Date: Mon, 22 May 95 14:51:14 
From: "mapostolides" 
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.