Should Needle Exchange Programs Receive Full Federal Funding?

Paige Billadeau

Department of Nursing, University of Mary

NUR 336 Ethics, Law, & Policy

Professor Mary Beth Johnson

November 14th, 2022

 Abstract

Needle exchange programs are facilities that provide clean needles and syringes and

properly dispose of unclean needles and syringes. These programs are trying to decrease

transmission of hepatitis B, hepatitis C, and HIV. Currently, there is not enough research to

conclusively say of these programs are effective or not. Research does show that these programs

cause a decrease in injection risk behaviors and discarded supplies in the community. Currently,

these programs can receive partial funding if approved by the Department of Health and Human

Services. This funding does not pay for needles and syringes. Needle exchange programs are

trying to receive full federal funding so that they may have a larger impact on their community

and others.
 Needle exchange programs are places where substances user may discard their old

needles in exchange for a new, clean needle. Giving a new needle benefits the substance user by

decreasing the risk of contracting an infectious disease such as hepatitis B, hepatitis C, and HIV.

These facilities also properly dispose of unclean needles and syringes to keep our communities

clean and safe. These programs are trying to get federal funding so that they may have a greater

effect on their communities.

There have been studies that prove that needle exchange programs are effective in

reducing injection risk behaviors (sharing needles, reusing needles, and discarding needles

unsafely) and increasing the likelihood that a substance abuser will enter treatment or stop drug

use (NIDA, 2021). The goal of needle exchange programs is to prevent the spread of infectious

diseases. The most common way to contract hepatitis C is by sharing needles. A study has

proven that needle exchange programs decrease the likelihood someone will share their needles

(Kåberg et al, 2020). The problem is the possibility of enabling the substance abuser. The

government does not want to support a program that is giving tools to substance users to

continue to inject more illegal drugs.

Scientifically, a new sterile needle will not transmit diseases because it is free from all

microorganisms. Although, there are no easy answers to this problem. On one hand, reducing

infectious diseases benefits the whole community, not just the substance user. On the other hand,

reducing the number of substance users would also help instead of just providing new

equipment. According to some studies, there is not enough evidence to justify that the

implementation of needle exchange programs will cause a decrease in infectious diseases (Davis

et al, 2017).
 If needle exchange programs would receive full federal funding, they would be able to

help more people and have a greater reach in the community. The government would be

condoning substance users by buying them new equipment. If the needle exchange programs do

not receive federal funding, they will have less of an impact on the community. There will be a

higher risk for the transmission of infectious diseases, which could be prevented with clean

equipment.

Needle exchange programs are in ordinance with the World Health Organization in effort

to have viral hepatitis eradicated by 2030 (Waheed et al, 2018). Needle exchange programs are

made with this exact issue in mind since hepatitis C is transferred by unclean needles. The

underlying problem is enabling the drug user. Needle exchange programs promote safe practices

but not necessarily the stopping of injecting drugs, which is the root of the problem. Diseases

would not be transferred by sharing needles if people didn’t inject substances in the first place.

The only people that should be using needles are professionals, healthcare employees, and those

that have been instructed to do so by their healthcare provider.

The decision to fully fund needle exchange programs is up to the federal government, the

Centers for Disease Control, and the Department of Health and Human Services. Needle

exchange programs can be partially funded but exclude purchasing needles and syringes. In order

to receive full federal funding, there would need to be extensive research that proves the

effectiveness of these programs in decreasing disease incidence.

Needle exchange programs provide clean needles so that drug users may inject illegal

substances safely. The only substances that are legal in the United States are alcohol, tobacco,

and marijuana depending on the state. None of these substances are ingested by way of injection.
In 2018, about 3,700,000 people in the United States were injecting drugs (Bradley et al, 2022).

This may sound like a large number, but it is only 1.46% of the population.

The Consolidation Appropriations Act was passed in 2018 and states that needle

exchange programs can apply for funding from the Department of Health and Human Services.

These funds may only be used for specific things such as personnel, disease testing kits, proper

disposal services, educational materials, contraceptives, and opioid overdose reversal agents

(CDC, 2019). The programs are not allowed to use this money to purchase needles or syringes.

Currently, in order to even apply for funding, the organization must provide proof that their

community is experiencing or is at risk of experiencing a disease outbreak due to unsafely

injecting drugs.

There are two probable outcomes of this situation, either needle exchange programs

receive full federal funding, or they do not. If these programs receive funding, they will be able

to have a greater impact on more communities. Funding would help create more facilities and

more extensive research could be completed. If these programs full federal funding the World

Health Organization’s goal of eliminating hepatitis could be a real possibility.

If needle exchange programs do not receive federal funding, there will be no risk of

enabling a substance user. Without funding, needle exchange programs may struggle to create

more facilities and help more people in the community. The programs are will not be as effective

as they could be. Data will continue to be inconclusive regarding whether or not these facilities

are beneficial. There could be more outbreaks of hepatitis B, hepatitis C and HIV due to unclean

needle use. Some substance users without access to needle exchange programs have nowhere to

safely dispose of their supplies. This would cause a higher chance of discarded items in the street

which could potentially infect a non-substance abuser.

 One ethical framework that can be applied to this dilemma is consequentialism.

Consequentialism is determining the morality of an action based on its consequences. This

framework demonstrates the duality of this problem. Funding needle exchange programs could

decrease disease incidence, but it also could increase substance abuse and attract more substance

users to the community. Not funding these programs prevents enabling the drug user, but also

prevents the possibility of helping more people. The goal of these programs isn’t to have people

continue to inject drugs but to prevent infection which can be difficult to separate.

Another ethical framework that can be applied is utilitarianism. Utilitarianism is the

greatest good for the greatest number of people. Utilitarianism supports needle exchange

programs. In needle exchange programs substance abusers are less likely to use a needle from

another person or share their needle with another person. Sharing needles exposes the substance

user to possible infections that could enter directly into the bloodstream. A smaller incidence of

disease would decrease the likelihood that diseases would spread to the whole community which

benefits everyone.

According to a study done in Illinois, faith leaders are split on whether or not needle

exchange programs would benefit their communities (Grundy et al, 2021). Of the people in the

survey, 71% were males and the average age was 50 years old. Most of the participants thought

that needle exchange programs would decrease disease incidence and the number of needles

discarded in the community. The faith leaders had concerns about how the program would affect

the community, such as drug use would increase, and more substance users would come to their

area. In the end, only 52% were in favor of needle exchange programs.

Beneficence is seen in this ethical dilemma. The use of needle exchange programs

supports doing good. A sterile needle is free from any microorganisms and will not cause any
disease or infection to occur. Other ways needle exchange programs do good is by making health

care assessable and providing numerous treatments, screenings, and referrals. When substance

users enter a needle exchange program, they are more likely to receive health care treatment,

enter a rehabilitation facility, and stop using drugs (Kåberg et al, 2020).

Nonmaleficence is also seen in this dilemma. Preventing harm is seen by having access to

naloxone for opioid overdoses. Harm can also be prevented by providing education to clients on

why sharing needles is harmful. People may receive screenings for different infectious diseases.

If they test positive, they are educated on how to not spread it to others which prevents harm to

noninfected people. Need exchange programs properly dispose of needles and syringes so they

will not cause harm to others in the community.

Another ethical principle that is seen is promoting quality of life. If a person were to

come into the facility, they would have access to healthcare. They can be screened, educated,

treated, and referred to a healthcare professional. Some people are unaware that they are infected

with a disease and that they have been spreading it to others. Needle exchange programs can help

people get the treatment and information they need to live a better quality of life. This is also

seen in referrals to rehabilitation centers. People have the opportunity to get help to stop

ingesting unhealthy substances.

The American Nurses Association (ANA) has released a statement of their position on

needle exchange programs. ANA's position is similar to the Department of Health and Human

Services. ANA supports access to healthcare, public health, and infection precautions. ANA does

not, however, support the exchange of needles. The association is more supportive of the

additional care that needle exchange programs provide such as HIV and hepatitis screening,

infection education, counseling, and referrals to rehabilitation centers.

 I think that needle exchange programs should be federally funded. Needle exchange

programs could decrease the incidence of diseases that are transmitted by intravenous drug use.

Decreased disease incidence would benefit the whole population if needle exchange programs

were available more readily. Needle exchange programs are also a way to get substance users

into healthcare. Once introduced to healthcare, the programs can help people find resources for

rehabilitation facilities or a referral to a different healthcare provider if needed. This could, in

turn, reduce the number of people who inject drugs. These programs would help the World

Health Organization’s goal of eradicating hepatitis. I think making healthcare more accessible is

the main benefit of these facilities. Once entered into healthcare substance users have the

opportunity to increase their quality of life and prevent infection in other people.
 Works Cited

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Handanagic, S., Crepaz, N., & Rosenberg, E. S. (2022). Estimated number of people who

inject drugs in the United States. Clinical infectious diseases: an official publication of

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Centers for Disease Control and Prevention. (2019, May 23). Federal funding for Syringe

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Grundy, S. A., Mozelewski, S. R., Adjei Boakye, E., Lee, M., & Levin, B. L. (2021). Faith

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8, 2022, from https://www.nursingworld.org/practice-policy/nursing-excellence/official-

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