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Funding ban on needle exchanges effectively lifted

Laura Ungar
USAToday

Congress effectively lifted the nation’s long-standing ban on federal funding for needle exchange programs, which allow intravenous drug addicts to trade dirty syringes for clean ones in the hope of preventing disease.

Hypodermic needles

The measure was quietly tucked into the omnibus spending package signed by President Obama last month. Though federal funds still can’t be used for the syringes themselves, they can  go toward the  costlier expenses associated with these programs, such as staff, vans, substance use counseling, referral to treatment and outreach in at-risk communities.

“We think this is fantastic news,” says Leana Wen, health commissioner in Baltimore, which has distributed more than 8 million clean syringes through a needle exchange operating for two decades. “We know needle exchanges reduce the transmission of disease. … Congress has made a critical first step in helping every state implement this evidence-based policy that has proven to save lives.”

Opponents have long argued that needle exchanges enable addicts to keep using. Congress first banned the use of federal funds for these programs in 1988, lifted the prohibition in 2009 and reinstated it in 2011. The latest change came at the suggestion of U.S. Rep. Hal Rogers, R-Ky., and Sen. Mitch McConnell, R-Ky., ensured the language remained in the Senate version of the spending bill, their spokespeople say.

“The opioid epidemic is having a devastating effect on communities throughout Kentucky and the nation," McConnell's office said in a statement. "As more people inject drugs like heroin, rates of Hepatitis C and HIV have been on the rise.  To help address this issue, Senator McConnell worked with Chairman Rogers to pass legislation to provide flexibility so that certain counties in Kentucky may be able to access federal funds for their treatment and education efforts.”

“Congressman Rogers supports efforts in Kentucky and elsewhere to mitigate the spread of devastating diseases, like HIV and (hepatitis) C, and the associated health care costs," says Danielle Smoot, communication director for Rogers. Though he still doesn't want federal money going to the needles themselves, she says, "he believes federal resources can effectively be used for needle exchange programs that focus on education and treatment to help end the cycle of dependency and curb an outbreak of needle-related diseases."

Under the law, she says, the U.S. Centers for Disease Control and Prevention will work to identify at-risk communities where federal funds can be used.

It's likely that parts of Kentucky will be determined to be at risk. The state has been hit hard by prescription drug and heroin abuse and suffers more than 1,000 drug overdose deaths each year. Nearby Indiana  experienced its worst-ever HIV outbreak last year — 184 cases in the southeastern region, most linked to addicts shooting up the powerful painkiller Opana. The center of that outbreak was Austin, Ind., which has a population of 4,200 and a higher incidence rate of HIV than any country in sub-Saharan Africa, according to CDC Director Tom Frieden.

A recent Indiana state law allows needle exchanges under certain circumstances when a community, such as  Austin, is wracked by an epidemic of HIV or hepatitis C. Indiana officials declined comment on the recent change of the federal funding ban but have said needle exchanges can effectively slow the spread of disease but only as part of a comprehensive strategy against addiction and IV drug abuse.

Nationally, there are at least 194 needle exchanges operating under budgets ranging from  $100,000 to $300,000, says Monica Ruiz of George Washington University, who led research on Washington’s exchanges last year. Ruiz and Wen say needles are by far the least expensive component of any programs.

Ruiz praised recent developments as reflecting "a sea change in people’s thinking” —  a realization that addiction and drug-related diseases affect families everywhere and need to be addressed based on what science shows will work.

“I’m delighted this is coming from our Republican congresspeople,” she says. “It’s an incredible development ... a long, long time coming.”

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