Syringe exchange programs and harm reduction: New evidence in the wake of the opioid epidemic☆

https://doi.org/10.1016/j.jpubeco.2022.104733Get rights and content

Highlights

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The effects of syringe exchange programs (SEPs) on HIV and opioid mortality rates.

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I compile a new dataset of SEP locations and openings and HIV rates between 2008-2016.

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I compare outcomes in counties with recent SEP openings to counties without a SEP.

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SEP openings reduce HIV rates but increase opioid-related mortality rates by 21.6%.

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Mortality effects are largest in areas that opened a SEP after the introduction of fentanyl.

Abstract

In light of the recent opioid crisis, many public health entities have called for an expansion in syringe exchange programs (SEPs), which provide access to sterile syringes and facilitate safe needle disposal for injection drug users. This paper uses a newly constructed administrative dataset to estimate the effects of recent SEP openings on HIV diagnoses and drug-related deaths. I find that SEP openings decrease HIV rates by up to 18.2 percent. However, I present new evidence that SEPs increase rates of opioid-related mortality. Effects are largest in rural counties and in counties that adopted SEPs after the influx of fentanyl to the US, suggesting that needle exchanges may be less effective during periods when illicit opioids are widely available, especially in areas with high barriers to substance abuse treatment.

Keywords

Syringe exchange programs
Opioid crisis
HIV

JEL Classification

K42
I10
I18

Cited by (0)

☆

I am especially grateful to Katherine Wells, who provided substantial data work and excellent research assistance. I am also grateful to Lisa Roberts for providing data and for many useful conversations about the interworkings of the Portsmouth syringe exchange program. I thank Felipe Barrera-Osorio, Lindsey Bullinger, Chloe East, Jeffrey DeSimone, Jennifer Doleac, Jevay Grooms, Erin Krupka, Ajin Lee, Mike Makowsky, Chuck Moul, Emily Owens, David Powell, Michelle Segovia, Nick Sanders, Aparna Soni, Rhet Smith, Sebastian Tello-Trillo, Barton Willage, seminar attendees at Cornell University, George Mason University, Georgetown University, University of Memphis, and West Virginia University, and participants of the Southern Economics Association 2018 Meeting, Association for Public Policy Analysis & Management 2019 Meeting, and 2019 Texas Economics Crime Workshop for useful feedback on work in progress.

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