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June 5, 2018

Public Support for Needle Exchange Programs, Safe Injection Sites Remains Low in U.S.

Implementing these harm-reduction strategies will be difficult as long as the stigma of opioid abuse remains high, suggests a large nationwide survey

Two strategies that research indicates would help alleviate America’s opioid crisis lack widespread public support, according to a study led by researchers at Johns Hopkins Bloomberg School of Public Health.

The study, published in the June issue of Preventive Medicine, is the first to poll a large, nationwide, representative sample of Americans for their views on safe consumption sites (also sometimes called “safe injection sites”) and syringe services (sometimes referred to as needle exchange) programs. Both of these harm-reduction strategies have been found to reduce drug overdoses and HIV transmission.

The results suggest that average Americans tend to view these strategies negatively. Among the 1,004 adults sampled, only 29 percent supported legalizing safe consumption sites in their communities and only 39 percent supported legalizing syringe services programs in their communities. Respondents who had negative views about these strategies also tended to have very negative views of opioid users.

“These results suggest that we need to reduce stigma toward people who use opioids and do a better job educating the public about why these strategies work,” says study lead author Emma E. McGinty, PhD, an assistant professor in the Department of Health Policy and Management at the Bloomberg School.

Syringe service programs provide clean syringes to people using drugs to reduce the transmission of HIV and other viruses by needle sharing. More than 300 of these programs are already in place across the U.S., including in cities such as Baltimore that have long been plagued by heroin use. Numerous studies have shown that they are effective in reducing disease transmission.

“Safe consumption site” programs provide spaces where users can legally use previously purchased opioids or other drugs under medical supervision. Studies have found that these programs, which have been implemented in Canada and multiple European countries, can decrease overdose deaths and public drug use. Although they have not yet been implemented within the U.S., a number of cities hard-hit by the opioid crisis are considering establishing them, including San Francisco, Philadelphia, New York City and Seattle.

Prior to the new study, there was no nationwide data on Americans’ attitudes towards safe consumption sites and no recent nationwide data on syringe service programs. Despite growing public attention to addiction prompted by the rapidly rising rates of opioid overdose deaths, the last national survey to assess public attitudes about syringe services programs was conducted in 2000. McGinty and colleagues conducted their web-based survey using the GfK Knowledge Networks (GfK) panel, a representative nationwide group of more than 65,000 U.S. adults. They administered the survey to a random sample of 1,429 people and received responses from 1,004.

Among the respondents, Democrats and Republicans diverged in their views. While only 18 percent and 30 percent of Republicans favored having safe consumption sites and syringe services programs, respectively, in their communities, the corresponding figures for Democrats were higher at 39 percent and 52 percent. Unemployed respondents and those with a bachelor’s degree or higher were also more likely to favor these programs. However, attitudes did not differ much by age, race or gender, and no demographic category was associated with strongly favorable views of these programs.

“The biggest take-home message from these sub-group analyses is that there are not many differences in attitudes across demographic categories, with the exception of political party identification.” McGinty says.

The survey measured the stigmatizing attitudes of respondents towards people who use opioids by asking, for example, about their willingness to have a person who is using opioids marry into their family or to start working closely with a user on a job. To those two questions, only 16 and 28 percent of respondents answered favorably. Respondents with highly negative views of people who use opioids were much less likely to support the two harm-reduction strategies.

While the general public shows low support for legalizing safe consumption sites and syringe services programs, these harm-reduction strategies are supported by research and could play important roles in alleviating the public health burden from the opioid epidemic. McGinty and colleagues are now considering how to design information campaigns to boost public support for them.

“We need to do more research on what messages are effective in correcting myths about syringe services and safe consumption programs and reducing the stigma attached to them to save lives,” says Susan Sherman, PhD, MPH, a professor in the Bloomberg School’s Department of Health, Behavior and Society and study co-author.

“Public support for safe consumption sites and syringe services programs to combat the opioid epidemic” was written by Emma E. McGinty, Colleen L. Barry, Elizabeth M. Stone, Jeff Niederdeppe, Alene Kennedy-Hendricks, Sarah Linden and Susan G. Sherman.

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Media contacts for the Johns Hopkins Bloomberg School of Public Health: Barbara Benham at 410-614-6029 or bbenham1@jhu.edu and Robin Scullin at 410-955-7619 or rsculli1@jhu.edu.