200304
Needle Exchange Programs
POSITION STATEMENT
Approved by the Board of Trustees, December 2003
| |
"Policy documents are approved by the APA Assembly and Board of Trustees… These are …position statements that define APA official policy on specific subjects…" -- APA Operations Manual. |
|
This policy statement was written by the Commission on AIDS.
Current treatment strategies for the Acquired Immune Deficiency Syndrome (AIDS) and its sequelae reflect major advances in both knowledge about the Human Immunodeficiency Virus (HIV) and effective new therapies, but there is still no known cure, The most effective public health approach to this devastating epidemic remains the prevention of HIV transmission.
Injection drug users (IDUs) are the second largest transmission group at risk for HIV infection in the United States. HIV and other blood-borne pathogens are transmitted easily from person to person through the sharing of contaminated needles and other contaminated drug injection equipment. High rates of HIV infection among IDUs also threaten transmission of the virus to their non-drug-using sexual partners and children. In fact, the majority of AIDS cases among women and children in the United States can be directly or indirectly traced to injection drug use.
Psychiatrists should recognize the challenges in achieving significant behavioral change, particularly with regard to the addictions. Programs that provide adequate therapeutic support and interventions, directed toward the ultimate goal of abstinence are essential. The frequently remitting and relapsing course of injection drug use, and the risk of AIDS with each use, argues strongly for treatment approaches that start with reducing the associated harm of HIV transmission while attempting to engage the individual in a more comprehensive treatment process. Examples of reducing HIV transmission include needle exchange programs and needle prescriptions.
Studies prepared for the U.S. General Accounting Office, the U.S. Centers for Disease Control and Prevention, and the X and XI International Congresses on AIDS have concluded that needle exchange programs are effective in reducing the sharing of drug injection equipment and in preventing significant numbers of HIV infections among those using such programs, their drug and sexual partners, and their children.
As early as September, 1995, the Institute of Medicine released a major report concluding that needle exchange programs are effective in reducing HIV transmission. After extensive review of the current available research, the panel members further concluded that needle exchange programs do not increase the amount of drug use by those using such programs, and do not increase overall community levels of new or continued injection or noninjection drug use. The recommendations of the reports from the Centers for Disease Control and Prevention and from the Institute of Medicine to remove government restrictions on the availability of sterile syringes through needle exchange programs as a viable strategy preventing the spread of HIV have also been endorsed by the American Medical Association.
Needle exchange programs should provide on-site counseling and education about alcohol and other substance use, as well as referrals and improved access to comprehensive drug treatment programs, medical and reproductive care, counseling and testing for HIV and other sexually transmitted diseases and blood-borne pathogens, psychiatric and psychosocial services, and alternative methods for further reducing the harm associated with drug use.
Therefore, the American Psychiatric Association supports the removal of government restrictions on the availability of sterile syringes specifically within the structure of organized needle exchange programs, encourages government sponsored efforts to broaden the availability of these programs in targeted areas and provide public health education to promote safer hygiene practices among IDUs, and continues to endorse the core strategy of increasing the availability of quality detoxification and treatment programs for all substance users.
References
1. Auerbach JD, Wypijewska C, Brodie HKH, eds: AIDS and Behavior: An Integrated Approach. Institute of Medicine, Washington, DC, National Academy Press, 1994
2. Centers for Disease Control: HIV/AIDS Surveillance Report 1994, 6 (2), Atlanta, Centers for Disease Control and Prevention, 1995
3. Des Jarlais DC,Hagan H, Friedman SR, Friedmann P, Goldberg D, Frischer M, Green S, Tumving K, Ljungberg B, Wodak A, Ross M, Purchase D, Millson ME, Myers T: Maintaining low HIV seroprevalence in populations of injecting drug users. JAMA 1995; 274-1226-12331
4. Des Jarlais DC, Friedman SR, Sotheran JL, Wenston J, Marmor M, Yancovitz SR, Frank B, Beatrice S, Mildvan D: Continuity and change within an HIV epidemic: injecting drug users in New York City, 1984 through 1992. JAMA 1994; 271:121-127
5. Friedman SR, Des Jarlais DC, Wenston J: New injectors remain at high risk for HIV infection. Presented at the X International Conference on AIDS, Yokohama, Aug 8, 1994, oral presentation 073C
6. Groseclose SL, Weinstein B, Jones TS, Valleroy LA, Fehrs LJ, Kasler WJ: Impact of increased legal access to needles and syringes on practices of injecting-drug users and police officers—Connecticut, 1992-1993. J Acquir Immun Defic Syndr Hum Retrovirol 1995; 10:82-89
7. Groseclose SL, Valleroy LA, Weinstein B, et al. New Connecticut laws to improve access to needles and syringes: what is their impact? In: Proceedings of Workshops on Needle Exchange and Bleach Distribution Programs. National Academy Press, Washington, DC, 1994
8. Guydish J Bucardo J, Young M, Woods W, Grinstead O, Clark W: Evaluating needle exchange: are there negative effects? AIDS, 1993; 7:871-876
9. Haverkos HW, Jones TS: HIV, drug-use paraphernalia, and bleach. J Acquir Immune Defic Syndr Hum Retrovirol 1994; 7:741-742
10. Kaplan EH, Heimer R: A circulation theory of needle exchange. AIDS 1994; 8:567-574
11. Klee H, Morris J: Needle exchange schemes: increasing the potential for harm reduction among injection drug users. Presented at the X International Conference on AIDS, Yokohama, Aug 9, 1994, oral presentation 298D
12. Lurie P, Reingold AL, Bowser B, Chen D, Foley J, Guydish J, Kahn J, Lane S, Sorensen J: The Public Health Impact of Needle Exchange Programs in the United States and Abroad: Summary, vols I, II. Berkeley, University of California, 1993
13. National Commission on AIDS. AIDS: An Expanding Tragedy. The Final Report of the National Commission on AIDS. Wash., DC, 1993
14. Normand J, Vishov D, Moses LE (eds): Preventing HIV Transmissions: The Role of Sterile Needles and Bleach. Washington, DC, National Academy Press, 1995
15. US General Accounting Office: Needle Exchange Programs: Research Suggests Promise as an AIDS Prevention Strategy: Report GAO/HRG-93-60. Washington, DC, US Government Printing Office, 1993
16. US Office of Technology Assessment: The Effectiveness of AIDS Prevention Efforts: Report OTA-BP-H- 172. Washington, DC, US Congress, Office of Technology Assessment, 21995
17. Valleroy LA, Weinstein B, Jones TS, Groseclose SL, Rolfs RT, Kassler WJ: Impact of increased legal access to needles and syringes on community pharmacies’ needle and syringe sales – Connecticut 1992-1993. J Acquir Immune Defic Syndr Hum Retrovirol 1995; 0:7381
18. Watters JK, Estilo MJ, Clark GL, Lorvick J: Syringe and needle exchange as HIV/AIDS prevention for injection drug use. JAMA 1994; 271:115-120y.