Needle Exchange Cuts Risks, Study Finds : AIDS: Underground San Francisco program curbs addicts’ sharing of syringes, doctors report. Survey rebuts charges that such practices promote drug use.
An underground needle exchange program in San Francisco--illegal but operating with the express backing of the mayor and the tacit approval of police--has been found to be highly effective in reducing risky behavior among drug addicts and, contrary to the fears of critics, does not promote drug abuse, a new study shows.
The research, published in today’s issue of the Journal of the American Medical Assn., along with similar research from New York, prompted leading doctors in Los Angeles to call for a far-reaching needle exchange program in Los Angeles County, where a small underground program has met with limited success.
In today’s report, researchers from UC San Francisco interviewed 5,644 intravenous drug users and discovered that as participation in the needle exchange program went up, the percentage of addicts who shared syringes--a practice that puts them at risk for infection with the virus that causes AIDS--went down, from 66% before the exchange began four years ago to 35% now.
Moreover, the study found, the average age of intravenous drug users has increased, while the number of first-time drug users has dropped dramatically--indications that the needle exchange is not enticing young people into a life of drug abuse, as some critics have contended.
“The bottom line is that syringe exchange reduces needle sharing and doesn’t lead to increased substance abuse,” said John Watters, a UC San Francisco health policy analyst and lead author of the study. “I am disappointed that the policy decisions that are being made with respect to this issue are being made based on fear and ideology, rather than on scientific evidence.”
The all-volunteer program, called Prevention Point, allows intravenous drug users to trade their dirty syringes for clean ones. It began in 1988, with volunteers passing out clean syringes as they pushed a beat-up baby carriage in which addicts could surreptitiously deposit their used needles. It has since won city backing and expanded to seven sites in San Francisco.
For two years Gov. Pete Wilson has vetoed legislation that would have made this project legal and cleared the way for others like it. But in March, 1993, San Francisco Mayor Frank Jordan defied Wilson and declared a public health emergency so that the city could provide funds for the Prevention Point.
In Los Angeles, meanwhile, officials of the Los Angeles County Medical Assn. convened a news conference Tuesday afternoon to call on local authorities to follow Jordan’s lead.
“The data seems to be pretty conclusive now that these needle exchange programs do help to reduce the transmission of AIDS and other blood-borne diseases,” said Dr. Richard Wigod, chairman of the group’s committee on AIDS. “We would like to see this done here in Los Angeles.”
The prospects for that are uncertain. Mayor Richard Riordan and the County Board of Supervisors have supported the legislation that Wilson vetoed, but whether they would invoke emergency powers to defy the governor and expand the Los Angeles program is unclear. AIDS activists are now trying to persuade them to do so.
“If we can work out the process of making it happen, all evidence suggests that it will in fact happen,” said Phill Wilson, public policy director for AIDS Project Los Angeles, an activist group. But John Schunhoff, the county’s AIDS program director, was more cautious.
“My best bet is we’ll go on with the current situation, which is that there are underground programs but not official funding or sanction by the county,” he said. “But that’s just my bet. I don’t know for sure.”
There an estimated 1.5 million intravenous drug users in the United States and 400,000 in California. AIDS infection rates in this population vary greatly, however, although experts are not certain why. Some studies suggest that half of all IV drug users in New York are infected with the human immunodeficiency virus. But in San Francisco, the estimate is 14%, and in Los Angeles, 7%.
The San Francisco and New York studies published in today’s journal add to a growing body of medical evidence showing that needle exchange programs reduce risky behavior among intravenous drug users. None of these studies, however, has proved that clean-needle projects actually cut down on the spread of AIDS.
But the New York researchers did report that their city’s needle exchange program--which became legal in the summer of 1992--has helped keep AIDS infection rates stable. The lead author of the study, Don C. Des Jarlais of Beth Israel Medical Center in New York City, said he expects to be able to show the program actually caused infection rates to go down.
“We will probably start seeing that in our 1993, ‘94, ’95 and ’96 data,” he said. “We see dramatic decreases in sharing, so there is good evidence that even the underground syringe exchanges were having an effect.”
Since the New York project became legal, participation has skyrocketed, from 1,000 addicts to 17,000, Des Jarlais said. The San Francisco researchers found similar patterns. During the spring of 1989, shortly after the program began, it exchanged 7,821 needles, compared with 343,883 in the spring of 1992.
By that time, Watters and his colleagues found, 61% of all the addicts they interviewed had used the needle exchange within the previous year, and nearly half--45%--said they usually obtained syringes from Prevention Point.
