Needle Exchange

Last week Scotland’s leading law officer, the Lord Advocate, brought a shuddering halt to a proposal from Glasgow City Council to develop a safe injecting centre in the city. Such a centre would have required a change in UK drug laws to enable individuals in possession of illegal drugs to use those drugs within the centre without fear of prosecution. Supporters of this initiative will be disappointed by the outcome, but they need to recognise that the provision of some level of legal protection covering the possession of illegal drugs within the injecting centre would also, by implication, need to be extended to all of those who might claim, legitimately or otherwise, that their drug possession should be green-lighted because they were en route to the injecting centre. In effect, such an initiative would deliver what many of its supporters actually desire – the legalisation of illegal drugs within at least some part of the UK.

In his judgement, the Lord Advocate has not ruled against setting up a centre where doctors can prescribe opiate drugs to addicts. Rather he has simply pointed out that he is not prepared to offer legal protection to a centre where illegal drugs are being used. The Glasgow proposal sought unwisely to tie the proposal for a doctor-led heroin prescribing clinic, which would be legal, with a setting where individuals are allowed to use illegal drugs which would break UK drug laws. There will be many who rightly question the wisdom (and the cost to the public purse) of linking those two proposals.

It is often said by the supporters of these centres that where they have been established in other countries no individual has actually died in a drug consumption room. That might be so, but the lack of such deaths is not the high-water mark of success for drug treatment services. The rise in addict deaths in Scotland and in England shows that we need to do much more by way of engaging drug users in services. Doing more should entail taking services to drug users themselves wherever they are living and wherever they are using illegal drugs. Setting up a city-centre location where people can use illegal drugs under some level of legal protection betrays a worrying lack of knowledge both about Glasgow itself and about the life of an addict. Glasgow is a territorial city par excellence and there are addicts who cross into different parts of the city at their genuine peril. Similarly, when addicts secure the drugs they so desperately need their first thought is not ‘How do I travel to a city-centre location where I may use these drugs without fear of prosecution?’ but ‘Where is the needle that will enable me to inject now?’ It is for both of those reasons that we should be talking about how to take services to the addicts rather than how to get the addicts to go to the services.

Glasgow’s addiction services have been slow to adopt a focus on recovery, and even to date they are unable to report how many drug users they have treated have managed to overcome their addiction – this despite having a strategy which for the last ten years has emphasised the importance of enabling drug users to become drug-free. That strategy is now being reviewed by the Scottish Government with the real risk that the commitment to abstinence-based recovery will be diluted in preference to the much woollier goal of seeking to reduce the harm associated with addicts’ continued drug use.

Within Scotland we spend more than £100million a year on drug treatment. We should be asking why our services seem to be achieving so little in terms of getting addicts into long-term recovery and why, in the face of that failure, public officials are seeking to promote centres where illegal drug use can take place without fear of prosecution. Injecting on the streets is a terrible reality but the response to that problem should not be the provision of a centre where injecting can occur beyond public view, but actively to discourage injecting at all.

The reason we need to be doing much more to discourage drug injecting is because the substances addicts are injecting are often manufactured, stored, and transported in dreadfully unhygienic conditions with the result that they often contain serious and potentially fatal bacterial contaminants. These drugs do not become safe when they are used in a drug consumption room, but remain harmful wherever they are injected. We need to do all we can to discourage drug use, to discourage injecting, and to ensure that as many addicts as possible are in contact with services focused on assisting their recovery. We need to be very wary of developing initiatives that run the real risk of normalising illegal drug use and driving a possible further increase in the number of people using illegal drugs.

Professor Neil McKeganey is Director of the Centre for Substance Use Research, Glasgow

Source: https://www.conservativewoman.co.uk/neil-mckeganey-good-sense-kills-not-safe-injecting-centre/ November 2017

 

THE PUBLIC HEALTH BENEFITS AND SOCIAL EFFECTS OF NEEDLE EXCHANGE PROGRAMS ARE AT BEST UNCERTAIN, AND AT WORST ARE DEVASTATING TO BOTH ADDICTS AND THEIR COMMUNITIES

A. NEEDLE EXCHANGE PROGRAMS ARE NOT SCIENTIFICALLY

PROVEN TO REDUCE THE EPIDEMIC OF HIV OR HCV INFECTION

AMONG INJECTION DRUG USERS

B. NEEDLE EXCHANGE PROGRAMS DO NOT REDUCE SUBSTANCE

ABUSE, BUT IN FACT FACILITATE AND ENCOURAGE SUBSTANCE

ABUSE

C. NEEDLE EXCHANGE PROGRAMS ARE DESTRUCTIVE TO THE

COMMUNITIES IN WHICH THEY ARE USED

D. NEEDLE EXCHANGE SENDS A BAD MESSAGE TO SCHOOL CHILDREN.

PROVISION OF NEEDLES TO ADDICTS WILL ENCOURAGE DRUG USE.

THE MESSAGE IS INCONSISTENT WITH THE GOALS OF OUR

NATIONAL YOUTH-ORIENTED ANTI-DRUG CAMPAIGN.

A. NEEDLE EXCHANGE PROGRAMS ARE NOT SCIENTIFICALLY PROVEN TO REDUCE THE EPIDEMIC OF HIV OR HCV INFECTION AMONG INJECTION DRUG USERS

(i) The New Haven Study

NEP activists frequently cite the results of a New Haven, Conn., study, published in the American Journal of Medicine, which reported a one-third reduction of HIV among NEP participants. However, the New Haven researchers tested needles from anonymous users, rather than the addicts themselves, for HIV. They never measured “seroconversion rates,” which determine the portion of participants who become HIV positive during the study. Also, sixty percent of the New Haven study participants dropped out; those who remained were presumably more motivated to protect themselves, while the dropouts likely continued their high risk behavior.1

Essentially, the New Haven study merely reported a one-third decrease in HIV-infected needles themselves, which, considering the fact that the NEP flooded the sampling pool with a huge number of new needles, is hardly surprising. Even Peter Lurie, a University of Michigan researcher and avid NEP advocate, admits that “the validity of testing syringes is limited.”2

Furthermore, the New Haven study was based on a mathematical model of anonymous needles using six independent variables to predict the rate of infection. The unreliability of any of the variables invalidates the result. The New Haven study also assumed that any needle returned by a participant other than the one to whom it had been given had been shared, and that any needle returned by the original recipient had not been shared. Both assumptions are suspect.3

Also, the role of HIV transmission through sexual activity is downplayed. Prostitution often finances a drug habit. Non-needle using crack addicts have high incidence of HIV. Recent studies reveal that the greatest HIV threat among heterosexuals is from sexual conduct, not from dirty needles.4
Less than one-third of the New Haven subjects practiced safe sex. In the New Haven study, sampling
error alone could account for the 30 percent decline.5

(ii) The HHS / NAS Study

In 1992, Congress directed the U.S. Department of Health and Human Services (HHS) to study NEPs. HHS in turn commissioned the National Academy of Sciences (NAS), an independent, congressionally chartered, non-government research center, to conduct the study. According to the Congressional directive, if the NAS could show that NEPs worked and did not increase drug use, the Surgeon General could lift the ban on federal funding. The study was completed in 1995, and it concluded that well run NEPs could be effective in preventing the spread of HIV, and do not increase the use of illegal drugs. The NAS panel further recommended lifting the ban on federal funding for NEPs and legalization of injection paraphernalia.

 

Now, seven years after the NAS study, Congress has yet to lift the NEP funding ban, clearly indicating that Congress maintains serious doubts as to the validity of the NAS/HHS conclusions regarding NEPs. Of note is that study chairman Dr. Lincoln E. Moses cites the dubious New Haven study as a basis for the NAS findings.6

The NAS panel admitted that its conclusions were not based on reviews of well-designed studies, and the authors admitted that no such studies exist. Incredibly, the panel reported that “[t]he limitations of individual studies do not necessarily preclude us from being able to reach scientifically valid conclusions.”7

Two of the physicians on the NAS panel, Herbert D. Kleber, M.D. and Lawrence S. Brown, M.D., say the news media exaggerated the NAS’s findings. “NEPs are not the panacea their supporters hope for…We personally believe that the spread of HIV is better combated by the expansion and improvement of drug abuse treatment rather than NEPs, and any government funds should be used instead for that purpose.”8

Dr. Kleber, executive vice president for medical research at Columbia University, added: “The existing data is flawed. NEPs may, in theory, be effective, but the data doesn’t prove that they are.”9

This questionable NAS study represents the cornerstone research data used by the notoriously-politicized U.S. Department of Health and Human Services. The pro-NEP advocacy of HHS, and its supporting data, has yet to convince Congress that NEPs are scientifically proven to reduce HIV infection while not increasing drug usage.

(iii) The CDC Study

The Centers for Disease Control (CDC) conducted a study whose chief architect, Dr. Peter Lurie, recommended NEPs. The CDC report calls for federal funds for NEPs and the repeal of drug paraphernalia laws.

However, although the CDC study endorses NEPs, Dr. Lurie, the study’s author, acknowledges numerous problems: None of the studies were randomized, and self-reported behavior was often the basis for outcomes. Poor follow up and rough measurement of risk behavior also present problems, and he notes that syringe studies have limited validity. The report concludes: “Studies of needle exchange programs on HIV infection rates do not, and in part due to the need for large sample sizes and the multiple impediments to randomization, probably cannot provide clear evidence that needle exchange programs decrease HIV infection rates.”10 randomization, probably cannot provide clear evidence that needle exchange programs decrease HIV infection rates.”11

 

(iv) The Montreal Study

A 1995 Montreal study, published in the American Journal of epidemiology, showed that IDUs who used the NEP were more than twice as likely to become infected with HIV as IDUs who did not use the NEP. Thirty three percent of NEP users and 13 percent of nonuser became infected. There was an HIV seroconversion rate of 7.9 per 100 person years among NEP participants, and a rate of 3.1 per 100 person years among non-participants.12

A high percentage of both groups shared intravenous equipment in the last six months: 78 percent of NEP users and 72 percent of non-NEP users. Risk factors identified as predictors of HIV infection included previous imprisonment, needle sharing and attending an exchange in the last six months. The study authors stated: “We caution against trying to prove directly the causal relation between NEP use and reduction in HIV incidence. Evaluating the effect of NEPs per se without accounting for other interventions and changes over time in the dynamics of the epidemic may prove to be a perilous exercise.” The study concluded: “Observational epidemiological studies…are yet to provide unequivocal evidence of benefit for NEPs.”13

(v) The Vancouver Study

Vancouver has the largest NEP in North America, and was praised in the 1993 CDC report. It is financed by public funds, and by 1996 was distributing over 2 million needles per year. A 1997 evaluation of the needle exchange program in Vancouver showed that since the program began in 1988, AIDS prevalence in intravenous users rose from approximately 2% to 27%. This occurred despite the fact that 92% of the intravenous addicts in that jurisdiction participated in the needle exchange program.14

The Vancouver study also found that 40% of the HIV-positive addicts who participated in the program had lent a used syringe in the previous six months, and that 60% of HIV-negative addicts had borrowed a used syringe in the previous six months. Despite the enormous number of clean needles provided free of charge, active needle sharing continued at an alarming rate. After only eight months, 18.6 percent of those initially HIV negative became HIV positive.15

The Vancouver study corroborates a previous Chicago study which also demonstrated that its NEP did not reduce needle-sharing and other risky injecting behavior among participants. The Chicago study found that 39% of program participants shared syringes, compared to 38% of non-participants; 39% of program participants, and 38% of non-participants “handed off” dirty needles; and 68% of program participants displayed injecting risks vs. 66% of non-participants.16

The Vancouver report noted that “it is particularly striking that 23 of the 24 seroconverters reported NEP as their most frequent source of sterile syringes, and only five reported having any difficulty accessing sterile syringes.”17

The authors continue: “Our data are particularly disturbing in light of two facts: first, Vancouver has the highest volume NEP in North America; second, HIV prevalence among this city’s IDU population was relatively low until recent years. The fact that sharing of injection equipment is normative, and HIV prevalence and incidence are high in a community where there is an established and remarkably active NEP is alarming.”18

What should be obvious from all of the studies above is that there is no conclusive scientific evidence that NEP’s arrest HIV infection. Indeed, there is evidence that NEP’s breed HIV infection.

Some claim that the federal government supports NEPs. While the previous administration’s Department of Health and Human Services actively favored NEPs, those who were actually in charge of our national drug policy do not. General Barry McCaffrey, then director of the Office of National Drug Control Policy (ONDCP), when addressing the issue of NEPS stated “we have a responsibility to protect our children from ever falling victim to the false allure of drugs. We do this, first and foremost, by making sure that we send them one clear, straightforward message about drugs: They are wrong and they can kill you.” McCaffrey’s strong views influenced President Clinton not to approve federal aid money for NEPs.19

A further elaboration of the ONDCP’s policy was provided by James R. McDonough, Director of Strategic Planning for ONDCP, who wrote:

The science is uncertain. Supporters of needle exchange frequently gloss over gaping holes in the data — holes which leave significant doubt regarding whether needle exchanges exacerbate drug use and whether they uniformly lead to decreases in HIV transmission. It would be imprudent to take a key policy step on the basis of yet uncertain and insufficient evidence.

The public health risks may outweigh potential benefits. Each day, over 8,000 young people will try an illegal drug for the first time. Heroin use rates are up among youth. While perhaps eight persons contract HIV directly or indirectly from dirty needles, 352 start using heroin each day, and more than 4,000 die each year from heroin/morphine-related causes (the number one drug-related cause of death).Even assuming that NEWS can further accelerate the already declining rate of HIV transmission, the risk that such programs might encourage a higher rate of heroin use clearly outweighs any potential benefit.

Treatment should be our priority. Treatment has a documented record of reducing drug use as well as HIV transmission. Our fundamental obligation is to provide treatment for those addicted to drugs. NEPS should not be funded at the expense of treatment.

Supporting NEPS will send the wrong message to our children. Government provision of needles to addicts may encourage drug use. The message sent by such government action would be inconsistent with the goals of our national youth-oriented anti-drug campaign.

NEPS do nothing to ameliorate the impact of drug use on disadvantaged neighborhoods. NEPS are normally located in impoverished neighborhoods. These programs attract addicts from surrounding areas and concentrate the negative consequences of drug use, including of criminal activity.20

(vi) Among IV drug users, HIV is transmitted primarily through high-risk sexual contact

Another reason why NEPs may not retard the spread of HIV is that HIV is transmitted primarily through high-risk sexual contact, even among IV drug users. Contrary to prior assumptions, recent studies on the efficacy of NEPs have discovered that it is not needle exchange, but instead, high-risk sexual behavior which is the main factor in HIV infection for men and women who inject drugs, and for NEP participants. A recently released 10-year study has found that the biggest predictor of HIV infection for both male and female injecting drug users (IDUs) is high-risk sexual behavior and not sharing needles. High-risk homosexual activity was the most significant factor in HIV transmission for men and high-risk heterosexual activity the most significant for women. The study noted that in the past the assumption was that IDUs who were HIV positive had been infected with the virus through needle sharing.21

The researchers collected data every 6 months from 1,800 IDUs in Baltimore from 1988 to 1998. Study participants were at least 18 years of age when they entered the study, had a history of injection drug use within the previous 10 years, and did not have HIV infection or AIDS. More than 90 percent of them said they had injected drugs in the 6 months prior to enrolling in the study. In their interviews, the participants reported their recent drug use and sexual behavior and submitted blood samples to determine if they had become HIV POSITIVE since their last visit. The study showed that sexual behaviors, which were thought to be less important among IDUs, are the major risk for HIV seroconversion for both men and women.22

If the above conclusions are correct, the very presumption of NEP efficacy becomes suspect. Indeed, the use of needle exchange programs to address a problem which is caused primarily by high-risk sexual behavior would seem to be highly misguided.

Another reason that Needle Exchange Programs do not effectively address the issue of “saving lives” is that HIV (regardless of how it is contracted) is not the primary cause of death for IVUs. A study conducted at the University of Pennsylvania followed 415 IV drug users in Philadelphia over four years. Twenty eight died during the study. Only five died from causes associated with HIV. Most died of overdose, homicide, suicide, heart or liver disease, or kidney failure.23

Clean needles, even if they in fact prevent HIV, will do nothing to protect the addict from numerous more imminent fatal consequences of his addiction. It is both misleading and unethical to give addicts the idea that they can live safely as IV drug abusers. Only treatment and recovery will save the addict. The myth of “safe IV drug use” is a lie which is perpetuated by NEPs, and it is a lie which will tend to kill the addict, although his corpse may be free of HIV, for whatever consolation that will provide to the NEP proponent.

B. NEEDLE EXCHANGE PROGRAMS DO NOT REDUCE SUBSTANCE ABUSE, BUT IN FACT FACILITATE AND ENCOURAGE SUBSTANCE ABUSE.

The rise of NEPs, with their inherent facilitation of drug use (coupled with the provision of needles in large quantities), may also explain the rapid rise in binge cocaine injection which may be injected up to 40 times a day. Some NEPs encourage cocaine and crack injection by providing “safe crack kits” with instructions on how to inject crack intravenously. Crack cocaine can be, and generally had been, ingested through smoking. But the easy and plentiful availability of needles facilitates crack injection, creating a new segment of IV drug users, subject to health dangers they would otherwise have been spared exposure to. In some NEPS, needles are provided in huge batches of 1000, and although there is supposed to be a one-for-one exchange, the reality is that more needles are put out on the street than are taken in.24

NEPs also facilitate drug use through lax law enforcement policies. Police are instructed not to harass addicts in areas surrounding NEPs. Addicts are exempted from arrest because they are given an anonymous identification code number. Since police in these areas must ignore drug use, and obvious and formidable disincentive to drug use disappears. As the presence of law enforcement declines in these areas, the supply of drugs rises, with increased purity and lower prices, attracting new and younger consumers.25

Many drug prevention experts have warned that the proliferation of NEPS would result in a rise in heroin use, and indeed, this has come to pass. (However, the increase in drug use was ignored by the federally-funded studies which recommended federally funding NEPS). The National Center on Addiction and Substance Abuse at Columbia University reported August 14, 1997 that heroin use by American teens doubled from 1991 to 1996. In the past decade, experts estimate that the number of US heroin addicts has risen from 550,000 to 700,000. 26

In 1994, a San Francisco study regarding a local NEP falsely concluded that there was no increase in community heroin use because there was no increase in young users frequenting the NEP. The actual rate of heroin use in the community was not measured, and the lead author, needle provider John Watters, was found dead of an IV heroin overdose in November 1995. According to the Public Statistics Institute, hospital admissions for heroin in San Francisco increased 66% from 1986 to 1995.27

In Vancouver, site of the largest NEP in North America, heroin use has risen sharply. In 1988 when the NEP started, 18 deaths were attributed to drugs. In 1993, 200 deaths were attributed to drugs. A 1998 report notes that drug deaths were averaging 10 per week. Now Vancouver has the highest heroin death rate in North America, and is referred to as Canada’s “drug and crime capital.”28

The 1997 National Institutes of Health Consensus Panel Report on HIV Prevention praised the NEP in Glasgow, Scotland, but the report failed to note Glasgow’s massive resultant heroin epidemic. Subsequently, as revealed in an article entitled “Rethinking Harm Reduction for Glasgow Addicts,” Glasgow took the lead in the United Kingdom in deaths from heroin overdose, and its incidence of AIDS continues to rise.29

Boston’s NEP opened in July 1993, and the city became a magnet for heroin. Logan Airport has been branded the country’s “heroin port.” Boston soon led the nation in heroin purity (average 81%), and heroin samples of 99.9% are found on Boston streets. Subsequently, Boston developed the cheapest, purest heroin in the world and a serious heroin epidemic among the youth. The Boston NEP was supposed to be a “pilot study,” but there was no evaluation of seroconversion rates in the addicts nor of the rising level of heroin use in the Boston area.30

Similarly, the Baltimore NEP is praised by those who run it, but the massive drug epidemic in the city is overlooked. The National Institute of Health reports that heroin treatment and ER admission rates in Baltimore have increased steadily from 1991 to 1995. At one open-air drug supermarket (open 9 a.m. to 9 p.m.) customers were herded into lines sometimes 20 or 30 people deep. Guarded by persons armed with guns and baseball bats, customers are frisked for weapons, and then allowed to purchase $10 capsules of heroin.31

One thing should be clear from the foregoing: since the implementation of NEPs, heroin use in our country has boomed. It is obvious: a public policy of giving needles to heroin addicts facilitates and encourages heroin use.

C. NEEDLE EXCHANGE PROGRAMS ARE DESTRUCTIVE TO THE COMMUNITIES IN WHICH THEY ARE USED.

Most citizens oppose NEPs in their communities, and are concerned about the prospect of dirty needles being discarded in public places. These fears are not without merit. NEPs distribute millions of needles every year, and there is little or no accountability for needles once they have been distributed. A survey conducted in 1998 revealed that in million needles unaccounted for.32

Carelessly discarded needles create a well-documented public hazard:

* On February 11, 2001, a six-year old from Glade View, Florida, stabbed five children with a discarded syringe. (Kellie Patrick/Scott Davis, “Playground Attack Raises Health Worries,” Sun Sentinal, 2/9/00, p 1B).

* On February 2, 2001, a nine year old from the Bronx stabbed four children with a discarded needle. (Diane Cardwell, “Boy Accused of Needle Attack,” The New York Times, 2/2/01, p. A17.)

* On February 13, 2001, a syringe left at a bus station stuck a four year old boy. (Mike Hast, “Big Fines for Syringe Litterers,” Frankson & Hastings Independent, February 13, 2001,www.mapinc.org/drugnews/v01/n304/ a08.html.)33

Besides the physical hazard created by discarded needles, there is a commonsense perception that NEPs bring an air of decay to the communities that host them. After several years of operation, 343 Massachusetts towns and cities (out of a total of 347) continue to decline the option of approving a local NEP, although of the 10 available slots, only 4 are taken.

In March 1997, accompanied by a New York Times reporter, a member of the Coalition for a Better Community, a New York City group opposed to NEPs, visited the Lower East Side Needle Exchange. She was not asked for identification and was promptly given 40 syringes (without having to produce any to exchange). She was also given alcohol wipes and “cookers” for mixing the drugs, and she was given an exchange ID card that would exempt her from arrest for possession of drug paraphernalia. She was then shown how to inject herself.34

Community opposition to the Lower East Side Needle Exchange arose soon after implementation of the local NEP due to an increase in dirty syringes on neighborhood streets, in school yards and in parks. There was observed to be a dramatic increase in the public display of injecting drugs. NEP users were seen selling their syringes to buy more drugs. Exchange workers themselves were photographed selling needles offsite. Neighbors perceived the Lower East Side NEP as little more than a wholesale distribution center for clean needles and a social club for addicts. Pro-needle activist Donald Grove concurred: “Most needle exchange programs actually provide a valuable service to users beyond sterile
injection equipment. They serve as sites of informal organizing and coming together. A user might be able to do the networking to find good drugs in the half an hour he spends at the street based needle exchange site networking that might otherwise have taken half a day. [Grove, D. The Harm Reduction Coalition, N.Y.C., Harm Reduction Communication, Spring 1996].35

In 1998, a U.S. Government official was sent to Vancouver, site of the largest NEP in North America, to assess the high incidence of HIV among NEP participants, and the skyrocketing death rate due to drug overdose. He reported that the highest rates of property crime in Vancouver were within two blocks of the needle exchange. He also observed, pursuant to a tour with the Vancouver Police, that there was a 24 hour drug market and plain view injection activity in the area immediately adjacent to the needle exchange. Most poignantly, he was told, in a private interview with an elementary school teacher, that the children at area schools are not allowed outside at recess for fear of needles.36

CONCLUSION

There is ample evidence to suggest that very fundamental premises used to justify and support NEPs are seriously flawed.

First, NEP participants routinely continue to share needles, and large percentages of the NEP participants are HIV positive, meaning that NEPs do nothing more than continue the spread of HIV (and HCV). Significantly, no one has been able to explain satisfactorily why enhanced needle availability in and of itself would discourage needle sharing: needle sharing is an intrinsic aspect of IV drug use, and a NEP-issued needle will transmit HIV as well as any other needle.

Second, NEP studies have discovered (inadvertently) that needle sharing is not even the primary cause of HIV infection for IVUs. It is primarily through high-risk sexual behavior that IVUs contract HIV; free needles do nothing to prevent sexually transmitted disease.

Furthermore, HIV (regardless of how it is contracted) is not even the primary cause of death for IVUs. Most die of overdose, homicide, suicide, heart or liver disease, or kidney failure. Clean needles may protect an addict from HIV, but they do nothing to protect him from the more numerous, and more imminent fatal threats of his addiction. Several key NEP proponents have died of heroin overdose; no doubt their needles were very clean.

Third, the science is inconclusive. Although the proponents of NEPs uniformly aver that the scientific debate regarding the efficacy of NEPs is over, in truth, even the reports favoring NEPs are burdened with imprecise methodology, and many of the authors of those reports caution that their results should not be deemed conclusive. Today, there is still no conclusive scientific evidence: (1) that NEPs reduce the spread of HIV and HCV, or (2) that NEPs do not encourage IV drug use. Indeed, the correlation between the rise of NEPs and the explosion of IV drug use, if it is a coincidence, is a remarkable one.

Dispassionate observers will look at the current epidemic of heroin and IV cocaine use as a tragedy which might have been averted, or mitigated, but for the misguided mercies of the NEP concept.

Fourth, while the benefits of NEPs may be in doubt, the costs to the surrounding communities are very real. The overwhelming majority of communities dread the prospect of a local NEP, for self-evident and well-documented reasons.

Notes

1New Jersey Family Policy Council, Needle Exchange Programs – Panacea or Peril, New Jersey Family Policy Council, POB 6011, Parsippany, NJ 07054, 973-263-5258, www.njfpc.org/research-papers/needle.htm 2. Loconte, Joe, Killing Them Softly,” Policy Review, The Heritage Foundation, 214 Massachusetts Ave. NE, Washington, DC 20002, p. 19 (August, 1998) 3. See New Jersey Family Policy Council, Needle Exchange Programs – Panacea or Peril, supra, note 1. 4.Mathias, Robert, high-Risk Sex Is Main Factor in HIV Infection for Men and Women Who Inject Drugs@, NIDA NOTES Staff Writer, NIDA Notes, (National Institute on Drug Abuse, Washington, DC) Volume 17, Number 2 (May 2002) (Source: Strathdee, S.A., et al.

Sex differences in risk factors for HIV seroconversion among injection drug users.@ Archives of Internal Medicine 161:1281-1288, 2001)

1

See New Jersey Family Policy Council, Needle Exchange Programs- Panacea or Peril, supra, note 1.

1 Id.

1See Loconte, Joe, Policy Review, supra, note 2.

1

See New Jersey Family Policy Council, ANeedle Exchange Programs – Panacea or Peril, supra, note 1.

1

See New Jersey Family Policy Council, Needle Exchange Programs- Panacea or Peril, supra, note 1.

4 Id.

4See Loconte, Joe, Policy Review, supra, note 2.

4 See New Jersey Family Policy Council, Needle Exchange Programs – Panacea or Peril, supra, note 1. 4 Sex differences in risk factors for HIV seroconversion among injection drug users.@ Archives of Internal Medicine 161:1281-1288, 2001) 5 See New Jersey Family Policy Council, Needle Exchange Programs- Panacea or Peril, supra, note 1.

6 Id.

7See Loconte, Joe, Policy Review, supra, note 2.

8 See New Jersey Family Policy Council, Needle Exchange Programs – Panacea or Peril, supra, note 1.

9 See Loconte, Joe, Policy Review, supra, note 2.

10See New Jersey Family Policy Council, Needle Exchange Programs – Panacea or Peril, supra, note 1. 11See New Jersey Family Policy Council, Needle Exchange Programs – Panacea or Peril, supra, note 1.

12 Bruneau J, Lamothe F, Franco E, Lachance N, Desy M, Soto J, et al. High rates of HIV infection among injection drug users participating in needle exchange programs in Montreal: results of a cohort study. Am J Epidemiol 1997;146(12):994-1002.

13 Id.

14Strathdee SA, Patrick DM, Currie SL, Cornelisse PG, Rekart ML, Montaner JS, et al. Needle exchange is not enough: lessons from the Vancouver Injecting Drug Use Study. AIDS 1997;11(8):F59-F65. British Columbia Centre for Excellence in HIV/AIDS.

15 Id.

16 National Research Council/ Institute of Medicine, Preventing HIV Transmission: the Role of Sterile Needles and Bleach, National Academy Press, Washington DC, p. 302-304, 1995.

17 See: Strathdee SA,et, al., supra, note 14.

18Id.

19Drug Czar Statement on Administration Decision to Continue Ban on Use of Federal Funds for Needle Exchange Programs,” Press Release, Office of National Drug Control Policy (ONDCP), Washington, D.C., April 24, 1998.

20 James R. McDonough, Director of Strategic Planning, Executive Office of the President, Office of National, Drug Control Policy, Washington, DC. 20503 to Ms. Elizabeth Edwards, Arizonans for a Drug-Free Workplace, P.O. Box 13223, Tucson, AZ 85732; Letter dated April 14, 1998.

21Mathias, Robert, High-risk Sex Is Main Factor in HIV Infection for Men and Women Who Inject Drugs@, NIDA NOTES Staff Writer, NIDA Notes, (National Institute on Drug Abuse, Washington, DC) Volume 17, Number 2 (May 2002) (Source: Strathdee, S.A., et al. Sex differences in risk factors for HIV seroconversion among injection drug users. Archives of Internal Medicine 161:1281-1288, 2001.

22 Id.

23 See Loconte, Joe, Policy Review, supra, note 2.

24Janet D. Lapey, MD, Needle Exchange Programs: 1998 Report, April 1998, Drug Watch, P.O. Box 45218, Omaha, Nebraska 68145-0218

25 Id. 26Id. 27 Id.

28 Id. 29 Id. 30Id. 31Id.

32Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, HHS, Washington, DC 2001;50:384-388.

33Maginnis, Robert L., 2001 Update On The Drug Needle Debate, Insight, Number 235, July 16, 2001, Family Research Council, 801 G. St. NW, Washington, DC 2001.

34See New Jersey Family Policy Council, ANeedle Exchange Programs – Panacea or Peril, supra, note 1.

35D.B. Des Roches, Information, Memorandum for the Director, Through: the Deputy Director, Subject: Vancouver Needle Exchange Trip Report, Executive Office of the President, Office of National Drug Control Policy, Washington, D.C. 20503, April 6, 1998.

 

Source: Testimony of David G. Evans, Esq.

Executive director, Drug-free Schools Coalition before the Health and Human Services

Committee of the New Jersey Assembly, Trenton, NJ in opposition to a-3256

September 20, 2004

Johns Hopkins University researchers describe recent findings. This trend article about Johns Hopkins University is an immediate alert from LawRx to identify developing directions of research.

Study 1: Targeting HIV prevention interventions based upon risk group membership alone fails to address the distinct risk behaviors and demographic characteristics of enrollees in different programs.

According to a recent study from the United States, “Injection drug use has accounted for more than one third of acquired immune deficiency syndrome cases in the United States. The purpose of this study was to compare the demographic characteristics, types, and frequency of human immunodeficiency virus (HIV)-risk behaviors among injection drug users (IDUs) recruited from a needle exchange program (NEP), methadone maintenance treatment (MMT), and detoxification (detox) program.”

“A cross-sectional, correlational design was used to determine whether the selected HIV-risk behaviors and demographic characteristics of IDUs varied by site of recruitment. Confidential questionnaires were completed by 445 IDUs in Philadelphia, Pennsylvania,” explained H.D. Mark and colleagues at Johns Hopkins University.

“Data analysis revealed that HIV sexual and injection-risk behavior varied by recruitment site. Subjects recruited from the NEP were more likely to engage in HIV-risk behaviors than subjects recruited from the MMT or detox sites,” reported investigators.

They concluded, “Interventions occurring in program and treatment sites need to be sensitive to various demographic characteristics and behaviors if they are to reach those at highest risk of HIV infection. Targeting HIV prevention interventions based upon risk group membership alone (e.g, IDUs) fails to address the distinct risk behaviors and demographic characteristics of enrollees in different programs.”

Mark and colleagues published their study in Public Health Nursing (Profiles of self-reported HIV-risk behaviors among injection drug users in methadone maintenance treatment, detoxification, and needle exchange programs. Public Health Nurs, 2006;23(1):11-19).

Source: AIDS Weekly & Law June 22, 2006 SECTION: EXPANDED REPORTING; Pg. 82
Filed under: Needle Exchange :

Objective: To describe prevalence and incidence of HIV-1. hepatitis C virus (HCV) and risk behaviours in a prospective cohort of injecting drug users (IDU).
Setting: Vancouver, which introduced a needle exchange programme (NEP) in 1988, and currently exchanges over 2 million needles per year.
Design: IDU who had injected illicit drugs within the previous month were recruited through street outreach. At baseline and semi-annually, subjects underwent serology for HIV-1 and HCV. and questionnaires on demographics, behaviours and NEP attendance were completed. Logistic regression analysis was used to identify determinants of HIV prevalence.
Results: 0f 1006 IDU, 65% were men, and either white (65%) or Native (27%). Prevalence rates of HIV-1 and HCV were 23% and 88%, respectively. The majority (92%) had attended Vancouver’s NEP, which was the most important syringe source for 78%. Identical proportions of known HIV-positive and HIV -negative IDU reported lending used syringes (40%). of HIV-negative IDU 39% borrowed used needles within the previous 6 months. Relative to HIV-negative IDU HIV-positive IDU were more likely to frequently inject cocaine (72% versus 62%; P< 0.001). Independent predictors of HIV-positive serostatus were low education. unstable housing. commercial sex, borrowing needles, being an established IDU. injecting with others, and frequent NEP attendance. Based on 24 seroconversion among 257 follow-up visits, estimated HIV incidence was 18.6 per 100 person-years (95% confidence interval, 11.1—26.0).
Conclusions: Despite having the largest NEP in North America, Vancouver has been experiencing an ongoing HIV epidemic. Whereas NEP is crucial for sterile syringe provision, they should be considered one component of a comprehensive programme including counselling, support and education.

Source: Strathdee, Patrick, Currie, et al Rapid Science Publishers ISSN 0269-9370
Filed under: Needle Exchange :

Helsinki City has trained 40 drug addicts to assist their drug colleagues with supplying clean needles and giving first aid. This idea is from Belgium where it all started already in 1987. These addicts are called ‘jobist’ and their activities are funded by the support from the European Union. After their training. 5 evenings, they also get a small reward of abt US $200. The work is otherwise on a voluntary basis and they get 100 needles/day when looking for their friends. These jobists seem to be well motivated which is of course might be a first preliminary step towards seeking rehab. On the other hand it shows how cheap the society wants treat seriously ill people. This all seems again to fall under the popular theme of harm reduction.
The authorities are scared of next year when Estonia will join EU and the Estonians have a very serious HIV and Hepatitis problem. As you know the drug smuggling is taken care by the Estonians, who today even transport drugs to Finland via Sweden.

Souce: Botho Simolin, Drug Watch International delegate, Finland.


The transmission of drug-resistant HIV among intravenous drug users (IDUs) who participate in high-risk behaviors is high, according to a new study. In addition, such drug users were often prescribed less effective and not recommended HIV drugs.

Evidence of increasing rates of drug resistance among those recently infected with HIV “indicates a growing public health concern and warrants an examination of the problems from a prevention perspective write the Journal of Acquired Immune Deficiency Syndromes.

The researchers examined predictors of unprotected sex and needle sharing among 638 HIV-infected drug users who completed 2731 visits between 1996 and 2000 in an ongoing study in Baltimore, Maryland.

“After taking account other factors, HIV-infected individuals were significantly more likely to engage in unprotected sex if their sexual partners were also HIV-infected,” Dr. Sethi said in an interview with Reuters Health. “Also, HIV-infected women were twice as likely as men to report unprotected sex.”

Among IDUs who had injected recently, there was an independent association between sharing needles and homelessness, daily injection, and trading sex for drugs. “IDUs were at higher risk of HIV and drug-resistant HIV transmission at 19 percent and 6 percent of all visits, respectively,” the investigators write. Among subjects who were at high risk of HIV transmission, significant drug-resistant HIV was found at 14 percent of visits.

“Although highly active antiretroviral therapy (HAART) was widely available during the study period, less effective and not recommended regimens were prescribed to nearly half of IDUs who were potential transmitters of drug-resistant HIV,” Dr. Sethi told Reuters Health. “Transmission of resistance is one consequence of continued wide-use of non-HAART regimens.”

“It is likely that reducing high-risk behaviors by HIV-infected individuals would reduce the transmission of HIV, including drug-resistant HIV, to uninfected individuals,” Dr. Sethi said. “Clinicians can play an important role by counseling HIV-infected patients about the importance of reducing high-risk behaviors.”

SOURCE: Authors: Dr. Ajay K. Sethi, of Case Western Reserve University School of Medicine,Cleveland, Ohio, and colleagues. Published in Journal of Acquired Immune Deficiency Syndromes, April 15, 2004.

Distributing nearly 3 million needles a year to drug addicts, Vancouver, Canada boasts the largest needle exchange program in North America. The program was established in 1988– 16 years ago– to prevent the spread of HIV and hepatitis C (HCV). A new study finds that co-infection with these two deadly viruses is “shocking” with 16% of study participants co-infected at the beginning of the study and 15% more becoming co-infected over the course of the study. The researchers note it took a median of 3 years for seroconversion to secondary infection.

NEW YORK (Reuters Health) Jun 28 – Coinfection with Hepatitis C virus (HCV) and HIV is prevalent in a “shocking” number of young injection drug users, according to Canadian researchers.

In the June 1st issue of the Journal of Acquired Immunodeficiency Syndromes, Dr. Carl L. Miller of the University of British Columbia, Vancouver and colleagues note that they sought to determine the incidence of such coinfections and to compare the socioeconomic characteristics of those infected.

The researchers used data from the Vancouver Injection Drug Users Study to identify 479 subjects aged 29 years or less. At baseline, 78 (16%) were coinfected and a further 45 (15%) became so over the course of the study.

Baseline infection was independently associated with factors including being female, being of aboriginal ancestry, being older and with the number of years of injecting.

Borrowing needles and injecting cocaine more than once a day were both among the factors associated with the time to secondary infection seroconversion. Having recently attended a methadone maintenance program was protective.

Across the categories of coinfected, monoinfected and HIV and HCV negative injection drug users, say the investigators, there were “clear trends for increasing proportions” of women, aboriginals, daily cocaine users and inhabitants of Vancouver’s 10-block injection drug use epicenter.

The researchers, who note that it took a median of 3 years for seroconversion to secondary infection, conclude that “appropriate public health interventions should be implemented immediately.”

Source:Journal of  Acquired  Immune Deficiency Syndrome 2004;36:743-749.

But a new study published in the Journal of Psychoactive Drugs finds that sex “accounts for nearly all the infection among” new injection drug users. Likewise, nearly half of HIV infections among long term injection drug users, (44.3 percent) are not attributed to sharing dirty needles. New injection drug users, in fact, had a similar rate of HIV infection as non-injection drug users.

Studies have found that substance abuse is a significant factor for high risk sexual behavior and HIV acquisition. Needle exchange, therefore, does not eliminate the risks for HIV infection for drug abusers, but rather enables addicts to abuse the drugs that impair their judgment, thereby increasing risk for HIV infection. The debate over needle exchange distracts from the real HIV prevention issues for drug abusers, which is preventing substance abuse and treating addiction.

Source: Health & Medicine Week March 1, 2004

Needle exchange programs (NEPs) are designed to prevent human immunodeficiency virus (HIV) transmission among Injecting drug users. Although most studies report beneficial effects in terms of behavior modification, a direct assessment of the effectiveness of NEPs in preventing HIV infection has been lacking. A cohort study was conducted to assess the association between risk behaviors and HIV seroprevalence and seroincidence among injecting drug users in Montreal, Canada. The association between NEP use and HIV Infection was examined in three risk assessment scenarios using intensive covariate adjustment for empirical confounders: a cross-sectional analysis of NEP use at entry as a determinant of seroprevalence, a cohort analysis of NEP use at entry as a predictor of subsequent seroconversion, and a nested case-control analysis of NEP participation during follow-up as a predictor of seroconversion. From September 1988 to January 1995, 1,599 subjects were enrolled with a baseline seroprevalence of 10.7%. The mean follow-up period was 21.7 months. The adjusted odds ratio for HIV seroprevalence in injection drug users reporting recent NEP use was 2.2 (95% confidence interval 1.5-3.2). In the cohort study, there were 89 incident cases of HIV infection with a cumulative probability of HIV seroconversion of 33% for NEP users and 13% for nonusers (p <0.0001). In the nested case-control study, consistent NEP use was associated with HIV seroconversion during follow-up (odds ratio = 10.5. 95% confidence interval 2.7-41.0). Risk elevations for HIV infection associated with NEP attendance were substantial and consistent in all three risk assessment scenarios in our cohort of injecting drug users, despite extensive adjustment for confounders. In summary, in Montreal, NEP users appear to have higher seroconversion rates then NEP nonusers.

Am J Epidemiol 1997;146:994-1002.
cohort studies; HIV; needle exchange programs; substance abuse; substance abuse, intravenous
Julie Bruneau, Francois Lamothe, Eduardo Franco, Nathalie Lachance, Marie Desy, Julio Soto, and Jean Vincelette. American Journal of Epiderniology vol. 146. No. 12

Objective: to describe prevalence and incidence of HIV-1, hepatitis C virus (HCV) and risk behaviours in a prospective cohort of injecting drug users (IDU).

Setting: Vancouver, which introduced a needle exchange programme (NEP) in 1988, and currently exchanges over 2 million needles per year.

Design: IDU who had injected illicit drugs within the previous month were recruited through street outreach. At baseline and semi-annually, subjects underwent serology for HIV-1 and HCV, and questionnaires on demographics, behaviours and NEP attendance were completed. Logistic regression analysis was used to identify determinants of HIV prevalence.
Results: Of 1006 IDU, 65% were men, and either white (65%) or Native (27%). Prevalence rates of HIV-1 and HCV were 23 and 88%, respectively. The majority (92% had attended Vancouver’s NEP, which was the most important syringe source for 78%. Identical proportions of known HIV-positive and HV-negative IDU reported lending used syringes (40%) Of HIV negative IDU. 39% ,.. borrowed used needles within the previous 6 months. Relative to HIV-negative lDU, HIV-positive IDU were more likely to frequently inject cocaine (72 versus 62%; p <0.001). Independent predictors of HIV-positive serostatus were low education, unstable housing, commercial sex, borrowing needles, being an established IOU, injecting with others, and frequent NEP attendance. Based on 24 seroconversions among 257 follow-up visits, estimated HIV incidence was 18.6 per 100 person-years (95% confidence interval, 11.1—26.0).

Conclusions: Despite having the largest NEP in North America, Vancouver has been experiencing an ongoing HIV epidemic. Whereas NEP are crucial for sterile syringe provision, they should be considered one component of a comprehensive programme including counseling, support and education.

Strathdee Patrick Currie, et al –
AIDS 1997. 11:F59—F65

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