Needle Exchange:
Needle Exchanges Not Proven to Work

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By Len Deo, President of the New Jersey Family Policy Council and a member of the Governor’s Advisory Council on AIDS.

With the support of Gov. McGreevey, the media, and many NJ legislators, the Assembly Health Committee recently voted in favor of two bills that would legalize needle exchange programs (NEPs) for injection drug users in NJ. They believe that providing clean needles to drug addicts, (rather than providing more needed money for treatment and rehabilitation programs), is an appropriate method to reduce the state’s rate of HIV, which is among the highest in the nation. Their rationale is that if intravenous drug users (IDUs), had access to clean needles, they would use them consistently, without sharing them, and the chain of HIV transmission from person to person would be broken. Although this idea may sound plausible, the program’s effectiveness is dependent upon addicts behaving consistently and dependably. Not surprisingly, the effectiveness of these programs has been difficult to evaluate because many studies have relied on the testimony of addicts to determine whether or not they are still sharing needles while participating in the needle exchange.

NEP supporters point to a number of studies that claim NEPs are succeeding in reducing the spread of HIV. But the key problem is, these supporters are depending upon research that uses improper statistical models, or lacks the hard data relating to HIV incidence and/or seroprevalence among NEP users versus non-users of the exchange . What has further confused the issue is some state health officials, who are in favor of needle exchanges, have made patently false statements to the media like, “Every bit of research shows that it reduces the spread of HIV and doesn’t encourage drug use” . The truth is that when you look only at valid studies that collect “hard data”, you cannot prove that these programs have reduced the spread of HIV, or hepatitis B or C. Here are results representative of the valid studies:

1. Baltimore – Results of a 10-year study of initially HIV negative Baltimore IDUs, (published in the Archives of Internal Medicine), showed that there was no significant difference in HIV seroconversion rates between those who used the exchange and those who did not. It was also found that “sexual behaviors” played a much greater role than originally thought, in terms of risks for HIV seroconversion for both men and women” .
2. Seattle – A study of needle exchange programs in Seattle found no protective effect of needle/syringe exchange on the transmission of Hepatitis B or Hepatitis C among participants. The highest incidence of infection with both viruses occurred among current users of the exchange . The authors stated that the goal of elimination or substantial reduction in risk behavior that may transmit HIV among IDUs had not been achieved.
3. Vancouver – Vancouver British Columbia administers the largest NEP in North America, distributing nearly 3 million needles every year. When the NEP was established in the late 1980’s, the estimated HIV prevalence was 1 to 2 percent. Now, rather than decreasing HIV rates, both HIV and hepatitis C have reached saturation among the IDU population, and the HIV prevalence rate among the Vancouver study population is 35 percent, ⁵one of the highest incidence reported worldwide. A study published in the Journal AIDS in 1997 found that “frequent NEP attendance” was actually one of the independent predictors of HIV-serostatus among IDUs.
4. Montreal – Researchers studied nearly 1,600 needle-exchange participants for an average of 21.7 months. The case-controlled study revealed a seroconversion probability of 33 percent among NEP users and only 13 percent among non-users; meaning that more NEP users contracted AIDS versus non-users of the exchange.

Assembly majority leader Joseph Roberts (D-Camden), (along with many newspapers), have asserted that our state is “way behind the curve⁶ ” because NJ and Delaware are the only two remaining states that still require a prescription to buy hypodermic needles. Is this appropriate rationale for New Jersey to “jump on the bandwagon”? In response, I must coin a wise and challenging phrase, that many a parent has used to question their children’s rationale for engaging in a particular behavior: “If some of your friends jumped off a bridge, does that mean I should allow you to do it?” For the safety of all our citizens, our state lawmakers must not legalize drug use or drug paraphernalia, in any setting, without clear, unambiguous, hard research data to support such a controversial and potentially dangerous move.

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¹Fred J. Payne, MD, MPH, FACPM, telephone conversation, 9/22/04. Dr. Payne is the author of An Evidence Based Review of Needle Exchange Programs, Aug 2004 at: www.childrensaidsfund . Formerly a Medical Epidemiologist with the CDC, Sr. Research Epidemiologist National Institute of Allergy and Infectious Diseases at the NIH. Currently, Medial Advisor to the Children’s AIDS Fund.

² The Time is Now For Needle Exchanges”, Star Ledger, p. 25, Sept. 10, 2004.

³Strathdee, S.A., et al. “Sex Differences in Risk Factors for HIV Seroconversion Among Injection Drug Users”, Archives of Internal Medicine 161:1281-1288, 2001, as cited in Congressional Subcommittee letter to Director Zerhoni, National Institutes of Health, Apr. 27, 2004.

⁴Hagan H, et. al. “Syringe Exchange and Risk of Infection with Hepatitis B and C Viruses”, Am J Epidermal, 1999; 149:203-218, as cited in Congressional Subcommittee letter to Director Zerhoni, National Institutes of Health, Apr. 27, 2004.

⁵Vancouver Drug Use Epidemiology Report 2003, as cited in letter to Director of NIH, from Congressional Sub Committee on Criminal Justice, Drug Policy and Human Resources, April 27, 2004.

⁶Panel Clears Two Measures for Needle Exchange”, be Robert Schwaneberg, Star Ledger, Sept. 24, 2004.

 

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