ICBioethics Blog 

Emergency Needle Exchange Program in Indiana

On March 26th, 2015, Governor Pence of Indiana declared a public health emergency in Scott County. According to public health records, 79 new cases of HIV since December 2014 were confirmed, meaning an epidemic level, compared to the typical 5 per year. The epidemic is linked to intravenous drug use and reuse of dirty, HIV+ needles. In response, Governor Pence issued an executive order that coordinated a short-term (30-day) needle exchange program (NEP) and other HIV treatment resources . . . interesting, considering that NEPs are illegal in Indiana. Pence maintains that this short-term NEP for addressing the epidemic issue does not provide support to legalizing such programs.

There are many who support NEPs, not drug usage, because they may limit HIV and other serious disease transmission. Although some favor NEPs and also favor the decriminalization of drug use, they do not necessarily go hand in hand. Studies have demonstrated that NEPs do not increase incidence rate of drug use; however, those same studies don’t examine the habits of current drug users seeking out an NEP. Nevertheless, studies have shown NEPs help reduce the spread of HIV among intravenous drug users.

This discussion takes center stage when an epidemic occurs. However, the ethical issues of NEPs bear examining in absence of emergency, as well. The issues of beneficence and nonmaleficence come into play. While providing clean needles may benefit the user and prevent HIV, it also provides the means to do harm – i.e., take illicit drugs. Some are concerned that NEPs indirectly permit, even encourage, drug use.

Creating a short-term NEP demonstrates that Pence recognizes its ability to prevent diseases. But considering their ability to prevent disease, should NEPs be used even when there isn’t an epidemic?

How would you describe Governor Pence’s action? Responsive? Smart? Inadequate? Hypocritical? Necessary? Inconsistent?

Mitch Gennuso