What do Syringe Services Programs (SSPs) mean for Maryland?

“It’s not the science that’s in question, it’s the politics.”

- Dr. Peter Beilenson, former Baltimore City Health Commissioner1

Why Maryland?

Maryland has the fourth highest percentage of cumulative AIDS diagnoses attributable to injection drug use (IDU) in the country.2 Maryland’s history shows that simple interventions requiring modest investment can reverse this trend. Syringe Service Programs Work in Maryland

• Baltimore City is currently the only jurisdiction in Maryland permitted to conduct syringe exchange. • The Baltimore City SSP Program began in 1994. It receives more than 17,000 visits annually and

exchanges nearly a half million needles each year. • It also provides vaccinations, wound care, and reproductive health services, and connects clients to drug

treatment and supportive housing slots. • Over the course of 12 years, the Baltimore SSP has served more than 14,000 IDUs and referred

approximately 2,300 SSP users to treatment programs.3

• A study in Baltimore has demonstrated that SSPs that are closely linked with drug treatment programs have high levels of retention for substance abuse treatment.4

• With the help of SSPs, the proportion of HIV diagnoses attributable to injection drug use in Maryland has dropped from 53.3% to an all-time low of 15.9% in 2010.5

Trends in HIV Diagnoses by Exposure Category in MD, 1985-20105  

                                                                                                                         1 Bor, Jonathan. Needle program no spur to crime: City’s exchange effort has little effect on arrests, study says. Baltimore Sun (March 30,

1999). Available at: http://articles.baltimoresun.com/1999-03-30/news/9903300196_1_clean-needles-needle-program-needle-exchange 2 40.6 percent, compared to 25.2 percent nationally. Maryland: Estimated Numbers of AIDS Diagnoses Among Adults and Adolescents by Transmission

Category, Cumulative through 2010. Available at: http://www.statehealthfacts.org/comparetable.jsp?ind=845&cat=11 3 Latkin, C.A., Davey, M.A., Hua, W. (2006). Needle exchange program utilization and entry into drug user treatment: Is there a long-term connection in

Baltimore, Maryland? Substance Use & Misuse 41(14): 1991-2001. 4 Brooner, R., et al. (1998). Drug abuse treatment success among needle exchange participants. Public Health Reports 113(Suppl 1): 129. 5 Maryland Department of Health and Mental Hygiene. (2011). Maryland HIV/AIDS Epidemiological Profile: Fourth Quarter 2011: 30. Available online at

http://ideha.dhmh.maryland.gov/OIDEOR/CHSE/Shared%20Documents/Maryland%20HIV%20AIDS%20Epidemiological%20Profile%2012-2011.pdf

30%  

8%  54%  

7%  

Maryland Population, by Ethnicity (2011)5

Non-Hispanic Black

Hispanic

Non-Hispanic White

Other 86%  

2%   12%  

IDU Living With HIV/AIDS In Maryland, by Ethnicity

(2010)4 Non-Hispanic Black

Hispanic

Non-Hispanic White

Lack of access to SSPs disproportionately affects African Americans

Although African Americans account for 30% of the state’s population, they comprise 86% of Maryland’s IDUs living with HIV/AIDS.5 African American IDUs have been identified as a priority population for HIV prevention.6

Syringe Service Programs are important for Hepatitis C prevention7891011    

   

 

 

How can Syringe Service Programs help address overdose deaths?

• In Maryland, the age-adjusted death rate for overdose/intoxication deaths for 2007 to 2011 was 11.5 per 100,000, ranging from 4.3 per 100,000 in Montgomery County to 27.7 per 100,000 in Baltimore City.12

• Heroin remains the most common substance associated with intoxication deaths in Baltimore City.13 • The Department of Health and Mental Hygiene has identified a recent shift from prescription opioids to

heroin among drug overdose deaths in Maryland.14 • In the state of Maryland, the number of drug overdose deaths increased 6% over the past year.14

• However, in the City of Baltimore, the drug overdose prevention program operated by Baltimore’s SSP has contributed to a  54% reduction in opioid related overdose deaths, from 307 deaths in 2002 to 140 deaths in 2011.12,15

16

Syringe Service Programs Save Money and Lives

Maryland’s relatively small investment in SSP funding can have huge returns. Studies have shown that every $1 invested in syringe service programs results in $3-7 in savings in HIV treatment alone.16

                                                                                                                         6 U.S. Census Bureau. (2012). State & county quick facts: Maryland. Available online at http://quickfacts.census.gov/qfd/states/24000.html. 7 Villano, S. A., Vlahov, D., Nelson, K. E., Lyles, C. M., Cohn, S., & Thomas, D. L. (1997). Incidence and risk factors for hepatitis C among injection drug

users in Baltimore, Maryland. Journal of clinical microbiology, 35(12), 3274-3277. 8 Thomas, D. L., Vlahov, D., Solomon, L., Cohn, S., Taylor, E., Garfein, R., & Nelson, K. E. (1995). Correlates of hepatitis C virus infections among

injection drug users. Medicine, 74(4), 212. 9 The BESURE Study 2012 Update. Available online at: http://ideha.dhmh.maryland.gov/OIDEOR/CHSE/Documents/Meeting%20Handout.pdf 10 Alter, M. J. (2002). Prevention of spread of hepatitis C. Hepatology, 36(5B), s93-s98. 11 Prevalence prior to implementation was 91% and fell to 56%. Des Jarlais, D. Reducing HIV and HCV transmission among injecting drug users in New

York, Presentation May 10, 2008, International Harm Reduction Conference. 12 Maryland Department of Health & Mental Hygiene report on “Drug and Alcohol Intoxication Deaths in Maryland, 2007 to 2011.” Available at:

http://dhmh.maryland.gov/vsa/Documents/Drug-and-Alcohol-Report-v5.pdf 13 Baltimore City Health Department, Press Release, July 28, 2011. Health Department releases 2009 annual drug intoxication report. 14 Data used to determine all overdose death figures comes from the Office of the Chief Medical Examiner. The methodology used for determining

overdose death figures was developed by the Vital Statistics Administration and is available online at: http://dhmh.maryland.gov/vsa/Documents/Methods--drug-report.pdf.

15 Office of Epidemiology and Planning, Baltimore City Health Department. Intoxication Deaths Associated with Drugs of Abuse or Alcohol. Baltimore City, Maryland: Baltimore City Health Department. January 2007.

16 Nguyen TQ. Increasing investment in syringe exchange is cost-saving HIV prevention: modeling hypothetical syringe coverage levels in the United States. Nineteenth International AIDS Conference, Washington DC, abstract MOAE0204, 2012.

The Problem

• Risk of Hepatitis C transmission increases by sharing drug paraphernalia7 and through increased frequency and duration of injecting.8

• 30-50% of Maryland’s IDUs have Hepatitis C.9 • 78% of IDUs in Baltimore became infected with

Hepatitis C after only 2 years of injecting.8  

How can SSPs help?

• The majority of hepatitis C cases are related to injection drug use.10

• Following large scale implementation of syringe services, hepatitis C prevalence among IDUs in NYC decreased by more than 35%.11