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Viewpoint
July 7, 2015

Ideological Anachronism Involving Needle and Syringe Exchange ProgramsLessons From the Indiana HIV Outbreak

Author Affiliations
  • 1Medicine and Epidemiology, Brown University, Providence, Rhode Island
  • 2The Center for Prisoner Health and Human Rights, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
  • 3Medical Science, Brown University, Providence, Rhode Island
JAMA. 2015;314(1):23-24. doi:10.1001/jama.2015.6303

On March 26, 2015, Governor Mike Pence of Indiana issued an executive order declaring a state of public health emergency in Scott County with an eye toward stemming the largest-ever HIV outbreak in the state. Evolving over 2 months, the HIV outbreak involved 153 confirmed cases and has been traced to extensive needle sharing by people who inject drugs.1 Most of the confirmed HIV cases were associated with the intravenous use of a liquefied form of the opioid agonist oxymorphone (a Schedule II controlled substance) otherwise marketed as an extended-release tablet (Opana). Methamphetamine and heroin have been implicated as well. Concurrently, Governor Pence authorized a renewable short-term (30-day) needle and syringe exchange program (NSEP), the scope of which was to be delimited to Scott County. In so doing, Governor Pence temporarily overrode 3 drug paraphernalia state laws criminalizing the possession and distribution of sterile syringes. This Viewpoint describes federal and state syringe access policies, explores their attendant ideological backdrop, and points out their role in the eruption and amplification of avoidable HIV outbreaks.

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