Public opinion about syringe exchange programmes in the USA: An analysis of national surveys

Background: Despite scientific evidence demonstrating their effectiveness, syringe exchange programs (SEPs) have not been as widely embraced by policy-makers in the USA as in some other nations. One reason for this disjunction between science and policy may be the effect of public opinion. Methods: To better understand the role of public opinion in shaping SEP policies, we undertook a systematic search for all reported U.S. national surveys asking about support or opposition to SEPs. Relevant polls were identified through a national database of public opinion questions, and a similar search of a newspaper database. We present the survey findings. The wording of poll questions and the agenda of organisations sponsoring the polls are also examined. Results: Twenty-one questions from 14 different polls conducted from 1987 to 2000 were identified. Support for SEPs ranged from 29 to 66%. Surveys conducted by organisations with a public health agenda were more likely to suggest support for SEPs than those sponsored by organisations with a "family values" perspective. Question wording appeared to strongly influence support for SEPs. Poll questions that referred to "drug addicts" were less likely to indicate majority support for SEPs than those that avoided loaded terms or that provided public health information to respondents. Discussion: Public opinion regarding SEPs is very malleable, strongly affected by question wording or other biases of organisations sponsoring the polls. Therefore, there may be no clear national consensus on the desirability of SEPs. Our findings are particularly relevant for national policy, such as federal funding for SEPs.