Tiffany Hatcher, PharmD
Tiffany Marissa Hatcher is a 2017 PharmD graduate from Hampton University School of Pharmacy. She is currently completing the UAMS Community Based Residency Program, with practice sites at Walmart Supercenters, Neighborhood Markets, and the Home Office as part of the Health and Wellness Quality Improvement team.
NEPs offer injection drug users (IDUs) a nonthreatening public location to bring a dirty needle and exchange it for a sterile one. Many of these locations also offer medical services such as HIV testing, STD screening, and hepatitis B and C counseling, among other supportive services.
The first NEP was started in Amsterdam in 1984 to address the spread of hepatitis B. Today, 35 US states plus the District of Columbia, Virgin Islands, and Puerto Rico participate in NEPs, according to the North American Syringe Exchange Network.
Although NEPs have produced positive statistics, many concerns remain regarding federal funding, enabling community injection drug use, and the legal system.
Why should you support NEPs in your state or community? Because they reduce the number of contaminated needles being shared among IDUs, which is reducing the rates of hepatitis and HIV infection.
NEPs also offer counseling services and health care screenings to IDUs returning needles. Despite these service offerings, NEPs are very cost effective.
The average budget for an NEP is reported at less than $200,000. Based on mathematical models used to predict the number of HIV infections prevented among IDUs, their partners, and their offspring, NEPs are reported to have a cost-effectiveness range from $3000 to $50,000 per averted infection, which is similar to the cost-effectiveness of zidovudine for perinatal transmission.
Although there are many benefits to NEPs, there are also several downfalls. For instance, by giving clean needles to a known IDU, opponents feel NEPs are directly encouraging and promoting the use of drugs. NEPs could also portray to the community that illicit drug use is “accepted” as long as a clean needle is used, thus increasing the number of potential IDUs.
In an effort to create a safe environment for IDUs to participate in NEPs, law enforcement in those areas is discouraged, which potentially forces local police to ignore illicit drug use. It’s also believed that NEP programs lead to increased crime rates and incidences of dirty syringes improperly disposed of in streets and parks. These incidences have a negative effect on communities, often decreasing property values, harming local businesses, and discouraging growth of the community.
Many believe that those who choose to abuse drugs must take full responsibility for the associated risks. Although NEPs offer screenings and treatment, actual referrals and follow ups appear low, so the thought is that clients are scared off by the additional services offered. In terms of funding, many recognize that NEPs are cost effective but don’t support the use of federal funding for such programs against the will of taxpayers.
Many NEPs have also been introduced without the support of their community. But, in communities that have already been damaged by drug use and crime, how much harm could an NEP really do?
Is it worth it to give IDUs clean needles, knowing that you may have prevented the spread of HIV and saved thousands of dollars associated with its medical costs? Or is it simply expediting drug-related death? The choice is yours.