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Syringe Access Programs and the Surgeon General

posted on Mon, Mar 21 2011 11:00 am by Corey Davis

Syringe Access Programs
A few weeks ago a notice in the Federal Register caught my eye. It said that the Surgeon General had determined that syringe services programs (what used to be called needle exchange or syringe exchange programs) “would be effective in reducing drug abuse and the risk of infection for… acquired immune deficiency syndrome.” This is almost certainly true.

There has been strong evidence dating back to the early 1990s that syringe access programs (SAPs) are cost-effective interventions that reduce HIV risk behavior and act as a gateway to social services and drug treatment. More recent studies strongly suggest that they are effective in reducing HIV incidence with few if any negative effects. This evidence base is well known, at least among public health officials.  But why was the Surgeon General posting a notice in the Federal Register?

Here’s the story: From 1998 to 2009, Congress inserted a proviso into the federal government’s yearly budget bill that prohibited any federal money from being used for SAPs, a restriction that was renewed every year. Congress has also inserted language into a number of other bills that prohibits specific programs from using federal money for SAPs.

The resulting lack of federal funding has been a significant impediment to efforts to scale up SAPs and has helped perpetuate the idea that they are dangerous or ineffective. Nearly 200 SAPs operate in 36 states, but they tend to run on shoestring budgets cobbled together from state and local governments and private donations. Several have recently closed down due to lack of funding, including the largest in Washington, DC – a city with one of the highest HIV rates in the country.

In 2009, the general funding ban was removed after years of politically charged debate. However, many of the program-specific bans remain. While some of these must be changed by Congress, a provision that bars the use of federal Substance Abuse Prevention and Treatment block grant funds for SAPs lasts only until the Surgeon General “determines that a demonstration needle exchange program would be effective in reducing drug abuse and the risk that the public will become infected with the etiologic agent for acquired immune deficiency syndrome.”

The Surgeon General, after reviewing the evidence, made the required finding, which was what I’d seen in the Federal Register. HHS plans to issue guidelines regarding SAP implementation based on  the Surgeon General’s determination. Hopefully the remaining program-specific bans will be removed as well, clearing the way for rapid scale up of federal funding for this proven public health intervention.

This information was developed by Corey Davis, staff attorney, for the Network for Public Health Law – Southeastern Region at National Health Law Program.

The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.
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