Emirhan Darcan, PhD
emirhan.darcan@gc4ss.org

Expert
Global Center for Security Studies

Approximately three decades ago in Zurich, Switzerland, specifically at Platzspitz Park, which is known as the “needle park”, there was an open area for drug use as well as injection of drug. As a social and health consequences of this, Switzerland was exposed to a fast-growing drug-related HIV epidemic and consequently, amongst the European countries, Switzerland was the highest HIV prevalence observed.

After this sad experience, the Swiss authorities have changed their attitude towards drug problem. Such that, whereas many other European countries’ drug-control policies are based on prohibition and law enforcement, Switzerland today considers the drug problem essentially as a public health matter rather than one of criminal justice. Whilst no country has succeeded so far, Switzerland has provided evidence on the effectiveness of the harm reduction strategy in drug-use. Therefore, the Swiss experience about the needle exchange program may hold lessons for not only EU countries but also for other countries in the world. [1]

For some, trying to control and eradicate the drug problem can be looked at as a losing battle. With the war on drug is still raging, we have not seen any real decrease in the production, sale and abuse of many drugs. Because of this, many different programs have been put in place to educate people about the dangers of drugs as well as keep them safe. As one of these programs, the needle exchange program tries to help addicted intravenous drug users prevent their sickness and diseases from spreading. Even though this program does not seem to resolve the drug problem immediately, it allows users to feed their drug addictions in a safe and secure manner.

The needle exchange programs serve a very important purpose. Although each program is different, the basic idea and model is the same. The program contains a few major elements: the exchange of dirty or used needles, a clean and safe environment to inject, a place to dispose of needles correctly, and cleaning and sterilization of products. The main idea behind the program is not to keep the users from consuming drugs, since the consumers are going to use the drug no matter what, rather, to provide a clean and safe environment for them to keep diseases such as HIV at a lower rate and help reduce the spread of all drug related infections. According to the US Centre for Disease Control, “syringe exchange programs (SEPs) provide sterile syringes in exchange for used syringes to reduce transmission of human immunodeficiency virus (HIV) and other blood borne infections associated with reuse of contaminated syringes by injection-drug users…”.[2]

When we review the function of the needle exchange program, it looks to help users stay safe. This idea behind the program is based on the harm reduction model, which keeps users safe while they are consuming any substance deemed illegal by the state. The model focuses on the fact that even though people are all different, the decision of any drug user can affect the entire community in some way or another. “Drug users are an integral part of the larger community. Protecting the health of the community as a whole therefore requires protecting the health of drug users, and this requires integrating the drug users within the community rather than attempting to isolate them from it” (Susser & Staff, 1995)[3]. The harm reduction program tries to stop this chain reaction by supplying these drug users a safe alternative that keeps not only them safe but the community as well.

In the US, even though the needle exchange programs are controversial in terms of their legality according to the US Constitution, different cities as well as states have made needle exchange programs part of their public health law. The idea is that they do not look at its legality or look to harbour criminals. Instead, they try to keep the public safe and not allow them to get sick. Hence, instead of looking at the legal analysis of the program, various states and cities choose to assess “these programs under the rubric of public health law. Philadelphia, Cleveland, Los Angeles, San Francisco and six other counties or cities in California conduct syringe exchange based on their public health powers under state and local law…” Despite they are not legal under state drug laws, the needle exchange programs have been accepted and voted on in accordance with experts, where “…legal advisors in 13 cities and counties have found it equally reasonable to conclude that syringe exchange, conducted under public health auspices, is authorized under public health law and not prohibited by drug law…”  In spite of the fact that except Swiss, these programs are not fully protected under the law, and users consuming drugs can be arrested and prosecuted, they are put in place by the local governments so as to try and reduce this harm. [4].

An important part of the needle exchange programs is to make sure that they not only prove some type of success, but also that they are not linked to other vices. In order to evaluate this, many different experts have tried to measure and chart the effectiveness of the program. Unfortunately, this is an extremely difficult task, as users can contract diseases not only from sharing needles, but from other activities. Literature says that there is a very positive effect of the needle exchange programs. For instance, according to Gibsona, “…of the 42 studies reviewed here, 28 found positive effects associated with use of syringe exchange, two found negative associations, and 14 found either no association or a mix of positive and negative effects…” Gibsona’s study shows that the programs help keep the users safe from blood borne diseases. But then, there is the question of whether or not the Needle Exchange Programs lead to any other vices. Usually, drug use can be linked to other vices such as prostitution and gambling, but because these programs are made to keep users in a clean and usually supervised environment, this would be more unlikely. Drugs are not consumed in a place where other vices may occur, or there is some type of temptation to commit other criminal acts. Instead, these institutions implementing the programs are reputable and not linked to other types of criminal activities. [5]

However, when we examine the needle exchange program, there are not only benefits but also drawbacks. According to some researchers, the biggest drawback is the fact that some people feel it is wrong and should not exist. The needle exchange programs can be under fire by some in certain communities. They feel that by allowing this may imply

[1] Csete, J., & Grob, P. J. (2012). Switzerland, HIV and the power of pragmatism: lessons for drug policy development. International Journal of Drug Policy, 23(1), 82-86.

[2] US Centers for Disease Control. (2005, July). Syringe Exchange Programs. Morbidity and Mortality Weekly Report, 54, 673.

[3] Susser, M., & & Staff. (1995, January). Harm Reduction- A Framework for Incorporating Science into Drug Policy. American Journal Of Public Health, 85(1).

[4] Burns, S., JD., Finucane, D., JD., Gallagher, H., JD., & Grace, J., JD. (1996, August). The Legal Strategies Used in Operating Syringe Exchange Programs in the United States. Health Law and Ethics, 86.

[5] Gibsona, D. R., Flynna, N. M., & Perales, D. (2001, Fall). Effectiveness of syringe exchange programs in reducing HIV risk behavior and HIV seroconversion among injecting drug users. AIDS 2001, 15:1329±1341.