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1996-05-06
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Date: Mon, 22 May 95 14:51:14
From: "mapostolides" <mapostolides@sorosny.org>
Message-Id: <9504228011.AA801179474@soros.sorosny.org>
To: drctalk-l@netcom.com
Subject: needle exchange fact sheet
Hey, folks. I'm writing from The Lindesmith Center (we sorta got
dissed a while ago, since we haven't really been posting much on
drctalk). But we read you guys everyday (my morning ritual is
peppermint tea, Crispex, and my beloved drctalk...!) Anyway, I'm
posting a fact sheet I wrote on NEPs. One of The Lindesmith Center's
projects for the summer is to compile brief fact sheets on issues like
methadone maintenance, mandatory minimums, Dutch drug policy, etc.
With these fact sheets, we'll be able to respond quickly when someone
like Solomon shoots off his mouth.
I'd be glad to send anyone the fact sheet via snailmail (it looks
nifty on our letterhead) in case you want to distribute it or
something. We also have a version that has citations for all the
statistics, if anyone wants that.
So, let me know what you think.
Marianne
NEEDLE EXCHANGE PROGRAMS
Needle exchange programs (NEPs) are a simple, cost-effective way to
reduce needle sharing, curtail the transmission of HIV/AIDS, increase
the safe disposal of used needles, provide information to injecting
drug users (IDUs), and help users obtain drug treatment, detox, and
primary health care. Yet the U.S. government prohibits federal
funding of NEPs, and many state governments criminalize them. By
contrast, national and local governments in Western Europe and
Australia have made sterile syringes widely accessible through needle
exchanges and pharmacies.
Scientific communities support needle exchanges.
? Virtually every scientific body supports needle exchanges: the
United States Centers for Disease Control, the National Commission on
AIDS, the General Accounting Office, the National Academy of Sciences.
? The National Commission on AIDS concluded "Legal sanctions on
injection equipment do not reduce illicit drug use, but they do
increase the sharing of injection equipment and hence the spread of
AIDS."
Needle exchanges reduce the spread of HIV/AIDS.
? As the use of needle exchanges increases, the use of shared needles
decreases.
? A 1994 study of New York City IDUs concluded that "regular
participation in these syringe exchange programs would reduce the risk
of HIV infection by approximately half."
? In one month in 1992, the Prevention Point NEP in San Francisco
disposed of approximately 8600 HIV-contaminated syringes.
? In a 1992 study of needle exchange clients in New Haven,
Connecticut, new HIV infections were cut by one-third.
? Diabetic IDUs with legal access to clean needles had significantly
lower rates of HIV than non-diabetic IDUs -- 9.8% versus 24.3% -- even
though the duration and intensity of drug use were similar.
The costs of AIDS are rapidly rising in both human and economic terms.
? By 1994, 125,000 people had developed AIDS as a result of injecting
drugs with unsterile syringes.
? Over a third of new AIDS cases stem from injection drug use.
? AIDS is the leading cause of death among all Americans aged 25 to
44.
? As more and more people contract HIV through dirty needles, the
proportion of all AIDS patients who are injecting drug users (IDUs),
their sex partners, or their children is growing.
? The cumulative cost in the United States of treating all people with
HIV or AIDS will be $15.2 billion in 1995.
? NEPs have a median annual budget of $169,000. Since the yearly cost
of treating one person with AIDS is $38,300, each needle exchange
program would more than pay for itself by preventing the transmission
of HIV/AIDS to just five people.
Drug paraphernalia and prescription laws impede the establishment of
needle exchanges.
? NEPs in the United States are either legal, decriminalized, or
illegal. The legal status of NEPs depend on individual states' drug
paraphernalia and prescription laws, and on local laws.
? All but six U.S. states have drug paraphernalia laws that
criminalize the possession or distribution of syringes except for
"legitimate medical purposes."
? Nine states and Washington, D.C. prohibit the purchase of syringes
without a prescription. These laws -- in states like New York,
California, and Illinois which have large IDU and HIV/AIDS populations
-- affect the vast majority of illicit drug injectors.
? Local governments, which understand the need for NEPs, sometimes
grant exemptions to state laws against them.
(continued on other side)
(continued from other side)
? By the late 1980s, virtually all developed countries other than the
U.S. had made legal access to sterile injection equipment a primary
component of AIDS prevention for IDUs. NEPs are now commonplace
throughout the Netherlands, Britain, Switzerland, Australia, and
dozens of other European cities.
? The only two countries in Europe and Oceania which ever enacted
prescription or paraphernalia laws -- France and Austria -- both
repealed those laws during the mid-1980s.
Needle exchanges in action: How they work, whom they affect.
? There are approximately 77 needle exchange programs, more than
double the number in 1993, when the existing 33 NEPs administered a
total of 102 exchange sites. The number continues to grow.
? Most NEPs operate on the principle of a one-for-one exchange: the
user receives one clean needle for every used needle he brings.
? The vast majority of needle exchange sites are storefronts,
scheduled mobile van stops at designated street corners, or street
exchanges by outreach workers.
? In addition to providing needles, programs distribute alcohol swabs
to clean the skin before injection, medicative ointments for
infections, sterile water, vials of bleach to disinfect used needles
when new ones are not available, health pamphlets, condoms, and
sharpsafe containers where users can safely dispose of dirty needles.
? People who use needle exchanges are not new users who start
injecting because they can get clean needles. One year after a San
Francisco needle exchange opened, only 3% of the clients had used
drugs for less than a year. Three years later, only 1.1% had.
? The 1988 opening of Prevention Point, an active NEP in San
Francisco, did not draw people to start using drugs. The minimum age
of IDUs in San Francisco remained virtually the same from 1987 to
1992, and the mean age increased by almost five years from 35.8 years
to 41.6 years.
? Since NEPs operate on a one-for-one exchange, they provide an
incentive against discarding needles on the street. A study conducted
by Portland's NEP Outside-In found that the number of needles
discarded in the neighborhood with the needle exchange dropped after
the NEP opened.
Other needle distribution methods can augment the effectiveness of
needle exchanges.
? Different options for obtaining syringes should be available to meet
the different needs of different users. The 1988 UK Advisory Council
on the Misuse of Drugs declared "a combination of syringe exchange
schemes and over-the-counter sales from community pharmacies offers
the best solution [to IDUs' lack of access to sterile injection
equipment]."
? Pharmacies sell syringes in almost all countries in Europe and
Australia. Pharmacies make needles readily available to most people
since they are located virtually everywhere and are open at all hours.
In addition, pharmacies do not carry the stigma some associate with
NEPs.
? In over a dozen European and Australian cities, needles are
available from vending machines which deliver a clean needle when a
used one is deposited. They make sense especially in high-use drug
areas where users need clean syringes late at night, and in rural
areas or smaller cities where the IDU population isn't big enough to
support needle exchanges.
The government should make specific policy changes to curtail the
spread of HIV/AIDS.
? State governments should repeal their drug paraphernalia laws so
that possession of syringes is legal.
? The nine state governments with prescription laws should repeal
those laws so that pharmacies and NEPs can legally sell or distribute
syringes.
? Local governments should seek exemptions to the prescription laws
until these laws are repealed.
? The federal government should repeal the ban on federal funding of
NEPs.
? The federal government should begin funding NEPs to expand the
network of needle exchanges and increase their hours of operation,
both of which would make sterile syringes more accessible. The funding
would also enable NEPs to provide services like primary health care
and testing for tuberculosis.
For further information or source citations, contact Dan Weiller at
(212) 887-0695 or via e-mail at dweiller@sorosnyorg.