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Syringe Availability: Notes

NOTES  Part 1 | 

Notes

  1. See: Drucker E, Lurie P, Wodak A, Alcabes P. Measuring harm reduction: the effects of needle and syringe exchange programs and methadone maintenance on the ecology of HIV. AIDS 1998:12(Supp. A):S217-S230. Centers for Disease Control and Prevention. New Attitudes & Strategies: A comprehensive Approach to Preventing Blood-Borne Infections Among Injection Drug Users. October 25, 2000. Normand J, Vlahov D, Moses LE, eds. Preventing HIV Transmission: The Role of Sterile Needles and Bleach (Note: only portions of this report are available online.) Washington, DC: National Academy Press; 1995. Lurie P, Reingold A. The Public Health Impact of Needle Exchange Programs in the United States and Abroad (prepared for the Centers for Disease Control and Prevention). Berkeley, CA: University of California, School of Public Health, and San Francisco, CA: University of California, Institute for Health Policy Studies; 1993. Des Jarlais DC, Friedman SR, Sotheran JL, Wenston J, Marmor M, Yancovitz SR, Frenk B, Beatrice S, Mildvan D. Continuity and change within an HIV epidemic: Injecting drug users in New York City, 1984 through 1992. JAMA. 1994;271:121-127.
  2. Ball AL, Rana S, Dehne KL. HIV Prevention Among Injection Drug Users: Responses in Developing and Transitional Countries. Public Health Reports, June 1998: 113 (Supp.1):170-181.
  3. American Medical Association, American Pharmaceutical Association, The Association of State and Territorial Health Officials, National Alliance of State and Territorial AIDS Directories. "HIV Prevention and Access to Sterile Syringes." Joint Resolution. October 1999.U.S. Conference of Mayors. Needle Exchange: Moving beyond the Controversy. Washington, DC: U.S. Conference of Mayors; 1997. American Medical Association 6/97 Statement on Syringe Exchange. Lurie P, Reingold A. The Public Health Impact of Needle Exchange Programs in the United States and Abroad (prepared for the Centers for Disease Control and Prevention). Berkeley, CA: University of California, School of Public Health, and San Francisco, CA: University of California, Institute for Health Policy Studies; 1993. Normand J, Vlahov D, Moses LE, eds. Preventing HIV Transmission: The Role of Sterile Needles and Bleach. Washington, DC: National Academy Press; 1995. National Commission on Acquired Immune Deficiency Syndrome. The Twin Epidemics of Substance Use and HIV, Washington, DC: National Commission on Acquired Immune Deficiency Syndrome; 1991. U.S. General Accounting Office. Needle Exchange Programs: Research Suggests Promise as an AIDS Prevention Strategy. Washington, DC: U.S. General Accounting Office; 1993. National Institutes of Health Consensus Panel. Interventions to Prevent HIV Risk Behaviors. Washington, DC: National Institutes of Health; 1997. Surgeon General David Satcher's report: Evidence-Based Findings for the Efficacy of Syringe Exchange Programs. U.S. Department of Health and Human Services. March 17, 2000. Other agencies supporting SEPs include: AIDS National Interfaith Network, American Academy of Pediatrics, American Academy of Psychiatrists in Alcoholism and Addictions, American College of Preventive Medicine, American Psychiatric Association, American Society of Addiction Medicine, Association for Professionals in Infection Control and Epidemiology-South Jersey Chapter, Brotherhood Crusade, California Latino Civil Rights Network, Denver Medical Society, Feminist Majority Foundation, Illinois Alcoholism and Drug Dependence Association, Illinois State Medical Society, Medical Society of New Jersey, National Association for the Advancement of Colored People, National Association of Psychiatric Health Systems, National Association of Social Workers, National Association of State Alcohol and Drug Abuse Directors, National Black Caucus of State Legislatures, National Black Nurses Association, National Black Police Association, National Nurses Association, National Urban Coalition, National Urban League, New Hampshire Medical Society, Office for Church in Society, People of Color Against AIDS Network, San Francisco Medical Society, Office for Church in Society, Texas Sheriffs' Association, United Church of Christ, World Health Organization, and others. "An impressive body of evidence suggests powerful effects from needle exchange programs. The number of studies showing beneficial effects on behaviors such as needle sharing greatly outnumber those showing no effects. There is no longer doubt that these programs work, yet there is a striking disjunction between what science dictates and what policy delivers. Can the opposition to needle exchange programs in the United States be justified on scientific grounds? Our answer is simple and emphatic-no. Studies show reduction in risk behavior as high as 80%, with estimates of a 30% or greater reduction of HIV in IDUs. The cost of such programs is relatively low. Such programs should be implemented at once."-NIH Consensus Panel.
  4. A Kaiser Family Foundation survey found that 66% of all Americans are in favor of providing clean needles to IDUs: 66% of those age 18-29, 63% of those over 65; 56% of Republicans, 67% of independents, 71% of Democrats; 62% of Evangelicals, 69% of non-Evangelicals, 67% of Catholics. Henry J. Kaiser Family Foundation. The Kaiser Survey on Americans and AIDS/HIV. Menlo Park, CA: Henry J. Kaiser Family Foundation; March, 1996. Drug Strategies. Americans Look at the Drug Problem. Conducted annually by Hart Research Associates. A separate poll found 55% in support of SEPs (Human Rights Campaign poll, conducted April 8-10, 1997, by Tarrance Group and Lake Sosin Snell & Associates). A 1997 poll conducted for the Family Research Council by the Polling Company found 62% opposition to SEPs; that poll, however, presented SEPs and drug treatment as either/or policy choices. In the Southern Focus Poll, a random digit dial telephone poll conducted in 1997, 61% of respondents agreed that making clean needles available to IDUs would reduce the spread of HIV (University of North Carolina-Chapel Hill, Department of Health Behavior and Health Education, School of Public Health.)
  5. Newspapers that have editorialized in favor of SEPs and/or syringe deregulation include: Arizona Republic, Asbury Park Press, Asheville Citizen-Times, Atlanta Journal Constitution, Bakersfield Californian, Baltimore Sun, Boston Globe, Capital Times, Chapel Hill Herald, Chicago Sun-Times, Chicago Tribune, Cleveland Plain Dealer, Denver Post, Detroit Free Press, Fresno Bee, Gazette Telegraph (Colorado Springs), Hartford Courant, Los Angeles Times, Milwaukee Sentinel, New Haven Register, New York Newsday, New York Times, News and Observer (Raleigh, NC), Oakland Tribune, Philadelphia Inquirer, Providence Daily Journal, Providence Journal Bulletin, Rocky Mountain News, Sacramento Bee, St. Petersburg Times, San Francisco Chronicle, Seattle Times, Star Tribune (Minneapolis), USA Today, Vancouver Sun, Washington Post, Washington Times. The Wall Street Journal is the only major U.S. newspaper that has editorialized against SEPs.
  6. Centers for Disease Control and Prevention. HIV/AIDS Among African Americans Fact Sheet. Updated: November, 2000. Day D, Health Emergency 2001: The Spread of Drug-Related AIDS and Hepatitis C Among African Americans and Latinos. Princeton, NJ: Dogwood Center Publications, 2000.
  7. Centers for Disease Control and Prevention. HIV/AIDS Among Hispanics in the United States Fact Sheet. Updated: January, 2001. Day D, Health Emergency 2001: The Spread of Drug-Related AIDS and Hepatitis C Among African Americans and Latinos. Princeton, NJ: Dogwood Center Publications, 2000.
  8. Day D, Health Emergency 2001: The Spread of Drug-Related AIDS and Hepatitis C Among African Americans and Latinos. Princeton, NJ: Dogwood Center Publications, 2000.
  9. Centers for Disease Control and Prevention. U.S. HIV and AIDS cases reported through June 2000. HIV/AIDS Surveillance Report. 2000; Midyear Edition Vol. 12(1):12-13. Categories include: IDUs, people who have had sex with an IDU, and children whose mothers are IDUs or have had sex with an IDU.
  10. Centers for Disease Control and Prevention. U.S. HIV and AIDS cases reported through June 2000. HIV/AIDS Surveillance Report. 2000;Midyear Edition Vol.12(1):22.
  11. Holmberg SD. The estimated prevalence and incidence of HIV in 96 large U.S. metropolitan areas. American Journal of Public Health. 1996;86:642-654.
  12. Alter MJ, Moyer LA. The Importance of Preventing Hepatitis C Virus Infection Among Injection Drug Users in the United States. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998: 18 (Supp.1):S6-S10. Of the cases of HCV occurring in persons younger than 30 years of age, most can be attributed to IDU.
  13. Alter MJ, Moyer LA. The Importance of Preventing Hepatitis C Virus Infection Among Injection Drug Users in the United States. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998: 18 (Supp.1):S6-S10. This may be because percutaneous transmission is more efficient for HCV than for other viral infections, see: MacDonald MA, et al. Hepatitis C Virus Antibody Prevalence Among Injecting Drug Users at Selected Needle and Syringe Programs in Australia, 1995-1997. Medical Journal Australia. Vol. 172. January 2000; Hagan H, McGough JP, Thiede H, Weiss NS, Hopkins S, Alexander ER. Syringe Exchange and Risk of Infection with Hepatitis B and C Viruses. American Journal of Epidemiology 1999:149(3):203-213.; Garefin RS, Doherty MC, Moterroso ER, Thomas DL, Nelson KE, Vlahov D. Prevalence and Incidence of Hepatitis C Virus Infection Among Young Adult Injection Users. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998: 18 (Supp.1):S11-S19.
  14. Thorpe L, et al. Hepatitis C Virus Infection: Prevalence, Risk Factors, and Prevention Opportunities among Young Injection Drug Users in Chicago, 1997-1999. Journal of Infectious Diseases. Vol. 183. pp. 1588-94. 2000. High rate of HCV persistence coupled with its ability to produce chronic liver disease indicate that current IDU populations will experience the bulk of future HCV-associated morbidity and mortality in the United States.
  15. Alter MJ, Moyer LA. The Importance of Preventing Hepatitis C Virus Infection Among Injection Drug Users in the United States. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998: 18 (Supp.1):S6-S10.
  16. Day D, Health Emergency 2001: The Spread of Drug-Related AIDS and Hepatitis C Among African Americans and Latinos. Princeton, NJ: Dogwood Center Publications, 2000.
  17. Abdala N, Stephens PC, Griffith BP, Heimer R. Survival of HIV-1 in Syringes. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1999: 20(1):73-80. The likelihood of viral survival increases as the volume of infected blood left behind in syringe increases. This research supports validity of SEP's because not only do they increase supply of sterile syringes, but they also remove potentially contaminated syringes from circulation. See also: Shah SM, Shapshak P, Rivers JF, Stewart RV, Weatherby NL, Xin KQ, Page JB, Chitwood DD, Mash DC, Vlahov D, McCoy CB. Detection of HIV-1 DNA in needle/syringes, paraphernalia, and washes from shooting galleries in Miami: A preliminary report. Journal of Acquired Immune Deficiency Syndromes. 1996;11:301-306.
  18. Centers for Disease Control and Prevention. Publication of HIV-prevention bulletin for health-care providers regarding advice to persons who inject illicit drugs. Morbidity and Mortality Weekly Report. 1997;46:510.
  19. Lurie P, Jones TS, Foley J. A Sterile Syringe for Every Drug User Injection: How Many Injections Take Place Annually, and How Might Pharmacists Contribute to Syringe Distribution? Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998: 18 (Supp.1):S45-S51. Estimates were calculated by multiplying the estimated number of IDUs by the average number of daily injections by 365 days. Estimates of the number of IDUs in the United States vary between 900,000 (CDC) and 1.64 million (NASADAD). The national average number of daily injections (2.8) was derived from regional SEP survey data.
  20. Gershon RRM. Infection Control Basis for Recommending One-Time Use of Sterile Syringes and Aseptic Procedures for Injection Drug Users. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998: 18 (Supp.1):S20-S24; Koester S. Following the Blood: Syringe Reuse Leads to Blood-Borne Virus Transmission Among Injection Drug Users [letter]. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998: 18 (Supp.1):S139-140. Although each IDU may use his or her own sterile syringe, multiple variations in the drug preparation and injection process can cause an IDU to inadvertently compromise the effectiveness of that use: an IDU might return his just used syringe to the drug mixing container and cotton filter to obtain any drug residue that was left behind from the initial injection; water used for rinsing syringes might be subsequently used for dissolving drugs into solution; or a single contaminated syringe might be used to mix and distribute each participating IDU's share of the drug.
  21. Lurie P, Reingold A. The Public Health Impact of Needle Exchange Programs in the United States and Abroad (prepared for the Centers for Disease Control and Prevention). Berkeley, CA: University of California, School of Public Health, and San Francisco, CA: University of California, Institute for Health Policy Studies; 1993:61. Sweden is the only European country with a prescription law. The two other countries in Europe or Oceania to enact such laws-Austria and France-repealed them in the mid-1980s.
  22. Asian Harm Reduction Network Newsletter. 1996;1:1-8. For further information, contact Paul Deany at Macfarlane Burnet Centre for Medical Research, POB 254, Fairfield VIC 3078 Australia (Tel: +61 3 9282 2213; Fax: +61 3 9482 3123; E-mail: deany@burnet.mbcmrunimelb.edu.au). Ball AL, Rana S, Dehne KL. HIV Prevention Among Injection Drug Users: Responses in Developing and Transitional Countries. Public Health Reports, June 1998: 113 (Supp.1):170-181.
  23. Drucker E, Lurie P, Wodak A, Alcabes P. Measuring harm reduction: the effects of needle and syringe exchange programs and methadone maintenance on the ecology of HIV. AIDS 1998:12(suppl A):S217-S230. Heimer R. Syringe Exchange Programs: Lowering the Transmission of Syringe-Borne Diseases and Beyond. Public Health Reports, 1998; 113 (Supp.1): 67-74.
  24. Heimer R. Syringe Exchange Programs: Lowering the Transmission of Syringe-Borne Diseases and Beyond. Public Health Reports, 1998; 113 (Supp.1): 67-74.
  25. Paone D, Des Jarlais DC, Clark J, Shi Q, Krim M, Purchase D. Update: Syringe-exchange programs-United States, 1996. Morbidity and Mortality Weekly Report. 1997;46:565-568. States with above-ground SEPs include: Alaska, California, Colorado, Connecticut, Hawaii, Illinois, Kansas, Maryland, Massachusetts, Michigan, Minnesota, New York, Ohio, Oregon, Pennsylvania, Rhode Island, Texas, Washington, and Wisconsin.
  26. Purchase D. North American Syringe Exchange Network. Personal Communication, Tacoma, Washington, June 1997. "The behavior placing the public health at greatest risk may be occurring in legislative and other decision-making bodies." National Institutes of Health Consensus Panel. Interventions to Prevent HIV Risk Behaviors: Draft Statement. Washington, DC: National Institutes of Health; 1997.
  27. Des Jarlais DC, personal communication, March 1, 2001.
  28. Des Jarlais DC, Marmor M, Paone D, et al. HIV incidence among injecting drug users in New York City syringe-exchange programmes. Lancet. 1996;348:987-991.
  29. Blumenthal RN, Kral AH, Gee L, Erringer EA, Edlin B. The effect of syringe exchange use on high-risk injection drug users: a cohort study. AIDS 2000, 14:605-611.
  30. Heimer R, et al. Syringe Use and Reuse: Effects of Syringe Exchange Programs in Four Cities. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998: 18 (Supp.1):S37-S44.
  31. Hurley SF. Effectiveness of needle-exchange programmes for prevention of HIV infection. Lancet 1997;349:1797. Survey included primarily U.S. cities and found that cities with SEPs had an 11% lower rate of increase in seroprevalence each year.
  32. Des Jarlais DC, Marmor M, Paone D, et al. HIV incidence among injecting drug users in New York City syringe-exchange programmes. Lancet. 1996;348:987-991. Participants in a Portland SEP decreased their renting and sharing of syringes by two-thirds (Oliver K, et al. Behavioral and community impact of the Portland syringe exchange program. In: National Research Council and Institute of Medicine. Proceedings, Workshop on Needle Exchange and Bleach Distribution Programs. Washington, DC: National Academy Press; 1994:35-46). Prevention Point, a San Francisco SEP, disposed of approximately 8,600 HIV-contaminated syringes in one month in 1992 (Watters JK, Estilo MJ, Clark GL, Lorvick J. Syringe and needle exchange as HIV/AIDS prevention for injection drug users. JAMA. 1994;271:119).
  33. Paone D. Presented at New York Statewide HIV Conference, February 1997. Of 16 HIV seroincidence studies, 14 showed a decrease, 1 (Montreal) showed an increase explained by basic operational problems, and 1 (Vancouver) showed a still-unexplained increase.
  34. Strathdee SA, Patrick DM, Currie SL, Cornelisse PGA, Rekart ML, Montaner JSG, Schechter MT, O'Shaughnessy MV. Needle exchange is not enough: lessons from the Vancouver injecting drug use study. AIDS. 1997;11:F59-F65. See also: Remis RS, Bruneau J, Hankins CA. Enough Sterile Syringes to Prevent HIV Transmission Among Injection Drug Users in Montreal? Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998: 18 (Supp.1):S57-S59. A recent study of the Vancouver data found no causal association between the SEP and HIV transmission. See: Schechter MT, et al. Do Needle exchange Programs Increase the Spread of HIV Infection Among Drug Users?: An investigation of the Vancouver outbreak. AIDS. Vol.13, No.6. pp. F45-F51. 1999.
  35. Normand J, Vlahov D, Moses LE, eds. Preventing HIV Transmission: The Role of Sterile Needles and Bleach. Washington, DC: National Academy Press; 1995:240-243. See also: Hagan H, et al. The incidence of HBV infection and syringe exchange programs. JAMA. 1991;266:1646-1647. Letter.
  36. Hagan H, Des Jarlais DC, Friedman SR, Purchase D, Alter MJ. Reduced risk of hepatitis B and hepatitis C among injection drug users in the Tacoma syringe exchange program. American Journal of Public Health. 1995; 85:1531-1537.
  37. Kaplan EH. Probability models of needle exchange. Operations Research. 1995; 43:558-569.
  38. Heimer R, Khoshnood K, Jariwala FB, Duncan B, Harima Y. Hepatitis in used syringes: the limits of sensitivity of techniques to detect HBV DNA, HCV RNA, and antibodies to HB core and HCV antigens. Journal of Infectious Diseases. 1996;173:997-1000.
  39. MacDonald MA, et al. Hepatitis C Virus Antibody Prevalence Among Injecting Drug Users at Selected Needle and Syringe Programs in Australia, 1995-1997. Medical Journal Australia. Vol. 172. January 2000.
  40. Lurie P, Reingold A. The Public Health Impact of Needle Exchange Programs in the United States and Abroad (prepared for the Centers for Disease Control and Prevention). Berkeley, CA: University of California, School of Public Health, and San Francisco, CA: University of California, Institute for Health Policy Studies; 1993:11.
  41. Hellinger FK. Forecasts of the costs of medical care for persons with HIV: 1992-1995. Inquiry. 1992;29:356.
  42. Deeks SG, Smith M, Holodniy M, Kahn JO. HIV-1 protease inhibitors: a review for clinicians. JAMA 1997;277:145-153. Sperling J, Jennings TS. Formulary considerations for selection of protease inhibitors. Pharmacy and Therapeutics. 1997;229-240.
  43. Lurie P, Drucker E. An opportunity lost: HIV infections associated with lack of a national needle-exchange programme in the USA. Lancet. 1997;349:604-608. In another paper, the authors provide data for 16 cities (Lurie P, Drucker E. An opportunity lost: estimating the number of HIV infections associated with lack of a national needle exchange programme in the United States. Lancet 1997, 349:604-608.)

    City

    Preventable
    HIV
    Infections
    1987-1995

    Unnecessary
    treatment
    costs
    1987-1995

    Preventable
    HIV
    Infections
    1996-2000

    Unnecessary
    treatment
    costs
    1995-2000

    Atlanta

    186

    $10,349,040

    234

    $13,019,760

    Baltimore

    499

    $27,764,360

    632

    $35,164,480

    Boston

    182

    $10,126,480

    209

    $11,628,760

    Chicago

    561

    $31,214,040

    710

    $39,504,400

    Dallas

    39

    $2,169,960

    44

    $2,448,160

    Detroit

    152

    $8,457,280

    188

    $10,460,320

    Gary, IN

    14

    $778,960

    18

    $1,001,520

    Houston

    260

    $14,4666,400

    328

    $18,249,920

    Los Angeles

    95

    $5,285,800

    100

    $5,564,000

    Miami

    297

    $16,525,080

    360

    $20,030,400

    N.Y. City

    2,308

    $128,417,120

    2,605

    $144,942,200

    Newark

    397

    $22,089,080

    388

    $21,588,320

    Philadelphia

    641

    $35,665,240

    810

    $45,068,400

    San Juan

    315

    $17,526,600

    382

    $21,254,480

    Seattle

    48

    $2,670,720

    60

    $3,338,400

    Wash., D.C.

    646

    $35,943,440

    817

    $45,457,880


  44. Holtgrave, et al. "Cost and Cost-Effectiveness of Increasing Access to Sterile Syringes and Needles as an HIV Prevention Intervention in the United States." Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998: 18 (Supp.1):S133-S138.
  45. Ibid.
  46. Alter MJ, Moyer LA. The Importance of Preventing Hepatitis C Virus Infection Among Injection Drug Users in the United States. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998: 18 (Supp.1):S6-S10.
  47. Hernandez ER, Lurie P, Williams N, Stafford K, Rudy J. Needle exchange programs may reduce local government spending for law enforcement. Paper presented at 11th International Conference on AIDS, Vancouver, Canada; 1996. Analysis suggested that 1) referrals from SEPs to drug treatment would take more IDUs out of criminal market and 2) reduced rate of infectious disease among IDUs would lead to lower health care expenditures in jails.
  48. Valente TW, Foreman RK, Junge B, Vlahov D. Satellite Exchange in the Baltimore Needle Exchange Program. Public Health Reports, 1998; 113 (Supp.1): 90-96.
  49. Normand J, Vlahov D, Moses LE, eds. Preventing HIV Transmission: The Role of Sterile Needles and Bleach. Washington, DC: National Academy Press; 1995:224-226, 248-250. Paone D, Des Jarlais DC, Gangloff R, Milliken J, Friedman SR. Syringe Exchange: HIV prevention, key findings, and future directions. International Journal of the Addictions. 1995;30:1647-1683. Watters JK, Estilo MJ, Clark GL, Lorvick J. Syringe and needle exchange as HIV/AIDS prevention for injection drug users. JAMA. 1994;271:115-120. The seven reports are: National Commission on Acquired Immune Deficiency Syndrome. The Twin Epidemics of Substance Use and HIV, Washington, DC: National Commission on Acquired Immune Deficiency Syndrome; 1991. U.S. General Accounting Office. Needle Exchange Programs: Research Suggests Promise as an AIDS Prevention Strategy, Washington, DC: U.S. General Accounting Office; 1993. Lurie P, Reingold A. The Public Health Impact of Needle Exchange Programs in the United States and Abroad (prepared for the Centers for Disease Control and Prevention). Berkeley, CA: University of California, School of Public Health, and San Francisco, CA: University of California, Institute for Health Policy Studies; 1993. Drug Policy Foundation, comp. The Clinton Administration's Internal Reviews of Research on Needle Exchange Programs: Previously Unreleased Documents Plus Background Material. Washington, DC: Drug Policy Foundation; 1993. Office of Technology Assessment. The Effectiveness of AIDS Prevention Efforts. Washington, DC: Office of Technology Assessment; 1995. National Research Council and Institute of Medicine. Proceedings, Workshop on Needle Exchange and Bleach Distribution Programs. Washington, DC: National Academy Press; 1994.
  50. Watters JK, Estilo MJ, Clark GL, Lorvick J. Syringe and needle exchange as HIV/AIDS prevention for injection drug users. JAMA. 1994;271:118. From 1987 to 1992, the mean age of IDUs increased from 36 to 42.
  51. Heimer R, Lopes M. Needle exchange in New Haven reduces HIV risks, promotes entry into drug treatment, and does not create new drug injectors. JAMA. 1994;271:1825-1826. Letter. Kaplan EH, Khoshnood K, Heimer R. Client shift or needle exchange: what caused the HIV prevalence drop in needles returned to New Haven's needle exchange program. American Journal of Public Health. 1994;84:1991-1994. Heimer R, Kaplan EH, O'Keefe E, Khoshnood K, Altice F. Three years of needle exchange in New Haven: what have we learned? Journal of AIDS and Public Policy. 1994;9:59-74. Studies found no increase in the rate of enrollment of juveniles or IDUs with less than one year of injecting.
  52. Buning EC. Effects of Amsterdam needle and syringe exchange. International Journal of the Addictions. 1991;26:1303-1311.
  53. Paone D, Des Jarlais DC, Clark J, Murillo S, Shi Q. Presentation at College for Problems of Drug Dependence Conference, sponsored by National Institute on Drug Abuse, San Juan, Puerto Rico, 1996.
  54. Heimer R, Lopes M. Needle exchange in New Haven reduces HIV risks, promotes entry into drug treatment, and does not create new drug injectors. JAMA. 1994;271:1825-1826. Letter.
  55. Heimer R, Kaplan EH, O'Keefe E, Khoshnood K, Altice F. Three years of needle exchange in New Haven: what have we learned? AIDS and Public Policy Journal. 1994;9:59-74.
  56. Paone D, Clark J, Shi Q, Purchase D, Des Jarlais DC. Syringe exchange in the United States, 1996: A national profile. American Journal of Public Health, 1999:89(1):43-6.
  57. Hagan H, Des Jarlais DC, Purchase D, Friedman SR, Reid T, Bell TA. An interview study of participants in the Tacoma, Washington, syringe exchange. Addiction. 1993;88:1694-1695.
  58. Heimer R, Eicher A, Eno R, et al. Needle exchange programs as a conduit to drug treatment: the New Haven experience. Paper presented at the 11th International Conference on AIDS, Vancouver, Canada, 1996. Heimer R, Lopes M. Needle exchange in New Haven reduces HIV risks, promotes entry into drug treatment, and does not create new drug injectors. JAMA. 1994;271:1825-1826. Letter.
  59. Wolk J, Wodak A, Guinan J, Macaskill P, Simpson JM. The effect of a needle and syringe exchange on a methadone maintenance unit. British Journal of Addictions. 1990;85:1445-1450.
  60. Brooner R, Kidorf M, King V, Beilenson P, Svikis D, Vlahov D. Drug Abuse Treatment Success Among Needle Exchange Participants. Public Health Reports, 1998; 113 (Supp.1): 129-139.
  61. Paone D, Des Jarlais DC, Clark J, Shi Q, Krim M, Purchase D. Update: syringe-exchange programs-United States, 1996. Morbidity and Mortality Weekly Report. 1997;46:565-568.
  62. Evidence-Based Findings for the Efficacy of Syringe Exchange Programs. Report, U.S. Department of Health and Human Services. March 17, 2000.
  63. Vlahov D. Deregulation of the sale and possession of syringes for HIV prevention among injection drug users. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology. 1995;10:71-72; Editorial.
  64. Nelson KE, Vlahov D, Cohn S, Lindsay A, Solomon L, Anthony JC. Human immunodeficiency virus infection in diabetic intravenous drug users. JAMA. 1991;266:2259-2261. Unlike other IDUs diabetics are trained not to aspirate and different injection practices may account for differential infection rates. See e.g., Gershon RRM. Infection Control Basis for Recommending One-Time Use of Sterile Syringes and Aseptic Procedures for Injection Drug Users. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998: 18 (Supp.1):S20-S24.
  65. Vlahov D. Deregulation of the sale and possession of syringes for HIV prevention among injection drug users. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1995;10:71; Editorial. Groseclose SL, Weinstein B, Jones TS, Valleroy LA, Kassler WJ. Impact of increased legal access to needles and syringes on practices of injecting-drug users and police officers-Connecticut, 1992-1993. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology. 1995;10:82-96.
  66. Vlahov D. Deregulation of the sale and possession of syringes for HIV prevention among injection drug users. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology. 1995;10:71-72; Editorial. Valleroy L, Weinstein B, Jones TS, Groseclose SL, Rolfs RT, Kassler WJ. Impact of increased legal access to needles and syringes on community pharmacies: needle and syringe sales-Connecticut, 1992-1993. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology. 1995;10:73-81.
  67. Lurie P, Reingold A. The Public Health Impact of Needle Exchange Programs in the United States and Abroad (prepared for the Centers for Disease Control and Prevention). Berkeley, CA: University of California, School of Public Health, and San Francisco, CA: University of California, Institute for Health Policy Studies; 1993:68. Ganz A, Byrne C, Jackson P. Role of community pharmacies in prevention of AIDS among injecting drug misusers: findings of a survey in England and Wales. British Medical Journal. 1989;299: 1076-1079. Bless R, et al. Urban Policies in Europe 1993. Amsterdam: Amsterdam Bureau of Social Research and Statistics; 1993.
  68. Lurie P, Jones TS, Foley J. A Sterile Syringe for Every Drug User Injection: How Many Injections Take Place Annually, and How Might Pharmacists Contribute to Syringe Distribution? Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998: 18 (Supp.1):S45-S51. For more information on IDU pharmacy packs, contact HIT (Political Palace; 9 Slater St.; GB-Liverpool, L14BW; United Kingdom).
  69. Case, P., et al. Access to Sterile Syringes in Maine; Pharmacy Practice After the 1993 Repeal of the Syringe Prescription Law. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998: 18 (Supp.1):S94-S101; Centers for Disease Control and Prevention/Academy for Educational Development. IDU/HIV Prevention Fact Sheet: Pharmacy Sales of Sterile Syringes. June 2000; Gleghorn AA, Gee G, Vlahov D. Pharmacists' Attitudes About Pharmacy Sale of Needles/Syringes and Needle Exchange Programs in a City Without Needle/Syringe Prescription Laws. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998: 18 (Supp.1):S89-S93; Jones TS, Taussig J. Should Pharmacies Sell Sterile Syringes to Injection Drug Users? Journal of the American Pharmaceutical Association. Vol. 39, No. 1. January/February 1999; Kaiser Daily HIV/AIDS Report. Syringe Access: Pharmacy-Based Sales Part of Broad-Based HIV Prevention Strategy. December 10, 1999; Paulson, A. "Syringe Access: Pharmacy-Based Sales Part of Broad-Based HIV Prevention Strategy." Kaiser Daily Report. December 1999; Singer M, Baer HA, Scott G, Horowitz C, Weinstein B. Pharmacy Access to Syringes Among Injecting Drug Users: Follow-up Findings from Hartford, Connecticut. Public Health Reports, 1998; 113 (Supp.1): 81-89. U.S. Conference of Mayors HIV/AIDS Program. The Role of Pharmacies in Preventing HIV Among Injection Drug Users. AIDS Information Exchange. December 1999. Weinstein B, et al. Peer Education of Pharmacists and Supplying Pharmacies With IDU Packets to Increase Injection Drug Users' Access to Sterile Syringes in Connecticut [Letter to the Editor]. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998: 18 (Supp.1):S146-S147.
  70. Burris S, Lurie P, Abrahamson D, Rich J. Physician Prescribing of Sterile Injection Equipment to Prevent HIV Infection: Time for Action. Annals of Internal Medicine. 2000:133218-226.
  71. These include: Amsterdam, Basel, Berlin, Bern, Bologna, Bremen, Copenhagen, Dortmund, Frankfurt, Luxembourg, Nuremberg, Rotterdam, Sydney, Zurich, and some smaller cities. Lurie P, Reingold A. The Public Health Impact of Needle Exchange Programs in the United States and Abroad (prepared for the Centers for Disease Control and Prevention). Berkeley, CA: University of California, School of Public Health, and San Francisco, CA: University of California, Institute for Health Policy Studies; 1993:66,71. Bless R, et al. Urban Policies in Europe 1993. Amsterdam: Amsterdam Bureau of Social Research and Statistics; 1993. Syringe exchanges by automat. International Journal on Drug Policy. 1989;1:6.
  72. Obadia Y, Feroni I, Perrin V, Vlahov D, Moatti J-P. Syringe Vending Machines for Injection Drug Users: An Experiment in Marseille, France. American Journal of Public Health 1999:89(12):1852-1854.
  73. Des Jarlais DC. "Single-Use" Needles and Syringes for the Prevention of HIV Infection Among Injection Drug Users. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998: 18 (Supp.1):S52-S56. Kaplan EH. Would Difficult-to-Reuse Needles Reduce the Spread of HIV? Center for Interdisciplinary Research on AIDS Policy Updates. Volume 1(4). November 1, 1998. Single-use syringes are misnamed, as all current designs to prevent reuse can be defeated. Single-use syringes may reduce the probability of a particular needle becoming infected, but if they are introduced via a one-for-one exchange for regular syringes, such that the total number of syringes and injections remains the same, then they actually increase the probability of the reusable syringes available at any given time becoming infected. Mathematical models demonstrate that in order for the number of needles that are currently infectious to remain the same, any reduction in the number of regular syringes consumed per unit time must be met by an increase in the rate of difficult to reuse syringes introduced that is larger by at least 40%. (To offset the impact of removing 1000 syringes from circulation, 1400 more expensive difficult to reuse syringes must be introduced.)
  74. Kaplan EH. Would Difficult-to-Reuse Needles Reduce the Spread of HIV? Center for Interdisciplinary Research on AIDS Policy Updates. Volume 1(4).
  75. Centers for Disease Control and Prevention/Academy for Educational Development. IDU/HIV Prevention Fact Sheet: Syringe Disposal. June 2000.
  76. Macalino GE, et al. Community Based Programs for Safe Disposal of Used Needles and Syringes. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998: 18 (Supp.1):S111-S119.
  77. Normand J, Vlahov D, Moses LE, eds. Preventing HIV Transmission: The Role of Sterile Needles and Bleach. Washington, DC: National Academy Press; 1995:237. Oliver KJ, Friedman SR, Maynard H, Magnuson L, Des Jarlais DC. Impact of a needle exchange program on potentially infectious syringes in public places. Journal of Acquired Immune Deficiency Syndromes. 1992;5:380.
  78. Lurie P, Reingold A. The Public Health Impact of Needle Exchange Programs in the United States and Abroad (prepared for the Centers for Disease Control and Prevention). Berkeley, CA: University of California, School of Public Health, and San Francisco, CA: University of California, Institute for Health Policy Studies; 1993:388.
  79. Doherty MC, Garfein RS, Vlahov D, et al. Discarded needles do not increase soon after the opening of a needle exchange program. American Journal of Epidemiology. 1997;145:730-737.
  80. Broadhead RS, Van Hulst Y, Heckathorn DD. The Impact of a Needle Exchange's Closure. Public Health Reports 1999, Vol. 114:439-447.
  81. Riley E, Vlahov D, Beilenson P, Smith L, Doherty M, Koenig M, Jones TS. Operation Red Box: a pilot project of needle and syringe drop boxes for injection drug users in East Baltimore. Presented by Elise Riley at the 8th International Conference on the Reduction of Drug-Related Harm, March 27, 1997.
  82. Reily E, Beilenson P, Vlahov D, Smith L, Koenig M, Jones TS, Doherty M. Operation Red Box: A Pilot Project of Needle and Syringe Drop Boxes for Injection Drug Users in East Baltimore. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998: 18 (Supp.1):S120-S125.
  83. Macalino GE, et al. Community Based Programs for Safe Disposal of Used Needles and Syringes. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998: 18 (Supp.1):S111-S119.
  84. Department of Health and Human Services Appropriations Act, 1998 (Pub. L. 105-78, Title II, Nov. 13, 1997, 111 Stat. 1477.)
  85. Department of Health and Human Services. Press Release: Research Shows Needle Exchange Programs Reduce HIV Infections Without Increasing Drug Use. April 20, 1998.
  86. Secretary of Health Donna E. Shalala, quoted in Department of Health and Human Services. Fact Sheet: Needle Exchange Programs: Part of a comprehensive HIV prevention strategy. April 20, 1998.
  87. Gostin LO. The Legal Environment Impeding Access to Sterile Syringes and Needles: The Conflict Between Law Enforcement and Public Health. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998: 18 (Supp.1):S60-S70; Gostin LO, Lazzarini Z, Jones TS, Flaherty K. Prevention of HIV/AIDS and other blood-borne diseases among injection drug users: a national survey on the regulation of syringes and needles. JAMA. 1997;277:53-62. The five states are: California, Delaware, Illinois, Massachusetts, New Hampshire, and New Jersey. Three states-Connecticut, Massachusetts, and Rhode Island-specifically exempt SEP operators and participants from prescription laws for syringes obtained from the SEP. New York, Connecticut, Maine, and Minnesota (as of 1988) allow over-the-counter sales of up to ten syringes. Rhode Island places no limit on the amount of syringes that may be purchased over the counter. Several localities in, for example, Michigan and Florida, require prescriptions for syringe transactions. Ohio, Oregon, Nevada, Texas, Virginia, and Washington also have some provisions restricting the sale of syringes. Also see Gostin LO, Lazzarini Z. Prevention of HIV/AIDS among injection drug users: the theory and science of public health and criminal justice approaches to disease prevention. Emory Law Journal. 1997;46:588-696; Burris S, Deregulation of Hypodermic Needles and Syringes as a Public Health Measure: A Report on Emerging Policy and Law in the United States. Prepared by the AIDS Coordinating Committeee of the American Bar Association, December, 2000.
  88. Burris S, Deregulation of Hypodermic Needles and Syringes as a Public Health Measure: A Report on Emerging Policy and Law in the United States. Prepared by the AIDS Coordinating Committeee of the American Bar Association, December, 2000.
    Gostin LO. The Legal Environment Impeding Access to Sterile Syringes and Needles: The Conflict Between Law Enforcement and Public Health. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998: 18 (Supp.1):S60-S70.Gostin LO, Lazzarini Z, Jones TS, Flaherty K. Prevention of HIV/AIDS and other blood-borne diseases among injection drug users: a national survey on the regulation of syringes and needles. JAMA. 1997;277:53-62. Four territories-American Samoa, Guam, Northern Mariana Islands, and Puerto Rico-have no restrictions. All but one state-South Carolina-have paraphernalia statutes or local ordinances-Alaska and Iowa-restricting sale and possession of syringes. Three states-Massachusetts, Ohio and Virginia-have additional laws specifically restricting the sale of syringes. Oregon and Wisconsin specifically exclude syringes from their laws. Three states-Hawaii, Maryland, Massachusetts, along with Washington, DC, have exceptions for SEP operators and participants. Washington state recognizes such an exception based on case law. New York, Maine, and Minnesota have modified their laws to allow possession of up to ten syringes; Connecticut now permits possession of up to 30.
  89. Burris S, Deregulation of Hypodermic Needles and Syringes as a Public Health Measure: A Report on Emerging Policy and Law in the United States. Prepared by the AIDS Coordinating Committeee of the American Bar Association, December, 2000.
    Gostin LO. The Legal Environment Impeding Access to Sterile Syringes and Needles: The Conflict Between Law Enforcement and Public Health. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998: 18 (Supp.1):S60-S70. Bluthenthal, R.N., et al. Drug Paraphernalia and Injection-Related Infections Disease Risk among Drug Injectors. Journal of Drug Issues. Vol. 29, No. 1. pp. 1-16. 1999. Rich J, et al. Strict Syringe Laws in Rhode Island Are Associated With High Rates of Reusing Syringes and HIV Risks Among Injection Drug Users [Letter to the Editor]. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998: 18 (Supp.1):S140-S141.
  90. National Commission on Acquired Immune Deficiency Syndrome. The Twin Epidemics of Substance Use and HIV. Washington, DC: National Commission on Acquired Immune Deficiency Syndrome; 1991:2.
  91. Case P, Meehan T, Jones TS. Arrests and Incarceration of Injection Drug Users for Syringe Possession in Massachusetts: Implications for HIV Prevention. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1998: 18 (Supp.1):S71-S75. See also: Rich J, Dokson L, Dickenson BP. The Economic Cost of Strict Syringe Control. Medicine and Health Rhode Island. 1998: 81(6):207-208.
  92. Burris S, Finucane D, Gallagher H, Grace J. The legal strategies used in operating syringe exchange programs in the United States. American Journal of Public Health. 1996;86:1161-1166.
  93. Ibid.
  94. Ibid.
  95. Des Jarlais DC, Friedman S. Fifteen Years of Research on Preventing HIV Infection among Injection Drug Users: What We Have Learned, What We Have Not Learned, What We Have Done, What We Have Not Done. Public Health Reports, 1998; 113 (Supp.1): 182-187.
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