Needle Exchange Programs and Safe Injection Sites are Not the Answer to the Drug Problem

Syringed in a pape bowl

Needle exchange programs are one of the more controversial approaches to the drug problem. Safe injection sites even more so. Both methods fall under the category of harm reduction.

The goal behind harm reduction is to reduce the harm in drug use. The ideology is that, while harm-reduction strategies don’t prevent drug use and they don’t help addicts get clean, harm reduction techniques allegedly make drug use safer.

But is there any circumstance under which drug use is even remotely safe?

Needle Exchange Programs

There are two recent stories on harm reduction developments. Both stories made headlines. One is about needle exchange programs, and the other is about safe injection sites.

A U.S. News article from mid-November reported on how needle exchange programs are halting the spread of thousands of HIV infections in Philadelphia and Baltimore. The stance taken in that article is that, because needle exchange programs are preventing the spread of HIV, those programs are ones we should support.

And that’s the basic argument. Needle exchange programs allegedly help to prevent new HIV cases from cropping up. Such programs also supposedly provide savings on public healthcare dollars in not then having to treat HIV cases. Quoting U.S. News, “Philadelphia saved about $243 million every year due to the drop in new HIV cases, while Baltimore saved about $62 million a year.”

“Small investments in syringe exchange programs yield large savings in treatment costs…”

Monica Ruiz, an associate professor at the George Washington University Milken Institute School of Public Health, commented on the Philadelphia and Baltimore needle exchange programs. “Small investments in syringe exchange programs yield large savings in treatment costs. Syringe exchange programs represent a powerful way to stop the spread of HIV, especially in communities struggling to fight the opioid epidemic.”

There is also some argument that needle exchange programs put addicts into the public healthcare system. Supporters suggest that every time an addict shows up for a clean needle, that’s a moment to talk to him or her about treatment options. It’s an opportunity for some form of intervention.

Ruiz goes on to say, “Giving injection drug users access to clean syringes can not only help them avoid HIV but often helps them obtain other health services, including access to drug treatment programs. Such programs offer communities huge public health and societal benefits, including a reduction in new HIV cases and cost savings to publicly funded HIV care.”

It’s challenging to take the stance that a program that might be reducing the spread of HIV is “wrong” or “bad.” However, the same programs that are preventing the spread of HIV are also making it easier for drug addicts to continue using drugs. That is an indisputably negative consequence of such programs.

Furthermore, the studies cited cannot prove that needle exchange programs help to halt the spread of HIV, only that HIV statistics went down after needle sharing programs were utilized.

There is also data that suggests that intravenous drug use is not the main factor that causes the spread of HIV. Quoting Dr. Steffanie Strathdee of the Johns Hopkins University Bloomberg School of Public Health, “In the past, we assumed that IDUs (intravenous drug users) who were HIV-positive had been infected with the virus through needle-sharing. Our analysis indicates that sexual behaviors, which we thought were less important among IDUs, really carry a heavy weight in terms of risks for HIV seroconversion for both men and women.”

And last but not least, is approval of needle exchange programs really the correct message we want to send? How can we, on one hand, tell our children that drugs are bad and that they should avoid drugs, but then allow our tax dollars to pay for federal and state-funded needle exchange programs that literally give addicts the paraphernalia they need to use drugs?

Safe Injection Sites

Woman gets injection

A story in USA Today covered new developments out of Philadelphia. Philadelphia might be the first city in the United States to host a legal, safe injection site. Emphasis on “might be.

The USA Today article reported on a 28-year-old needle exchange program in Philadelphia called Prevention Point. That program provides peer support and counseling to addicts. Depending on future judge rulings, the program could also become the first safe injection site not just in Philly, but in the entire nation.

Prevention Point also gives out free naloxone, an overdose reversal medicine. Everything that Prevention Point is currently doing is legal, but safe injection sites are not legitimate and should remain so.

We would do well to be wary of the precedent that legal, safe injection sites would set. If addicts are allowed to use drugs in specialized settings legally, the next step would be to legalize drug use under any circumstances or setting. Furthermore, while safe injection sites might provide a monitored environment for drug use, such sites do not help addicts get better.

Shouldn’t we be focused on helping addicts get off of drugs? Not making it easier for them to use drugs? To set up a federal or state-funded facility that literally gives addicts a “safe” location to shoot up is the very definition of enabling addicts. It’s making it easier for them to use drugs.

The Philadelphia judge’s recent ruling was overturned in a federal court. But supporters of the program say that as long as proposed safe injection sites would also try to get addicts to seek treatment options, they should be legalized and even supported by federal law.

Whether safe injection sites encourage addicts to seek treatment or not, should we really be legalizing official programs which allow for IV drug use on their premises? One of the strongest arguments for the implementation of safe injection sites is that such sites would help lower drug overdoses. As no legal safe injection sites are currently operating in the U.S., we have to look to other countries for data on this point.

One of the most commonly cited programs is a safe injection facility in Vancouver, Canada called Insite. There have been claims that Insite led to a reduction in drug overdoses, but that is not substantiated. In fact, according to The Lancet, the argument that safe injection sites lead to a reduction in total drug overdoses is a weak argument at best. Making drug use more accessible and more legitimate is not going to lead to a reduction in drug overdoses.

Addiction Treatment is the Answer to the Drug Problem

Helping an addicted girl

At the end of the day, our public healthcare dollars would be better spent on funding residential drug treatment centers to help addicts get clean. Needle exchange centers and safe injection sites may be well-intentioned. They may be envisioned, created, managed, and run by people who genuinely do want to help addicts stay alive. But the truth is, such programs simply enable addicts to go on using drugs. They make the problem worse, not better.

Addiction always gets worse the longer someone uses drugs. Harm reduction centers like needle exchange programs and safe injection sites might reduce some of the harm in drug use, and even that is highly debatable.

An addict who is allowed access to clean needles and a safe injection site one day may overdose and die at home the next day. There’s no guarantee he will keep coming back to the safe injection site every day. Wouldn’t it be better to spend our time, energy, and resources on helping addicts get off of drugs completely? As opposed to assisting them in continuing to use drugs?

If you know someone who is struggling with an addiction to drugs, be sure you do your best to get them help, to assist them in finding freedom and sobriety. That should be the ultimate goal. We need to work together to get our addicted family members and loved ones into residential treatment centers. That should be our focus, not safe injection sites or needle exchange programs.


Reviewed by Claire Pinelli, ICAADC, CCS, LADC, RAS, MCAP



After working in addiction treatment for several years, Ren now travels the country, studying drug trends and writing about addiction in our society. Ren is focused on using his skill as an author and counselor to promote recovery and effective solutions to the drug crisis. Connect with Ren on LinkedIn.