Needle and syringe programmes

The United States took a far more reluctant approach, typically requiring IDUs to already have used needles to exchange for sterile ones - this "one-for-one" system is where the same number of syringes must be returned.[5] United Nations Office on Drugs and Crime for South Asia suggests visual estimation or asking the client how many they brought back.[3]: 391 In the United States, where the one-for-one system still dominates, some 25% of injecting drug users are living positive with HIV; in Australia, which hands out equipment for free to anyone needing it (only charging a small fee for some more expensive equipment, like wheel filters and higher-quality tourniquets), only 1% of the IDU population is HIV-positive as of 2015, compared to over 20% in the late 1980s when NSP programs began to spread nationally and became accessible to most of the population.[11] IA comprehensive 2004 study by the World Health Organization (WHO) found a "compelling case that NSPs substantially and cost effectively reduce the spread of HIV among IDUs and do so without evidence of exacerbating injecting drug use at either the individual or societal level.The Burnet Institute research organisation completed the 2013 'North Richmond Public Injecting Impact Study' in collaboration with the Yarra Drug and Health Forum and North Richmond Community Health Centre and recommended 24-hour access to sterile injecting equipment due to the ongoing "widespread, frequent and highly visible" nature of illicit drug use in the areas.[15] On 28 May 2013, the Burnet Institute stated that it recommended 24-hour access to sterile injecting equipment in the Melbourne suburb of Footscray after the area's drug culture continued to grow after more than ten years of intense law enforcement efforts.[18] The British public body, the National Institute for Health and Care Excellence (NICE), introduced a recommendation in April 2014 due to an increase in the number of young people who inject steroids at UK needle exchanges.This sanction, which was originally executed as a state of emergency to address the HIV epidemic, allowed SEPs to provide sterile syringes, take back used devices, and operate as a service for health education to support individuals struggling with substance use disorders.[29] In April 2018, acting Mayor Mark Farrell allocated $750,000 towards the removal of abandoned needles littering the streets of San Francisco.[30] A 1997 study estimated that while the funding ban was in effect, it "may have led to HIV infection among thousands of IDUs, their sexual partners, and their children.[31] The funding ban was effectively lifted for every aspect of the exchanges except the needles themselves in the omnibus spending bill passed in December 2015 and signed by President Obama.[41] For example, between 1989 and 1992, three exchanges in New York City tagged syringes to help demonstrate rates of return prior to the legalization of the approach.[46] Boulder County health department reports between January 2012 and March 2012, the group received over 45,000 dirty needles and distributed around 45,200 sterile syringes.[48] Removal of legal barriers to the operation of NEPs and other syringe access initiatives has been identified as an important part of a comprehensive approach to reducing HIV transmission among IDUs.[56] Even police officers with accurate knowledge of the law, however, reported intention to confiscate syringes from drug users as a way to address problematic substance use.[34] Preliminary evidence also suggests that training can shift police knowledge and attitudes regarding NEPs specifically and public health-based approaches towards problematic drug use in general.The Wodak and Cooney review had, from 11 studies of what they determined as demonstrating acceptable rigour, found 6 that were positive regarding the effectiveness of NSPs in preventing HIV, 3 that were negative and 2 inconclusive.[81] Tilson (2007) concluded that only comprehensive packages of services in multi-component prevention programmes can be effective in reducing drug-related HIV risks.[76] Multiple examples can be cited showing the relative ineffectiveness of needle exchange programmes alone in stopping the spread of blood-borne disease.For example, David Noffs of the Life Education Center wrote, "I have visited sites around Chicago where people who request info on quitting their habit are given a single sheet on how to go cold turkey—hardly effective treatment or counseling.[86] According to a 2022 study by Vanderbilt University economist Analisa Packham, syringe exchange programs reduce HIV rates by 18.2 percent but lead to greater drug use.[94] Portland residents in areas where syringe acquisition is unlimited claim to be "drowning in needles" and picking up upwards of 100 per week.For example, in the United Kingdom, proponents of SEPs assert that, along with other programmes, they have reduced the spread of HIV among intravenous drug users.[107][108][109] Other promoted benefits of these programmes include providing a first point of contact for formal drug treatment,[110] access to health and counselling service referrals, the provision of up-to-date information about safe injecting practices, access to contraception and sexual health services and providing a means for data collection from users about their behaviour and/or drug use patterns.The provision states that "Needle and syringe exchange services application submissions, authorizations, and operations performed pursuant to this chapter shall be exempt from review under the California Environmental Quality Act, Division 13 (commencing with Section 21000) of the Public Resources Code.