Drug War Distortions: Needle Exchange

Distortion 3: Drug warriors claim that needle exchange increases drug use by citing Vancouver, Canada and claiming HIV rates are higher among participants in the needle exchange program (NEP) than among injecting drug users who do not participate; incidence of AIDS and hepatitis C virus has risen since NEP was introduced; age of drug users decreased since NEP introduced.

(sometimes cited: Office of National Control Policy 1998)

The authors of the Canadian studies specifically refuted ONDCP's claim in an op-ed published in The New York Times. [Julie Bruneau & Martin T. Schechter, "The Politics of Needles and AIDS," New York Times, April 9, 1998, p. 27.]

All the research shows that needle exchange does not increase drug use, and it decreases the spread of HIV. The US Surgeon General and the US Secretary of Health and Human Services have both reached this conclusion.

[US Surgeon General Dr. David Satcher, Department of Health and Human Services, Evidence-Based Findings on the Efficacy of Syringe Exchange Programs: An Analysis from the Assistant Secretary for Health and Surgeon General of the Scientific Research Completed Since April 1998 (Washington, DC: Dept. of Health and Human Services, 2000), from the website of the Harm Reduction Coalition at http://www.harmreduction.org/issues/surgeongenrev/surgreview.html; Varmus, Harold, Director of the National Institutes of Health, Press release from Department of Health and Human Services, (April 20, 1998); Bluthenthal, Ricky N., Kral, Alex H., Erringer, Elizabeth A., and Edlin, Brian R., "Drug paraphernalia laws and injection-related infectious disease risk among drug injectors", Journal of Drug Issues, 1999;29(1):1-16; Friedman, Samuel R. PhD, Theresa Perlis, PhD, and Don C. Des Jarlais, PhD, "Laws Prohibiting Over-the-Counter Syringe Sales to Injection Drug Users: Relations to Population Density, HIV Prevalence, and HIV Incidence," American Journal of Public Health (Washington, DC: American Public Health Association, May 2001), Vol. 91, No. 5, p. 793.]

On March 26, 1998, ONDCP Director Barry McCaffrey gave testimony to a House subcommittee in which he misinterpreted the results of two Canadian needle exchange studies in order to justify his opposition to syringe exchange. The study authors, Julie Bruneau (assistant professor of psychiatry at the University of Montreal) and Martin T. Schechter (professor of epidemiology at the University of British Columbia) wrote an op-ed in the New York Times on April 9, 1998 to rebut McCaffrey's assertion, and to explain their results.

According to the authors, among other factors, in Canada syringes can be purchased legally, while they could only be purchased with prescriptions in the US. Therefore, unlike in US studies, the populations in the Canadian studies were less likely to include the more affluent and better functioning addicts who could purchase their own needles and who were less likely to engage in the riskiest activities. Thus, it was not surprising that participants in the study had higher rates of HIV than those who did not, because the Canadian users forced to use needle exchanges were a much higher-risk population.

The following is an excerpt from Julie Bruneau & Martin T. Schechter, "The Politics of Needles and AIDS," New York Times, April 9, 1998, p. 27, from the web at
http://www.mapinc.org/newscsdp/v98/n258/a05.html

"In a letter to Congress, Barry McCaffrey, who is in charge of national drug policy, cited two Canadian studies to show that needle-exchange plans have failed to reduce the spread of HIV, the virus that causes AIDS, and may even have worsened the problem. Congressional leaders have cited these studies to make the same argument.

"As the authors of the Canadian studies, we must point out that these officials have misinterpreted our research. True, we found that addicts who took part in needle exchange programs in Vancouver and Montreal had higher HIV infection rates than addicts who did not. That's not surprising. Because these programs are in inner-city neighborhoods, they serve users who are at greatest risk of infection. Those who didn't accept free needles often didn't need them since they could afford to buy syringes in drug stores. They also were less likely to engage in the riskiest activities.

"Also, needle-exchange programs must be tailored to local conditions. For example, in Montreal and Vancouver, cocaine injection is a major source of HIV transmission. Some users inject the drug up to 40 times a day. At that rate, we have calculated that the two cities we studied would each need 10 million clean needles a year to prevent the re-use of syringes. Currently, the Vancouver program exchanges two million syringes annually, and Montreal, half a million.

"A study conducted last year and published in The Lancet, the British medical journal, found that in 29 cities worldwide where programs are in place, HIV infection dropped by an average of 5.8 percent a year among drug users. In 51 cities that had no needle-exchange plans, drug-related infection rose by 5.9 percent a year. Clearly these efforts can work."

More support for syringe exchange:

"After reviewing all of the research to date, the senior scientists of the Department and I have unanimously agreed that there is conclusive scientific evidence that syringe exchange programs, as part of a comprehensive HIV prevention strategy, are an effective public health intervention that reduces the transmission of HIV and does not encourage the use of illegal drugs."

Source: US Surgeon General Dr. David Satcher, Department of Health and Human Services, Evidence-Based Findings on the Efficacy of Syringe Exchange Programs: An Analysis from the Assistant Secretary for Health and Surgeon General of the Scientific Research Completed Since April 1998 (Washington, DC: Dept. of Health and Human Services, 2000), from the website of the Harm Reduction Coalition at
http://www.harmreduction.org/issues/surgeongenrev/surgreview.html.

According to Dr. Harold Varmus, Director of the National Institutes of Health, "An exhaustive review of the science in this area indicates that needle exchange programs can be an effective component in the global effort to end the epidemic of HIV disease."

Source: Varmus, H., Director of the National Institutes of Health, Press release from Department of Health and Human Services, (April 20, 1998).

According to a study in 1996, "Drug paraphernalia laws in 47 U.S. states make it illegal for injection drug users (IDUs) to possess syringes." The study concludes, "decriminalizing syringes and needles would likely result in reductions in the behaviors that expose IDUs to blood borne viruses."

Source: Bluthenthal, Ricky N., Kral, Alex H., Erringer, Elizabeth A., and Edlin, Brian R., "Drug paraphernalia laws and injection-related infectious disease risk among drug injectors", Journal of Drug Issues, 1999;29(1):1-16.

"The data in this report offer no support for the idea that anti-OTC laws prevent illicit drug injection. However, the data do show associations between anti-OTC laws and HIV prevalence and incidence. In an ongoing epidemic of a fatal infectious disease, prudent public health policy suggests removing prescription requirements rather than awaiting definitive proof of causation. Such action has been taken by Connecticut, by Maine, and, recently, by New York. After Connecticut legalized OTC sales of syringes and the personal possession of syringes, syringe sharing by drug injectors decreased. Moreover, no evidence showed increased in drug use, drug-related arrests, or needlestick injuries to police officers."

Source: Friedman, Samuel R. PhD, Theresa Perlis, PhD, and Don C. Des Jarlais, PhD, "Laws Prohibiting Over-the-Counter Syringe Sales to Injection Drug Users: Relations to Population Density, HIV Prevalence, and HIV Incidence," American Journal of Public Health (Washington, DC: American Public Health Association, May 2001), Vol. 91, No. 5, p. 793.

"Anti-OTC laws are not associated with lower population proportions of IDUs. Laws restricting syringe access are statistically associated with HIV transmission and should be repealed."

Distortion 3: Needle Exchange