Averting a Crisis: Legalization of Needle Exchange Programs in Virginia

ACT UP march for syringe exchange


In February 2017, Virginia governor Terry McAuliffe signed legislation that legalizes syringe access programs in the state. Needle exchange programs provide anyone needing a clean needle with a place to exchange their used needle for a sterile needle at no cost. These programs can also offer HIV testing and counseling, alcohol swabs, and male and female condoms, among other resources that vary by organization.

According to the approved bill, these programs will only be implemented in regions meeting certain criteria created from information such as overdose rates, number of Hepatitis C cases, and morbidity data. Thanks to several federal and private funds, these programs will not take away from the state’s general funds.



There has been controversy regarding whether needle exchange programs are helpful or detrimental. In 2011, Archbishop Francis Chullikat spoke on behalf of the Catholic Church at the United Nations in opposition of harm-reduction programs. The Catholic Church believes that people dealing with drug addictions should be given tools and assistance to break free from their addiction as opposed to measures that allow them to “continue” in their cyclic, addictive behavior. On the other hand, the CDC and NIH both advocate that needle exchange programs play a role in preventing HIV transmission and other health problems among people who inject drugs.

A needle exchange program in Virginia is important for preventing an HIV outbreak, considering an outbreak like this has happened in Indiana and the number of HIV cases rose from a typical 5 cases a year to 200 cases in 2015. It is important for local government officials and residents to voice their support for needle exchange programs to ensure the continuity and growth of such programs. A needle exchange program can be the difference between a public health crisis and a public health victory.


4 Responses to “Averting a Crisis: Legalization of Needle Exchange Programs in Virginia”

  1. lukeglaudeblog Says:

    Very interesting and timely issue. A couple things stand out for me: the fact that the programs are not funded by state tax money and that there are only 8 counties that will be available for the NEP. My guess is that they governor and state legislators do not want their constituents believing they are funding programs like this. Reading the linked articles were interesting, especially when reading the comments from other readers; things like: why don’t we just give them clean heroine while we’re at it!

    Nevertheless, I completely support the NEP in Virginia and in other places. There has been no research showing that they increase drug and it is such a cost-effective policy. One needle costs less than a dollar, whereas one pill of an HIV medication costs over $30 (I got those numbers from a linked article). Having lived in New York City for years, I’ve seen these programs work very well in big cities… I’m just wondering how popular and supportive the people of those counties in Virginia will.

    Public health measures are most successful when nobody notices what is happening. But one bad outcome or mistake can break a public health intervention. In this case, especially, it will be challenging to highlight the successes of preventing disease – something that is just not visibly seen by the public.

  2. mliaoblog Says:

    Behaviour change is recognized to be one of the hardest things to do by public health professionals hence so much effort is placed on making healthier lifestyle choices easier passively e.g. heavy taxation on alcohol and tobacco. However, it is not impossible so I do agree with the Catholic Church that active effort needs to be made to give people assistance to break the cycle of their addiction. That being said, I am fully supportive of the needle exchange program. There are many studies worldwide that have proven its benefit beyond a doubt in reducing the transmission of blood-borne diseases such as HIV and hepatitis. Even if assistance programs are in place, overcoming addiction is not a quick or easy process nor is it without relapses. To not have a needle exchange programme to help these individuals during their process of change seems an unnecessary and inhumane penalty. It is also against basic human rights to not provide such a basic preventative programme for those not yet ready to break their addiction. I believe at the end of the day people must overcome personal views and judgement for the greater good.

  3. earnestrebecca Says:

    I think that needle exchange programs play a critical role in immediately reducing some of the harm associated with illicit drug use, and that it’s an important step in the right direction. Ideally however, these programs should be supported regardless of criteria such as thresholds for the number of Hepatitis C rates or overdose deaths. The idea behind such programs is to help prevent such issues before they become a big problem, by both immediately reducing infectious disease transmission via needles and by connecting substance abusers with other health and social services. It’s also important to remember that such harm reduction programs like needle exchange programs are often the first positive interaction that substance abusers may have had with groups like health workers or law enforcement given the criminalization vs. public health approach that’s often taken toward substance abuse in the United States. So, needle exchange can be a good first step toward positively connecting substance abusers with the services they need. I hope in the future to see Virginia and other states continue to roll of these programs and shift to focus on how substance abuse can be treated more and more like a public health issue instead of a purely law enforcement issue.

  4. rachelekinneyjhu Says:

    This posting is timely given the recent opioid addiction problem that is occurring U.S. wide. On a national level, we have realized drug overdoses due to opioid use increasing steadily from 2000 to 2014. Governor Terry McAuliffe of Virginia announced in November of 2016 that opioid addiction had become a Public Health emergency in Virginia. His state and it’s citizens had become victim to prescription opioid and heroin abuse, noting an increase in overdose and mortality.

    Mortality is not the only issue with opioid addiction, as is stated above. Infections that may occur as a result of needle injected drugs include cellulitis, botulism, necrotizing fasciitis, and endo carditis. Transmissible diseases that are more easily spread as a result of needle sharing include HIV/AIDS, hepatitis, syphilis and TB. In fact, 10% of diagnosed HIV cases have been shown to be from intravenous drug users, and 30-40% of diagnosed Hepatitis C cases result from intravenous drug users. In other cities where needle exchange programs have been implemented, such as New York City, the prevalence of Hepatitis C dropped from 91% prior to NEP implementation to 56% after implementation. NEP have been shown to be successful in both decreasing mortality due to overdose and decreasing the spread of transmissible disease.

    As is noted in the blog, there is resistance to these types of programs, with the major fears being that drug use will increase, crime will increase, and used needles will increase in the surrounding neighborhood or environment. NEP began in the Netherlands in 1984, and now they are instituted in many countries around the world including Canada, Nepal, Thailand, and others. These myths have been debunked as not factual and the opposite has proven to be true. NEP provide other services in addition to clean and safe needles. There are HIV testing and counseling services, STD testing, methadone treatment and a support network. Many users end up quitting after using NEP for a period of time.

    It is important for the community/residents and local government officials to voice their support for NEP. It may be well to educate them prior so they do not carry the same biases that the Catholic Church carries as these are wide held beliefs and stigmas that must be changed to institute these programs and guarantee their success.

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