The use of injection drugs has been exploding over the last several years. More people now die from an overdose than car crashes. As we all know intravenous drug users are at high risk of death from overdose. Much of the increase in IV drug abuse has been in rural areas where there are fewer resources to address the problem. What many people do not know is that IV drug abusers are also at very high risk for other disorders such as sepsis, endocarditis, spinal epidural abscess, HIV and Hepatitis. An IV drug abuser with a fever has a higher risk of a serious bacterial infection than a neutropenic patient on chemotherapy. Much of the reason for this is that IV drug abusers share needles that are often contaminated. In a recent Journal of the American Medical Association article, Director of the CDC Tom Frieden stated that sharing needles is “a horrifyingly efficient route for spreading HIV, hepatitis and other infections.”1
In December 2015 Congress recognized the seriousness of IV drug abuse and the fact that needle exchange programs can be an effective way to fight the opioid epidemic.1 Congress gave states and local communities permission to use federal funds to support certain aspects of needle exchange programs. IV drug abuse has been shown to reduce the transmission of diseases such as HIV and hepatitis. It has been shown that needle exchange programs do NOT cause an increase in drug abuse. Needle exchange programs DO increase IV drug abusers enrollment in substance abuse programs. Needle exchange programs DO reduce the incidence of HIV. Needle exchange programs DO reduce the risk of accidental needle sticks in EMS personnel.2
Most needle exchange programs are in urban areas. There are very few needle exchange programs in rural settings. A recent study published by the CDC showed that in 2013 there were 40 million needle exchanges for urban and suburban locations and only 2.7 million exchanges in rural areas.3 These numbers demonstrate that rural areas do not have adequate access to needle exchange programs since half of all IV drug abuses live in rural areas.3 Rural Americans do not have sufficient access to medical care or access to substance abuse programs. Needle exchange programs can reduce the burden of disease for rural populations and increase the rate of IV drug abusers seeking treatment. EMS is extremely well positioned to make the lives of its citizens better by assisting with needle exchange.
There is a stigma associated with substance abuse, especially IV drug abuse. This should not be the case. The sad fact is that IV drug abuse is now a problem for everyone. This problem cuts across the lower, middle, and upper socioeconomic classes. EMS is one the few organizations which already has the ability to implement needle exchange programs, the training to handle dirty needles, the contact with the community and community organizations to refer people for treatment, and is out in the community in people’s homes not stuck in a clinic. EMS is also very well organized and has the ability to implement standardized procedures for needle exchange and substance abuse referral. In addition, there is now funding from the federal government to help with this. The North Carolina Legislature is also poised to pass the STOP Act to make it easier to put needle exchange programs in place. Our communities are in crisis from an issue many do not want to talk about. EMS can make a difference.
- Abbasi J. CDC Says More Needle Exchange Programs Needed to Prevent HIV. The JAMA Network 2017.
- HHS Implementation Guidance to Support Certain Components of Syringe Services Programs, 2016. Center for Disease Control and Prevention. 2017, at www.cdc.gov
- Syringe Service Programs for Persons Who Inject Drugs in Urban, Suburban, and Rural Areas — United States, 2013. Center for Disease Control and Prevention, 2015. 2017, at https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6448a3.htm.