It has been nearly 30 years since the first needle exchange program opened in the United States, in Tacoma, Wash., in 1988. It was a health measure to prevent injecting drug users from sharing needles, and therefore spreading H.I.V. and hepatitis.
The idea was controversial, to say the least. Many people felt – and still feel – that it enables drug use and sends a message that drug use is O.K. and can be done safely.
Today the evidence is overwhelming that needle exchange prevents disease, increases use of drug treatment by winning users’ trust and bringing them into the health system, and does not increase drug use. Its utility has won over some critics. When Vice President-elect Mike Pence was governor of Indiana, he authorized needle exchange programs as an emergency response to an H.I.V. outbreak. “I do not support needle exchange as antidrug policy, but this is a public health emergency,” he said at a news conference in 2015.
Needle exchange saved New York City from a generalized H.I.V. epidemic. In 1990, more than half of injecting drug users had H.I.V. Then in 1992, needle exchange began – and by 2001, H.I.V. prevalence had fallen to 13 percent.
America has another epidemic now: overdose deaths from opioids, heroin and fentanyl, a synthetic opioid so powerful that a few grains can kill. A thousand people died of overdose in the city last year – three times the number who were killed in homicides. Nationally, drug overdose has passed firearms and car accidents as the leading cause of injury deaths.