Obstacles in harm reduction implementation: Lessons from founding the Orange County Needle Exchange Program

Issue: Public health researchers have repeatedly shown needle exchange programs (NEPs) to be effective, cost-efficient tools to combat HIV and hepatitis C while connecting injection drug users (IDUs) to resources. However, despite decades of evidence, the United States has a national ban on federal funding for NEPs, harm reduction programs are illegal in many states, and local opposition can prevent the implementation of programs even where they are legal. Overcoming these obstacles can be easier with an understanding of alternative legal, research, and community organization approaches.

Description: The Orange County Needle Exchange Program is a volunteer-run, student-organized, consensus-driven needle exchange implemented in Orange County, a conservative region of California. Our program has overcome substantial local opposition to harm reduction efforts and limited funding through working with state public health, building a diverse, strong community coalition, support from other NEPs and similar non-profits, and operating in an open format.

Lessons learned: Off-the-beaten track options sometimes exist to allow NEP implementation. Legal options exist in some states for non-local authorities to approve programs. Incorporating IDUs into the leadership of programs can build respect and sustainability when organizers are not from the local community and ensures programs serve actual IDU needs. Establishing a broad coalition of community support, both local and regional, helps overcome hurdles and rally support. NEPs should understand potential law enforcement objections, zoning regulations, land use or other permit regulations, and other methods used to delay or prevent program implementation.

Recommendations: Programs in some regions can face local opposition, but this can be bridged. Other needle exchanges and harm reduction experts are crucial sources of advice and support, as are IDUs themselves. Understanding alternatives to standard implementation via local public health agencies can make it possible to implement programs where it would otherwise be impossible.