Association for Public Policy Analysis & Management

The increase in the use of prescription and illegal opioid drugs in the United States since the early 2000s has raised concern about the spread of bloodborne illnesses through syringe sharing. In response, many public health entities have called for an expansion in syringe exchange programs (SEPs), which provide access to sterile syringes and facilitate safe disposal of used needles for injection drug users. This paper investigates the effects of recent SEP openings on HIV diagnoses and drug-related mortality in the wake of the opioid crisis using a difference-in-differences approach that compares the changes in health outcomes in counties that introduced SEPs to changes in other US counties with existing SEPs. I find that SEP openings decrease HIV diagnoses by 11.3-30.0 percent, corresponding to 30 fewer HIV cases per county per year, on average. However, I present new evidence that SEPs increase rates of opioid-induced mortality and opioid-related hospital admissions, especially in rural and high-poverty areas, suggesting that needle exchanges may be less effective than other interventions at stimulating recovery.