News that Congress reached a budget deal has been met with glee by D.C. pundits, but there is an unresolved issue on the minds of many in the Maryland medical community — will they see sense and lift the ban on federal funding for Syringe Services Programs (SSPs)?
Currently Congress refuses to provide us with one of the cheapest, most effective tools as we struggle against the spread of HIV/AIDS and hepatitis C in our communities. In response, over 70 scientists and health practitioners from Maryland have written to Sen. Barbara Mikulski, asking her to help end the ban. Such action is essential not just for our state but for the country as a whole.
By providing sterile syringes to people who inject drugs, SSPs minimize the spread of both HIV and hepatitis C. Baltimore City has first-hand knowledge of their success, having had a locally funded needle exchange program since 1994. It has been pivotal in reducing HIV diagnoses attributable to injection drug use in Maryland. However, additional resources are needed in Baltimore and throughout Maryland as the crackdown on prescription drugs has led to a dramatic rise in heroin use because individuals switch to cheaper and more available drugs. More people in Maryland now die from heroin overdoses than homicide. Lifting the federal funding ban would encourage other jurisdictions in Maryland to establish their own SSPs and tackle these issues.
Our letter to Senator Mikulski demonstrates the broad-based support for SSPs among nurses, physicians, scientists and other public health professionals throughout Maryland. Our partners in the law enforcement community have also made the public safety case. Jim Pugel, interim chief of the Seattle Police Department, recently wrote that, SSPs were a "vital bridge to drug treatment" and the ban has "made our communities, police officers and medical responders less safe." They make neighborhoods safer because they provide a place for syringe disposal, reducing the risk that our children will accidentally pick up syringes.
The ban is a remnant of the polarized HIV/AIDS debate in the '80s and '90s, when politicians wrongly believed that providing sterile syringes would increase drug use. In fact, research shows that SSPs connect people to addiction treatment and overdose prevention services. The ban was briefly lifted under the Obama administration in 2009, only to be reinstated in December 2011. The federal ban takes the form of language inserted into appropriations legislation.
Importantly, at a time of fiscal frugality, lifting the ban would not involve the spending of additional federal dollars; the change would simply allow state and local health officials to spend federal dollars as they see fit. SSPs also save taxpayer money because such a low-cost intervention can prevent a lifetime's worth of cost for HIV/AIDS treatment — estimated to be around $400,000 to $600,000.
Fortunately for Marylanders, Senator Mikulski is a longtime champion of evidence-based health policy. As Senate appropriations chairwoman, she has drafted and supported legislation to lift the ban in the fiscal 2014 government funding bill. If there are bicameral negotiations to fund the federal government, it is our hope that Senator Mikulski will continue to push the House to remove this counterproductive regulation.
There are few occasions where members of the medical community can advocate for a program that costs nothing, saves taxpayer dollars, and saves lives. This is one of those occasions. Last week saw the celebration of World AIDS Day, which had the theme of "Shared Responsibility" — it is time for Congress to do its part in the fight against AIDS by lifting the senseless syringe funding ban.
Dr. Chris Beyrer is a professor of epidemiology, international health and health, behavior and society at the Johns Hopkins Bloomberg School of Public Health. He is also President-Elect of the International AIDS Society. His email is firstname.lastname@example.org.
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