RAND Study Identifies Most Effective Needle Exchange Programs for Drug Addicts

Drug addicts who participate in programs that allow them to exchange an unlimited number of clean syringes are less likely to reuse needles, reducing chances they will spread infectious diseases, according to a new RAND Corporation study.

As a result, syringe exchange programs that limit the number of clean needles that intravenous drug addicts can receive may not be as effective at preventing the spread of HIV and other infectious diseases as programs that do not impose limits, according to the study.

The study in the October edition of the journal Addiction by researchers from RAND Health and the RAND Drug Policy Research Center is among the first to look at traits of needle exchange programs that encourage safe behavior among intravenous drug users. Most research has looked at the effectiveness of syringe exchange programs compared with what happens in the absence of such programs.

“It is vitally important for drug users who inject to have access to sterile needles in the least restrictive way,” said Ricky Bluthenthal, RAND social scientist and principal investigator on this study. “All syringe exchange programs may not be equally effective. Our findings suggest ways to design programs so that they do the most to prevent the spread of infectious diseases.”

Intravenous drug users face many obstacles in obtaining sterile syringes because drug paraphernalia laws and other regulations often prohibit people from possessing syringes without a prescription, such as the prescription a diabetic would receive to possess syringes to inject insulin. Other rules limit the number of sterile syringes by placing limits on the number of syringes that can be exchanged or possessed.

According to the Centers for Disease Control, in 1998 there were 131 syringe exchange programs for drug addicts operating in the United States covering at least 31 states and 81cities. Some of these programs were illegal or operating under uncertain legal status.

In addition to legal issues, a number of factors affect the success of exchange programs, according to RAND researchers. Most programs cover only limited geographic areas and provide only a modest number of needles relative to actual need. Most operate only a few hours per day or a few days per week and have few locations. And public opposition to an exchange location can also have a negative impact on how willing drug users are to exchange needles.

The RAND study examined the effectiveness of different syringe exchange programs between 1998 and 2000 in Hartford, Connecticut; Oakland, California; and Chicago.

The study found that intravenous drug users who live in communities with the greatest restrictions on syringe possession tend to come into contact with the police more frequently than those who lived in less restrictive communities. Previous studies have found drug users are at risk for contracting HIV or may engage in syringe sharing if they come in contact with police or fear coming in contact with police.

Researchers looked at drug users who took advantage of syringe exchange programs in Chicago and Oakland, where large-volume exchanges are allowed to operate, and found that they were less likely to reuse syringes, but not necessarily less likely to share syringes with other drug users.

Drug users in Hartford, where small-volume exchanges of syringes are permitted, were more likely to reuse syringes but no less likely to share their syringes. The habits of drug users who did not participate in exchange programs did not vary significantly from those who did.

Researchers also found that younger drug users were less likely to re-use or to share syringes with others. Homelessness and having less than a high school education tended to predict higher levels of syringe sharing.

Other authors of the study were: Mohammed Rehan Malkin of the Pardee RAND Graduate School; Lauretta Grau and Robert Singer of the Yale University School of Medicine; Merrill Singer of the Hispanic Health Council in Hartford, Connecticut; and Patricia Marshall the Case Western Reserve University School of Medicine.

Funding for the study was provided by the National Institute on Drug Abuse, the Office of AIDS Research at the National Institutes of Health and the National Institute for Mental Health.

RAND Health is the nation’s largest independent health policy research organization, with a broad research portfolio that focuses on health care quality, costs and delivery, among other topics.