Needle exchange programs are a proven means of reducing the spread of HIV and hepatitis among intravenous drug users. They are endorsed by the Centers for Disease Control and Prevention, the surgeon general of the United States, the World Health Organization, the American Public Health Association, and the American Medical Association. Nevertheless, needle exchange programs are legally permitted to operate in only 30 states and the District of Columbia. Drug paraphernalia laws make them illegal elsewhere.

Critics of needle exchange programs claim they “enable” or “endorse” illicit drug use. “Not‐​in‐​my‐​backyard” attitudes fuel opposition in local communities. Experts will discuss the efficacy and role of this harm‐​reduction strategy as well as the political challenges to its widespread adoption.