title: Examination of the association between syringe exchange program (SEP) dispensation policy and SEP client-level syringe coverage among injection drug users.
abstract: OBJECTIVE
  To determine whether syringe exchange programs' (SEPs) dispensation policy is associated with syringe coverage among SEP clients.
  
  
  METHODS
  Cross-sectional samples of SEPs and their clients.
  
  
  METHODS
  SEPs in California, USA.
  
  
  METHODS
  Twenty-four SEPs and their injection drug using (IDU) clients (n = 1576).
  
  
  METHODS
  Clients were classified as having adequate syringe coverage if they received at least as many syringes from the SEP as their self-reported injections in the last 30 days. SEPs were classified based on their syringe dispensation policy. Dispensation schemes ranging from least restrictive to most are: unlimited needs-based distribution; unlimited one-for-one exchange plus a few additional syringes; per visit limited one-for-one plus a few additional syringes; unlimited one-for-one exchange; and per visit limited one-for-one exchange.
  
  
  RESULTS
  Adequate syringe coverage among SEP clients by dispensation policy is as follows: unlimited needs-based distribution = 61%; unlimited one-for-one plus = 50%; limited one-for-one plus = 41%; unlimited one-for-one = 42%; and limited one-for-one = 26%. In multivariate analysis, adequate syringe coverage was significantly higher for all dispensation policies compared to per visit limited one-for-one exchange. Using propensity scoring methods, we compared syringe coverage by dispensation policies while controlling for client-level differences. Providing additional syringes above one-for-one exchange (50% versus 38%, P = 0.009) and unlimited exchange (42% versus 27%, P = 0.05) generally resulted in more clients having adequate syringe coverage compared to one-for-one exchange and per visit limits.
  
  
  CONCLUSIONS
  Providing less restrictive syringe dispensation is associated with increased prevalence of adequate syringe coverage among clients. SEPs should adopt syringe dispensation policies that provide IDUs sufficient syringes to attain adequate syringe coverage.
authors.affiliation: Health Program and Drug Policy Research Center, RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA. rickyb@rand.org
authors.forename: Ricky N
authors.initials: RN
authors.lastname: Bluthenthal
authors.forename: Greg
authors.initials: G
authors.lastname: Ridgeway
authors.forename: Terry
authors.initials: T
authors.lastname: Schell
authors.forename: Rachel
authors.initials: R
authors.lastname: Anderson
authors.forename: Neil M
authors.initials: NM
authors.lastname: Flynn
authors.forename: Alex H
authors.initials: AH
authors.lastname: Kral
mesh_terms: D000293:Adolescent; D000328:Adult; D002140:California; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018671:Needle-Exchange Programs / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D015819:Substance Abuse, Intravenous / Q000534:rehabilitation*; D013594:Syringes / Q000600:supply & distribution*