Needle exchange saving money and saving lives

In 1990, Hawai‘i was the first state to start and fund a syringe-exchange program. In other areas, 30 to 40 percent of intravenous drug users tend to be infected with HIV. Here it’s still under 1 percent.

Do the math: HIV treatment costs $20,000 a year, while it costs the state $650,000 a year to sponsor the exchange program. That means it’s cost-effective if it prevents 33 cases of HIV each year.

That seems likely; 219,000 needles were exchanged in Hawai‘i last year. It’s estimated that between 10,000 and 20,000 users inject drugs in the state.

Opponents object that needle-exchange programs actually encourage use of injectable drugs. Perhaps it does take some of the worry out of it. But just look at places where needle exchange isn’t available, where users share needles even though the risk of HIV infection is substantial.

An encouraging aspect of needle-exchange programs is that they bring users into contact with people who can counsel them and direct them to treatment programs. Getting in touch with these lost souls may be society’s best chance of getting them whole again.

Now the state is considering looking for $1 million to vaccinate the drug-injecting population for hepatitis B, a disease that causes liver failure. It’s spread the same way as HIV, by sharing drug paraphernalia. From a public health standpoint, vaccination should be a no-brainer. They might also consider vaccinating the prison population, while they’re at it.

But only 4 percent to 8 percent of injecting addicts carry hepatitis B. The real problem is hepatitis C, for which there’s no vaccination.

An estimated 45-60 percent of injecting drug users have hepatitis C. It’s a mighty strong argument for even more aggressive needle-exchange programs. And that’s happening, as a larger proportion of users is approached on a one-on-one basis and as programs reach farther into rural areas.

It’s interesting, of course, that users seem to be mixing methamphetamine with their heroin these days. Interesting, but somewhat beside the point — which is, if they’re doing it with clean needles, they’re saving society huge sums of money it doesn’t have.

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