In light of the recent opioid crisis, many public health entities have called for an expansion in syringe exchange programs (SEPs), which provide access to sterile syringes and facilitate safe needle disposal for injection drug users. This paper investigates the effects of recent SEP openings on HIV diagnoses and drug-related overdoses in the wake of the opioid crisis. I find that SEP openings decrease HIV diagnoses by up to 18.2 percent. However, I present new evidence that SEPs increase rates of opioid-related mortality and hospitalizations, suggesting that needle exchanges alone may be less effective than other interventions at stimulating recovery.
This volume addresses the interface of two major national problems: the epidemic of HIV-AIDS and the widespread use of illegal injection drugs. Should communities have the option of giving drug users sterile needles or bleach for cleaning needs in order to reduce the spread of HIV? Does needle distribution worsen the drug problem, as opponents of such programs argue? Do they reduce the spread of other serious diseases, such as hepatitis? Do they result in more used needles being carelessly discarded in the community? The panel takes a critical look at the available data on needle exchange and bleach distribution programs, reaches conclusions about their efficacy, and offers concrete recommendations for public policy to reduce the spread of HIV/AIDS. The book includes current knowledge about the epidemiologies of HIV/AIDS and injection drug use; characteristics of needle exchange and bleach distribution programs and views on those programs from diverse community groups; and a discussion of laws designed to control possession of needles, their impact on needle sharing among injection drug users, and their implications for needle exchange programs.
This book reports on research on and experience with needle exchange and bleach distribution programs and their effects on rates of drug use, the behavior of injection drug users, and the spread of HIV and other infectious diseases among injection drug users. It discusses U.S. needle exchange data, international evaluations of needle exchange programs, legal issues and drug paraphernalia laws, evaluation methods, and bleach distribution programs.
Drug overdose, driven largely by overdose related to the use of opioids, is now the leading cause of unintentional injury death in the United States. The ongoing opioid crisis lies at the intersection of two public health challenges: reducing the burden of suffering from pain and containing the rising toll of the harms that can arise from the use of opioid medications. Chronic pain and opioid use disorder both represent complex human conditions affecting millions of Americans and causing untold disability and loss of function. In the context of the growing opioid problem, the U.S. Food and Drug Administration (FDA) launched an Opioids Action Plan in early 2016. As part of this plan, the FDA asked the National Academies of Sciences, Engineering, and Medicine to convene a committee to update the state of the science on pain research, care, and education and to identify actions the FDA and others can take to respond to the opioid epidemic, with a particular focus on informing FDA's development of a formal method for incorporating individual and societal considerations into its risk-benefit framework for opioid approval and monitoring.
According to the Centers for Disease Control and Prevention (CDC), 115 Americans die each day from an opioid overdose, which averages one death every 12.5 minutes. Between 1999 and 2016, the number of drug overdoses catapulted by 300 percent, with injection drug use increasing by 93 percent between 2004 and 2014 and opioid-related hospital admissions increasing by 58 percent over the past decade. And an inexorable sequela of the opioid epidemic is the spread of infectious diseases. To address these infectious disease consequences of the opioid crisis, a public workshop titled Integrating Infectious Disease Considerations with Response to the Opioid Epidemic was convened on March 12 and 13, 2018, by the National Academies of Sciences, Engineering, and Medicine. Participants discussed strategies to prevent and treat infections in people who inject drugs, especially ways to work efficiently though the existing public health and medical systems. This publication summarizes the presentations and discussions from the workshop.
North America is in the grips of a drug epidemic; with the introduction of fentanyl, the chances of a fatal overdose are greater than ever, prompting many to rethink the war on drugs. Public opinion has slowly begun to turn against prohibition, and policy-makers are finally beginning to look at addiction as a health issue as opposed to one for the criminal justice system. While deaths across the continent continue to climb, Fighting for Space explains the concept of harm reduction as a crucial component of a city’s response to the drug crisis. It tells the story of a grassroots group of addicts in Vancouver's Downtown Eastside who waged a political street fight for two decades to transform how the city treats its most marginalized citizens. Over the past twenty-five years, this group of residents from Canada's poorest neighborhood organized themselves in response to the growing number of overdose deaths and demanded that addicts be given the same rights as any other citizen; against all odds, they eventually won. But just as their battle came to an end, fentanyl arrived and opioid deaths across North America reached an all-time high. The "genocide" in Vancouver finally sparked government action. Twenty years later, as the same pattern plays out in other cities, there is much that advocates for reform can learn from Vancouver's experience. Fighting for Space tells that story—including case studies in Ohio, Florida, New York, California, Massachusetts, and Washington state—with the same passionate fervor as the activists whose tireless work gave dignity to addicts and saved countless lives. This publication meets the EPUB Accessibility requirements and it also meets the Web Content Accessibility Guidelines (WCAG-AA). It is screen-reader friendly and is accessible to persons with disabilities. A Simple book with few images, which is defined with accessible structural markup. This book contains various accessibility features such as alternative text for images, table of contents, page-list, landmark, reading order and semantic structure.
