Evaluating needle exchange: are there negative effects?
OBJECTIVE
We analyzed data on all drug-treatment admissions in San Francisco County over a 4-year period (n = 35,460) to evaluate the potential negative effects of the San Francisco needle-exchange program.


METHODS
Admissions in the 2 years preceding implementation of the exchange program (1987-1988) were compared with admissions in the 2 years following implementation (1989-1990).


RESULTS
No negative consequences of needle exchange were detected. Specifically, the presence of the exchange program was not associated with (1) increases in injection drug use, (2) increases in needle-sharing behavior, or (3) changing drug-use behavior from non-injection to injection. We also compared high-drug-use neighborhoods with and without local needle-exchange sites. Neighborhoods without needle-exchange sites showed a greater increase in proportion of admissions for injection drug use, and in frequency of injection, over time.


CONCLUSIONS
Because of methodological limitations, our findings are preliminary. Longitudinal studies comparing needle-exchange and non-exchange cohorts are needed to further evaluate effects of this intervention.
Institute for Health Policy Studies, San Francisco, CA 94109.
J
J
Guydish
J
J
Bucardo
M
M
Young
W
W
Woods
O
O
Grinstead
W
W
Clark
D000328:Adult; D016000:Cluster Analysis; D015331:Cohort Studies; D005006:Ethnicity; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008297:Male; D016485:Needle Sharing / Q000706:statistics & numerical data; D009339:Needles / Q000600:supply & distribution*; D010343:Patient Admission / Q000706:statistics & numerical data; D015397:Program Evaluation; D012495:San Francisco / Q000453:epidemiology; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000453:epidemiology; D014505:Urban Population