Evaluating needle exchange: are there negative effects?

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.

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).

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.

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.