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

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.