it finds that the results of these programs can be filed under the law of unintended consequences.

In a large survey, encompassing rural, suburban, and urban counties, and adjusting for changes in demographics, Packham found that the programs did, in fact, succeed in lowering HIV rates, by about 18 percent. The problem was everything else they did.

Drug usage rates rose, as did ER visits for overdoses. Arrest rates for drug use increased or stayed the same, meaning that concentrating users around a clinic did not significantly suppress open drug use. And drug related deaths, especially opioid deaths, rose, around 12 percent and 25 percent, respectively.

The problem with SEPs is that, while succeeding in their goal of flooding the “market” with clean needles, they lower the effort and costs for injecting drugs. It turns out that when you make something easier to do, people do it more.

It also creates perverse social networks. Drug users, drawn to one site, provide each other with information and aid. They also, critically, reduce stigma, making it easier for users to justify avoiding treatment. Finally, they promote a climate of leniency that draws drug users to the locales.

This should not only give advocates of SEPs pause. Advocates of drug legalization or decriminalization, who argue that connecting addicts to safe usage sites and treatment is preferable to stigma, may be doing far more harm than good. However, the study did not find that SEPs necessarily reduced the effectiveness of drug treatment, just that they encouraged more drug usage and increased drug-related deaths. But the widespread provision of needles does not, on balance, mitigate much harm at all.


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