Jerome Adams and Mazen Saleh: Clean syringes seem counterintuitive to fentanyl fight. But needle exchange saves lives.

(Dr. Jerome Adams, a licensed anesthesiologist, is the executive director of Purdue University’s Health Equity Initiatives. He served as the 20th U.S. surgeon general from 2017 to 2021, and as commissioner of the Indiana Health Department 2014-17. Mazen Saleh is the policy director for the Integrated Harm Reduction program at the R Street Institute.) It can seem counterintuitive to provide clean syringes to individuals who inject drugs. After all, why make it easier to consume illicit substances that are increasingly resulting in overdoses? In the fight against fentanyl, however, a clean syringe can be a lifesaving connection. We might not be able to stop every overdose, but if we can provide a tool to forge those connections and make illicit drug use safer, then we should. Colloquially known as syringe services programs, SSPs aim to reduce infectious disease transmission acquired from shared needles. In this regard they are undeniably effective, yielding a 50% reduction in HIV and hepatitis C transmission. Syringe exchange programs are certainly not without controversy, but having been around for more than three decades, SSPs are neither novel nor lacking in evidence of their public health efficacy and societal cost savings.

A growing number of conservative states – often concerned that overdoses are increasing year over year – are moving to restrict or close down needle exchange programs. We’ve seen this in Idaho, Nebraska and West Virginia. Skepticism is understandable, as we are all frustrated by an ever-evolving opioid epidemic that now is dominated by fentanyl. Even so, it is critical to follow the facts and use every tool at our disposal to fight this unrelenting enemy. One of us is a former commissioner of the Indiana Health Department and knows from working on the ground with vocal opponents of SSPs – ranging from local law enforcement to community members – that contrary to what some skeptics claim, these programs have long contributed to community safety. An SSP in Indiana had a lifetime syringe return rate of 92%. One in Florida reduced public syringe litter by nearly half. Being uncomfortable with a solution, or frustrated with what seems like a lack of progress, is not a reason to stop using tactics proven to save lives and advance public safety. If we’re going to create connections to those who often feel separated from society, and protect individuals and communities, we have to stop pitting public health against public safety. We can accomplish both, which is reflected in how SSPs have evolved to address this crisis. They offer not just sterile syringes but also overdose prevention education and tools, community support services, and pathways to treatment and recovery.