Beyond Clean: Syringe Exchange and the Role of the ChurchHillary Brownsmith I Spirituality & Religion I Commentary I March 16th, 2016
In April of 2015, Indiana's Governor Mike Pence declared a state-wide public health emergency in response to a rapid increase in new HIV and hepatitis C infections. The rise in infection rates, initially recognized in Scott County, was linked to syringe sharing among folks injecting a prescription opioid. As a result of Pence's declaration, counties that could prove that they were being affected by the emergency were permitted to open temporary syringe exchange programs (SEPs), a harm reduction service that furnishes drug users with sterile syringes in exchange for their used syringes. (1) Indiana's fourth SEP opened last month. (2)
Though Indiana has received significant media attention, the problems faced there are not isolated to one state. Between 2006 and 2012, hepatitis C infection rates increased by 364% in central Appalachia. (3) Hepatitis C is most commonly transmitted through the sharing of needles or injection equipment. Half of all new HIV cases reported in the United States are diagnosed in the South, due at least in part to the increased use of intravenous drugs in rural areas. (4) Between 2013 and 2014, heroin-related overdose deaths increased by 28%, a number so staggering that the CDC's chief of mortality statistics has compared the current drug overdose epidemic to the American HIV/AIDS epidemic during the late 1980s. (5)
Following Pence's decision and in the midst of a mounting national health crisis, the United States Congress overturned the federal funding ban on SEPs by quietly adding a repeal to the 2015 year-end omnibus spending measure. (6) Removal of the 1988 ban was unexpected. And Senate Majority Leader Mitch McConnell and Rep. Hal Rogers, both tough on crime Republicans from Kentucky, seemed like unlikely candidates to spearhead the effort for repeal. *
In 2004 the World Health Organization (WHO), released a study that concluded "needle and syringe programs substantially and cost effectively reduce the spread of HIV among intravenous drug users and do so without evidence of exacerbating injecting drug use at either the individual or societal level." (7) The operative phrase, at least for the conservative legislators who recently worked to repeal the ban, was "cost effectively". Based on the most recent numbers, a lifetime of HIV treatment is projected to cost $380,000 per person. (8) Additionally, the drug most commonly used to cure hepatitis C, Solvadi, has drawn attention for years for its inflated $1,000 per pill price tag (the full regimen costs $84,000). (9) The cost of caring for persons who contract HIV and/or hepatitis C through intravenous drug use has the potential to empty state medicaid and medicare coffers. In contrast SEPs, long the target of anti-paraphernalia laws and judgement from moneyed organizations only willing to support abstinence-based models of care, have learned how to operate with minimal funding and low overhead.
Legislators, namely representatives from fiscally conservative, largely rural states, made a shrewd financial decision when they overturned the ban on federal funding for SEPs. The reality that this action wasn't primarily motivated by mercy or a concern for human dignity is perhaps unimportant when so many lives will be bettered or even saved by the proliferation of SEPs.
But the Harm Reduction Coalition describes harm reduction not only as a cost effective service delivery model and public health strategy but also as a social justice and human rights movement. (10) While this description might not have been the explanation of harm reduction programs that swayed senators, it is an explanation that should rally another group of potential and seemingly unlikely SEP supporters: churches.
Like the rest of the country, American Christians have been slowly accepting that addiction is an illness not a moral failing. But the programs hosted and funded by most churches still reflect an incomplete understanding of drug use and addiction.
Between AA and NA meetings held in church spaces to faith-based sober houses and drug treatment centers, the North American church has thrown lots of support behind abstinence-based approaches to drug treatment. While these programs can yield powerful healing for some participants, they are not effectively curbing the rising numbers of overdose deaths and infection rates among people who inject drugs. SEPs are doing that work.
In addition to exchanging needles, most of the roughly 230 SEPs in North America also provide general health screenings, HIV counseling, referrals to drug treatment centers, information about safer sex, and access to life-saving overdose reversal drugs like Naloxone. SEPs keep used syringes off the streets and out of landfills. Drug users, highly stigmatized and afraid of arrest, are more likely to seek medical care in these non-judgmental harm reduction programs. And folks who access syringe exchanges have been found to be five times more likely to enter drug treatment than drug users who don't or can't utilize a SEP. (11)(12) This rate of drug treatment enrollment has a great deal to do with SEPs compassionate, low threshold approach to care.
Despite SEPs proven effectiveness, a growing awareness of the cruelty of the drug war and mass incarceration, medical professionals who treat drug addiction like an illness, and a political shift in favor of harm reduction no Christian denomination within the US has released a declaration explicitly in support of SEPs (in 2010 the Central Conference of American Rabbis did release such a statement). (13) Certainly there are a handful of churches employing harm reduction practices but they do so with low funding and little support.
If people of faith are offended by the idea of putting a needle in the hand of a person who injects drugs, it is because of the dangerous and persistent belief that drug users deserve their suffering. Prevailing rhetoric, made more virulent during the drug war of the last few decades, asserts that the person who does not use drugs is "clean", automatically ascribing the category of "unclean" to the drug user. In our collective imagination the drug user has become inherently criminal, asocial, lazy, and deceptive. Biblical purity laws are called forth in these categorizations.
In the Gospel healings performed by Christ, we witness disruption of the existing social stratification more than the working of medical miracles. The unclean were dirty because of their perceived sins, failures, and debts. Quarantining these people outside the boundaries of towns and refusing them entrance into markets and temples was more about domination than fear of contagion. When Christ touches the unclean, he is not merely moving them to a different category. He is invalidating the delineations themselves.
Christ's work to abolish the binary of clean and unclean persons remains part of the church's work today. Drug use will always be a part of our culture. Refusing to provide clean needles to active drug users does nothing to alter that reality. It is the responsibility of the Christian to work for mercy and the alleviation of suffering without judgement of the person seeking services. Christians are already accustomed to providing this kind of care through overflow homeless shelters, soup kitchens, and clothing closets.
During an era when the need is so urgent, churches can respond by adding their monies to now available federal dollars for syringe exchange. Congregants can be rallied to volunteer for existing SEPs. Clergy and lay leaders can make information about harm reduction, drug policy, and overdose prevention available in churches.(14) Buildings emptied by declining church membership but still owned by denominational bodies can be offered to house syringe exchanges. And, most importantly, churches can make space to hear from current and former drug users about the stigma they face.
The overdose epidemic is catastrophic, and the rates of new HIV and hepatitis C infections is only increasing. Christians have an imperative to forward the social justice and human rights movement that is harm reduction for drug users. Making clean syringes available to those in need is our most important work now.
1. Tribune Wire Reports. "Indiana Gov. Mike Pence signs needle-exchange bill as HIV outbreak cases grow." Chicago Tribune. 5 May 2015. < http://www.chicagotribune.com/news/nationworld/ct-indiana-needle-exchange-bill-hiv-outbreak-20150505-story.html >.
2. Bondus, Brian. "Monroe County non-profit opens state's fourth needle exchange program." Fox 59. 14 February 2016. < http://fox59.com/2016/02/14/monroe-county-non-profit-opens-states-fourth-needle-exchange-program/ >.
3. Sanchez, Ray. "Appalachia's hepatitis C infection rates soar." CNN. 6 June 2015. < http://www.cnn.com/2015/06/05/health/appalachia-hepatitis-c-rates/>.
4. Cleek, Ashley. "HIV/AIDS has migrated to Deep South, where stigma endures." Aljazeera America. 26 July 2014. < http://america.aljazeera.com/articles/2014/7/26/hiv-aids-in-the-deepsouth.html >.
5. Park, Haeyoun, and Matthew Bloch. "How the Epidemic of Drug Overdose Deaths Ripples Across America." The New York Times. 19 January 2016. < http://www.nytimes.com/interactive/2016/01/07/us/drug-overdose-deaths-in-the-us.html >.
6. Stanton, John. "After Decades, Congress Effectively Lifts Ban on Federally Funded Needle Exchanges." Buzz Feed News. 5 January 2016. < http://www.buzzfeed.com/johnstanton/after-decades-congress-effectively-lifts-ban-on-federally-fu#.le6e3PNzK >.
7. "Effectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users." World Health Organization. 2004. <http://www.who.int/hiv/pub/prev_care/effectivenesssterileneedle.pdf >.
8. "HIV cost-effectiveness." Centers for Disease Control and Prevention. 23 September 2015. < http://www.cdc.gov/hiv/prevention/ongoing/costeffectiveness/>.
9. Fox, Maggie. "Company Put Profit Over Patients in Pricing $1,000 Hepatitis Pills: Senate Report." NBC News. 1 December 2015. < http://www.nbcnews.com/health/health-news/company-put-profit-over-patients-pricing-1-000-hepatitis-pills-n472171 >.
10. "Principles of Harm Reduction." Harm Reduction Coalition. n.d. < http://harmreduction.org/about-us/principles-of-harm-reduction/>.
11. North American Syringe Exchange Network. 2016. <https://nasen.org/>.
12. "Needle Exchange Programs Promote Public Safety." American Civil Liberties Union. 2015. < https://www.aclu.org/needle-exchange-programs-promote-public-safety#16 >.
13. "Resolution on Syringe Exchange Programs (CCAR)." Religious Institute. 7 July 2010. < http://www.religiousinstitute.org/resolution-on-syringe-exchange-programs-ccar/ >.
14. Among other organizations, the Harm Reduction Coalition and the Drug Policy Alliance provide print and online educational materials. The Harm Reduction Coalition also hosts online trainings and webinars.
*Though the ban on federal funding for exchange programs has now been repealed, federal money still can't be spent on the syringes themselves. Syringes are hard for drug users to procure because most pharmacies require persons to present a prescription to buy syringes.