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
- 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
- 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
- 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.
- 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.
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
- 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. 3 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
- 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
- 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
- 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 [email protected].