Needle Exchange Programs

Needle exchange programs (NEPs) consist of two components: (1) the collection and safe disposal of used syringes and (2) the provision of sterile syringes to individuals. NEPs were developed to prevent the spread of human immunodeficiency virus (HIV) and viral hepatitis (HBV and HCV) among injection drug users (IDUs), most of whom inject heroin, methampheta-mine, or cocaine. NEPs prevent the spread of HIV, HBV, and HCV by removing from circulation potentially contaminated syringes and replacing them with sterile syringes. Most NEPs also provide other disease prevention supplies, such as condoms; infectious disease testing and counseling; and access to other medical and social services, including substance abuse treatment. NEPs can operate in a variety of settings, including pharmacies, street and alley sites, mobile vans, substance abuse treatment centers, and hospitals.

Drug injection is associated with a wide range of health ailments. However, with the emergence of HIV and viral hepatitis, the societal health consequences of drug injection have increased in magnitude and reach. IDUs are at risk for becoming infected with infectious diseases anytime they use syringes that have been previously used by another IDU. Transmission of HBV and HCV may occur through sharing of injection materials, including rinse water, cookers, filters, or tourniquets.

According to the World Health Organization, there are an estimated 13.2 million IDUs in the world, and approximately 3 million current and former IDUs are believed to be infected with HIV. Approximately 10% of all new AIDS cases worldwide are attributable to drug injection. HCV epidemics among IDUs have been reported in 57 countries, and 2 million people are estimated to be infected with HCV due to drug injection in the United States alone. The number of individuals impacted by injection-related HIV and HCV represents a significant global health problem.

NEPs employ harm reduction principles of easy access, practical services, and nonjudgmental and nonpunitive attitudes to attract IDUs into service settings where they can obtain prevention supplies, counseling, and other services. Because harm reduction principles do not condemn drug use and might be perceived to actually facilitate it, some governments and stakeholders (i.e., police) have sometimes opposed NEP implementation.