https://www.economist.com/united-states/2022/12/01/americas-syringe-exchanges-kill-drug-users

 Skip to content

  * Menu
  * Weekly edition
  * Search

Log in

  * Featured

      + War in Ukraine
      + Recession watch
      + The World Ahead 2023
      + US politics
      + Climate change
      + Coronavirus
      + 1843 magazine
      + The world in brief
  * Sections

      + The world this week
      + Leaders
      + Letters
      + Briefing
      + United States
      + The Americas
      + Asia
      + China
      + Middle East & Africa
      + Europe
      + Britain
      + International
      + Business
      + Finance & economics
      + Science & technology
      + Culture
      + Graphic detail
      + Obituary
      + Special reports
      + Technology Quarterly
      + Essay
      + By Invitation
      + Schools brief
      + The Economist explains
      + The Economist reads
  * More

      + Newsletters
      + Podcasts
      + Films
      + Subscriber events
      + iOS app
      + Android app
      + Online courses

  * My Economist
  * Saved stories
  * Log out

  * Saved stories
  * Account
  * Log out

Search
[                    ]
United States | Academic sparring

America's syringe exchanges kill drug users

But harm-reduction researchers are unwilling to admit it

A woman shows her clean syringes at the Aids Center of Queens County
needle exchange outreach center in New York, November 28, 2006.
Participants bring used syringes to the program, and trade them for
clean ones. REUTERS/Shannon Stapleton (UNITED STATES) - GM1DUAZKRBAA
Dec 1st 2022 | New York
Share

"These guys keep the costs down for me," Flaco says. On a Friday
evening the 52-year-old comes to collect needles and tourniquets from
the syringe-exchange van parked beneath the west Bronx's elevated
train line. Flaco started using drugs at the age of six. The free
needles keep him safe, he says, and make things just a little bit
easier.

Listen to this story. Enjoy more audio and podcasts on iOS or Android
.

Your browser does not support the <audio> element.

Listen to this story
Save time by listening to our audio articles as you multitask
OK

The van Flaco frequents is run by OnPoint NYC, one of 185
syringe-exchange programmes across America. Having started as an
underground effort by non-profit groups in the 1980s, such exchanges
took off as the AIDS epidemic burgeoned. The logic was simple: if
barriers to obtaining needles were removed, drug users would stop
sharing them and rates of HIV infections would fall. The schemes were
a test of "harm reduction", the idea that de-emphasising abstinence
and destigmatising drug use would improve outcomes for addicts.

Critics feared that harm reduction would encourage drug use. Upon
launching a pilot needle-exchange programme in New York City in 1988
the city's health commissioner was accused of running a genocidal
campaign against black constituents. That same year Congress banned
the use of federal funds for syringe exchanges.

Decades of research prove that these programmes curtail disease.
Junkies are in fact less prone to sharing needles when they get free
ones. That sharply decreases rates of blood-borne illnesses. In 2014
an analysis found that every dollar spent on syringe exchanges spares
the government around $7 in HIV-related health-care costs. Needle
exchanges opened across America and Europe. For years no one detected
the feared rise in substance abuse.

That was before the opioid crisis plagued America and economists
started looking into the trade-offs. A new study by Analisa Packham
published in the Journal of Public Economics uncovers an
uncomfortable truth: this particular harm-reduction tool does lots of
harm. Ms Packham compares how drug users fared in counties that
opened syringe exchanges between 2008 and 2016 with those in counties
that did not. Before the clinics opened, upticks in HIV diagnoses or
overdoses in one set of counties were mirrored in the other. Once a
syringe exchange came to town, outcomes diverged. Rates of HIV fell
by 15% in counties with the new programme. But deaths soared. On
average syringe-exchange programmes led to a 22% spike in
opioid-related mortality.

Ms Packham notes that when fentanyl hit the market in 2013 the danger
posed by needle exchanges increased. The synthetic stuff, which is 50
times more potent than heroin, is responsible for most American
overdoses. Now that HIV is no longer a death sentence and opioids are
more fatal than ever, the costs of drug addiction are far higher than
they were--and the benefits of reduced HIV infections are lower.

Simply lowering the risks of getting sick--and the costs of
paraphernalia, as Flaco from the Bronx articulated--could also
incentivise drug use. Distributing PrEP, an HIV-prevention
medication, has been shown to make gay men less inclined to use
condoms during sex. So too could harm-reduction tools make addicts
use drugs more incautiously. In a study published in 2018 Jennifer
Doleac and Anita Mukherjee found that when states legalised naloxone,
a medication that reverses overdoses, opioid abuse increased. Though
lauded by public-health advocates, naloxone did not save lives as
intended. In some regions, fewer addicts died; in others, more did.

These works have been met with anger. Their findings upset
harm-reduction defenders who consider their efforts already besieged
by critics. The experience was so miserable that Ms Doleac, who
studies crime, has decided never to write another health paper.

Leo Beletsky, a former drug dealer, now at Northeastern University,
deems Ms Packham's findings "nonsensical" and thinks her paper should
not have been published. Don Des Jarlais, at New York University,
argues that addicts do not respond to incentives like others do,
making the moral-hazard effect inconceivable. Susan Sherman of Johns
Hopkins University says she doubts that new evidence that harm
reduction does more bad than good would convince her to disregard
previous research demonstrating otherwise.

A barrage of complaints led the editors of the International Journal
of Drug Policy to retract a meta-analysis that found that
safe-injection sites, where users do drugs in supervised settings,
did not decrease rates of deadly overdose. "Retractions used to be
reserved for fraud," says Keith Humphreys of Stanford University, a
former drug-policy adviser for the Obama administration. No longer,
it seems.

The economists aim to do no harm. They want to show which policies
work. If syringe exchanges were better at referring addicts for
treatment they could have more desirable outcomes, Ms Packham notes.
Harm-reduction researchers admonish her for ignoring precedent.
Disregarding the canon can indeed be dicey. But ignoring fresh
evidence is worse. #

Stay on top of American politics with Checks and Balance, our weekly
subscriber-only newsletter, which examines the state of American
democracy and the issues that matter to voters.

This article appeared in the United States section of the print
edition under the headline "No harm intended"

United States December 3rd 2022

  * How will America deal with three-way nuclear deterrence?
  * America's syringe exchanges kill drug users
  * The Democrats muster an orderly leadership succession
  * Women are revitalising funeral services in America
  * A winemaker's lawsuit against Napa County is about more than sour
    grapes
  * Elon Musk is showing what a waste of time Twitter can be

China's covid failureChina's covid failure

From the December 3rd 2022 edition

Discover stories from this section and more in the list of contents

Explore the edition
Share
Reuse this content

More from United States

[20221203_USP503]

Young Americans increasingly end their own lives

Suicide is now the second-biggest killer of ten- to 18-year-olds

[20221203_USD000]

Elon Musk is showing what a waste of time Twitter can be

He, and his critics, should remember the meaningful work he is
capable of

---------------------------------------------------------------------
[20221203_USP001]

Women are revitalising funeral services in America

A once-conservative industry has started to change

---------------------------------------------------------------------

  * Subscribe
  * Group subscriptions
  * Reuse our content
  * The Trust Project
  * Help and contact us

Keep updated

  *  
  *  
  *  
  *  
  *  
  *  

Published since September 1843 to take part in "a severe contest
between intelligence, which presses forward, and an unworthy, timid
ignorance obstructing our progress."

The Economist

  * About
  * Advertise
  * Press centre

The Economist Group

  * The Economist Group
  * Economist Intelligence
  * Economist Impact
  * Economist Events
  * Working Here
  * Economist Education Courses
  * Which MBA?
  * Executive Jobs
  * Executive Education Navigator

  * Terms of Use
  * Privacy
  * Cookie Policy
  * Manage Cookies
  * Accessibility
  * Modern Slavery Statement
  * Sitemap
  * Do Not Sell My Personal Information

Copyright (c) The Economist Newspaper Limited 2022. All rights
reserved.