Needle exchange programs today  

Needle exchange programs provide a way for people who are unable or unwilling to stop injecting drugs  to obtain sterile syringes and to safely dispose of used syringes at no cost.

In 1998, there were 131 needle exchange programs in the United States, up from 113 the previous year.⁽¹⁾  Many major cities - including Chicago, Detroit, Honolulu, New York City, Philadelphia, and San Francisco - had needle exchange programs.  

Progress in making needle exchange programs legal has been much too slow.  Of the 110 exchanges responding to the 1998 survey, 59 were legal; 24 were illegal-tolerated by local officials, and 27 were illegal-underground.^{(2), (3)}

Once legal, programs have achieved considerable success in getting public funds.  In 1998, 51 programs reported receiving state or local government funds.

The illegal-tolerated exchanges are often able to exist in a relatively public fashion because, while officials have not yet reformed the needle access laws and regulations, they nonetheless understand that it makes no sense to arrest people working to stem an epidemic.

But arrests do occur.  In 1998, there were 10 arrests of needle exchange staff or volunteers in five different states.  In the worst case, arrest and successful prosecution can shut down a needle exchange entirely.⁽⁴⁾  Arrest or the threat of arrest can reduce the effectiveness of a needle exchange by discouraging donations, by deterring volunteers from working at the exchange (effectively reducing the number of hours the exchange is open), and by frightening away prospective clients.  The threat of arrest can also force a program to move to a less accessible location, making it difficult for those who need the exchange's services to find it.⁽⁵⁾  Arrest or the threat of arrest also reduces the effectiveness of needle exchange programs in getting interested drug users into drug treatment.  

The continuing epidemic

For those concerned about the spread of HIV/AIDS among injecting drug users, their non-drug-using sexual partners, and newborn children, the pace of needle access reform has been far too slow.  Of the ten states with the highest rates of injection-related AIDS in 1998, substantial progress in reform has been made in three (Connecticut, New York, and Rhode Island).  Some progress had been made in another three (Maryland, Massachusetts, and Pennsylvania), but virtually no progress had been made in four (Delaware, Louisiana, New Jersey, and Florida).⁽⁶⁾  

Footnotes

(1) The information on needle exchange programs in 1998 is taken from Denise Panoe, Don C. Des Jarlais, Mytri Ptritam Singh, Courtney McKnight, and Stephen Titus, "National Syringe Exchange Survey 1998," presentation at the North American Syringe Exchange Convention, Portland, Oregon, April 2000 and from  Morbidity and Mortality Weekly Report. 2001. "Update: syringe exchange programs -- United States, 1998." May 18. vol. 50. no. 19. pages 384-387. The 1997 information is from Morbidity and Mortality Weekly Report. 1998. "Update: syringe exchange programs - United States, 1997." August 14. vol. 47. no. 31.  pages 652-655.

(2) Paone and her colleagues define legal needle exchange programs as those operating in states that had no law requiring a prescription to purchase a hypodermic syringe or that had an exemption to the law allowing the program to operate. Illegal-tolerated programs operated in states with a prescription law and received a formal vote of support or approval of a local elected body such as a city council. Illegal-underground exchanged operated in states with a prescription law and did not have formal support of local elected officials.

(3) Scott Burris, Davis Finucane, Heather Gallagher, and Joseph Grace, "The Legal Strategies Used in Operating Syringe Exchange Programs in the United States," American Journal of Public Health,  August 1996, vol. 86,  pages 1161-1166.

(4) This is what happened in New Jersey.  See Dawn Day, "Sad Termination of a Life-Saving Project," Trenton Times, December 25, 1998, page A13. 

(5) Ricky N. Bluthenthal, Alex H. Kral, Jennifer Lorvick, and John K. Watters, 1997, "Impact of Law Enforcement on Syringe Exchange Programs: A Look at Oakland and San Francisco," Medical Anthropology, vol. 18, pages 61-83.  

(6) Dawn Day.1999. States and Metro Areas Hardest Hit by the HIV/AIDS Epidemic, Princeton, N.J.: Dogwood Center, November.  

See also:

For state by state information on needle exchange: Heather Sidwell and Amanda Watson (updated by Julie Scales). 2001. "Needle exchange and access to sterile syringes." Health Policy Tracking Service of the National Conference of State Legislatures.

For background on the estimated annual number of IDU injections per year: Peter Lurie, T.S. Jones and J. Foley. 1998. "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. vol. 18 (Supplement 1). pages S45-S51.

From the Centers for Disease Control and Prevention: "Syringe exchange programs," "Access to sterile syringes," and other materials on HIV prevention among people who inject drugs.

From the National Institute on Drug Abuse: Principles of HIV prevention in drug-using populations.

For a list of other materials used on this website, see References.