A critical need for needle exchanges in NC

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The N.C. House’s recent passage of a measure that would launch two pilot needle disposal programs and strengthen protection from criminal prosecution for people who disclose syringe possession before being searched is a small step toward addressing the deadly link between infectious diseases and injection drug use.

The pilot programs would provide educational materials as well as safe disposal sites for people who inject drugs. But the public health benefits would be limited because there is no clean-needle provision, which reduces needle-sharing and is an important incentive that helps link people who use drugs to other health services.

Addressing this link in North Carolina is critical. The most recent surveillance data available indicate that 10 percent of the state’s HIV cases were likely due to injection drug use. With epidemics expanding in other states, failure to take action would be costly.

In Indiana, the state legislature recently passed and the governor signed a bill allowing communities with infectious disease epidemics linked to injection drug use to provide sterile syringes and needles in exchange for used ones. The new state law that takes effect immediately authorizes syringe exchange programs in communities with documented HIV epidemics. It follows two emergency 30-day measures that authorized a syringe exchange program in one county where rates of HIV have spiked. The month before, Kentucky legislators passed a sweeping bill in response to that state’s heroin use emphasizing medical interventions, including establishment of needle exchange programs.

With these actions, policymakers are recognizing what public health professionals have long known: Needle exchange programs are effective at preventing transmission of HIV, hepatitis and other blood-borne infectious diseases, as well as linking people to preventive and health care services. I am pleased to see this growing recognition of an important low-cost intervention, but we must do more.

In Indiana, the measure comes late: The U.S. Centers for Disease Control and Prevention reported this month that an Indiana community at historically low risk for HIV transmission saw numbers of new HIV diagnoses rise from fewer than five annually to 135 by the middle of April. The report describes a rural impoverished community where multiple generations of family members and neighbors inject drugs together, sharing syringes among as many as six people at a time. Nearly 85 percent of those diagnosed with HIV also are infected with hepatitis C.

In Kentucky, the new legislation is more forward-reaching. It allows communities to be proactive and establish needle exchange programs to prevent an upsurge of new HIV or hepatitis infections. But without state or federal support, implementation will depend on communities coming up with their own funding for the programs.

All of these measures are limited because they focus on states and local communities

when we know all too well that infectious diseases are not contained by borders. Federal support for syringe exchanges, currently banned by the U.S. Congress, and enhanced resources for other effective drug-use prevention and treatment programs are urgently needed.

As an infectious-diseases physician specializing in HIV, over the last couple decades it has been a privilege to see the dramatic effects of evidence-based interventions on the lives of patients who had limited options and often little hope of survival. In the early ’90s, highly active antiretroviral treatment transformed HIV into a disease people could live with and, we now know, also helped to avert new infections. The recent development of a new treatment for hepatitis C, known as direct acting antivirals, has increased cure rates of hepatitis C dramatically – more than 90 percent.

These medical responses required years of research and development before they were able to save lives and help control epidemics. With injection drug use, we don’t have to wait. We have the tools to reduce the risks that state legislators are acknowledging cannot be ignored. We must act now.

Adaora Adimora, M.D, is a professor of medicine at the UNC School of Medicine and chair of the HIV Medicine Association.