When it comes to combating opioid misuse and addiction, needle exchanges and safe injection sites have solid evidence behind them. Yet a new study published in Preventive Medicine found that a majority of Americans oppose both — and stigmatizing attitudes toward people with addiction appear to be to blame.
A new study shows stigma is hurting our response to the opioid epidemic
Needle exchanges have decades of evidence behind them — but not public support.
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For the study, researchers conducted a survey of more than 1,000 Americans asking about their attitudes on needle exchanges, safe injection sites, and addiction more broadly. They found that about 39 percent of Americans support needle exchanges, while around 29 percent back safe injection sites.
The survey also measured respondents’ stigmatizing attitudes toward addiction, putting together a composite of questions — whether they’d be willing to have a person who is using opioids marry into their family or start working closely with them on a job, and their overall feelings of people who use opioids.
The researchers concluded: “Individuals with higher stigma toward people who use opioids were less likely to support legalization of safe consumption sites … or syringe services programs.”
Needle exchanges are places where someone can dispose of used syringes, which are used to inject drugs, and obtain sterile syringes. The idea is that although you can’t stop everyone from using drugs, you can at least minimize the harms of drug use. The decades of research into such programs is clear: They combat the spread of bloodborne diseases like hepatitis C and HIV, cut down on the number of needles thrown out in public spaces, and link more people to treatment — all without enabling more drug use.
Safe injection sites, meanwhile, provide a place for people to use drugs under medical supervision in case anything goes wrong — like, say, an overdose. Drawing on more than a decade of studies, the European Monitoring Centre for Drugs and Drug Addiction in 2017 concluded that safe injection sites led to “safer use for clients” and “wider health and public order benefits.” Among those benefits: reductions in risky behavior that can lead to HIV or hepatitis C transmission, drops in drug-related deaths and emergency service call-outs related to overdoses, and greater uptake in drug addiction treatment, including highly effective medications for opioid addiction.
Yet despite the preponderance of empirical evidence supporting needle exchanges and safe injection sites, stigma holds back these policies. This is something I’ve seen time and time again in my reporting on the opioid epidemic. For example, when I asked the architects of Vermont’s “hub and spoke” system — which integrates addiction treatment into the rest of health care — what the biggest hurdles were to implementation, the barriers were not so much money or lack of evidence, but stigma.
John Brooklyn, a chief architect of the hub-and-spoke system, referred to perceptions of evidence-based anti-addiction medications like buprenorphine as an example: “It’s now 14 years after buprenorphine’s been approved [by the Food and Drug Administration], and you still have an awful lot of docs — you even have our [former] secretary of health and human services — who [say] medication-assisted treatment is just a crutch.”
Or consider one of the emails I received in response to a story on opioids: “Darwin’s Theory says ‘survival of the fittest.’ Let these lost souls pay the price of their criminal choices and criminal actions. Society does not owe them multiple medical resuscitations from their own bad judgment, criminal activity, and self-inflicted wounds.”
It is inconceivable that anyone would view, say, heart disease or cancer in a similar way. If the health care system let someone die of a heart attack because he ate a hamburger, or of cancer because that person once smoked a cigarette, it would be widely decried.
After decades of treating addiction as mainly a criminal justice, not public health, problem, the same does not seem to apply to drug use disorders. The result is studies like this one — showing that rather than the lack of evidence for a policy intervention, it’s stigma that plays a prominent role.
