Needle Exchange Programs: Counter-Productive?

Alive magazine, December 2001

Needle Exchange Programs (NEP) provide clean needles to IV drugs addicts. It seems obvious that cleaner needles should lead to lower levels of HIV and Hepatitis infections in addicts. So obvious, in fact, that it was years before any research was done to test this hypothesis. The results of the best research came as a total surprise - indicating that needle exchange is associated with a dramatic increase in the rate of HIV and Hepatitis B and C.

Opposition to Needle Exchange Programs has largely come from ‘conservatives’ who feel that they only encourage and validate drug use, bitterly opposed by ‘liberals’ who view them as a rational form of ‘harm reduction’. The debate has been politicized with little discussion of the evidence. In fact the researchers of the most negative studies have tried to suppress discussion of this research, and have performed a strange kind of hari-kari, trying to throw their research on the sword without hurting themselves.

One of the first studies to ask whether NEP’s reduce the rate of HIV infection found some reductions, but it was seriously flawed, combining information from three groups that differ from each other in average age, race, gender and injection frequency. Only one of the groups studied contained a combination of addicts using and not-using needle exchange(Des Jarlais, 1996).

A better designed study was based in Montreal (Bruneau, 1997). It showed that addicts that always used NEP were 10-20 times MORE likely to be HIV-positive than those who never did! These results were so politically charged that they were omitted from the abstract of the paper. The following pages of the journal contained an immediate rebuttal, followed by the researcher’s comments, where they tried to twist their results in favour of NEP, without admitting to any flaws in their research. The lead researcher (Dr. Julie Bruneau) has refused to talk to the author of this article.

A Vancouver study found similar results (Strathdee, 1997 and Schechter, 1999) but also found that HIV-positive drug abusers were more likely to inject cocaine and to have been using drugs for more than 2 years. Negative effects of NEP are not limited to HIV. A Seattle based study found that NEP users were more likely to become positive for Hepatitis B or C antibodies (Hagan, 1999).

Scientists have tried to explain these results away. Perhaps, they muse, it is becase Canadian drug users are more likely to inject cocaine. Or because higher-risk drug users are more likely to use NEPs. Or because needle exchange users sometimes use dirty needles, and non-users sometimes buy clean needles from pharmacies.

None of these explanations is satisfactory, nor are any backed up by science. There is one explanation that researchers avoid like the plague - that injection of drugs is the direct source of the antibodies. If this is true it would mean that drug addicts were not generating antibodies because of infectious diseases, but because of the drugs, impurities in the drugs, or fillers used to ‘cut’ the drugs. Supporting this, one study (Sterk, 1988) found a much higher percentage of non-injection cocaine users to be HIV-positive (84%) than injection users (46%). Clean needle users may be more likely to have antibodies because they are exposed to more drugs. Consideration of this theory would call into question the basis for the ‘harm reduction’ philosophy that considers exposure to pathogens to be a greater risk than use of drugs, and that has persuaded some addicts to move from injecting to snorting drugs. It would also underme confidence in the accuracy of antibody tests, and reduce the perception that HIV, Hepatitis B and Hepatitis C are threats to healthy people.

The only real solution to the damage done by drugs is to stop using them. People recovering from drug abuse (just like recovering alcoholics or the over-medicated), will also be suffering from nutritional deficiencies as, during their addiction their diet was likely poor and their body absorbed nutrients inefficiently. According to Dr. Roberto Cappelletti, an Italian doctor who has worked extensively with recovering drug addicts, they need lots of protein in their diet to help their recovery, especially those from meat, curd, whey, fresh milk and eggs. Antioxidants are important, particularly poly-phenols, from fruits such as plum, blackberry, bilberry and grape. Green tea is also valuable. They have high needs for essential fatty acids found in linseed oil, enotera oil (omega-6) and fish oil (omega-3). Fresh or boiled foods and lots of roughage are preferred, and fried foods and sugar are to be avoided. Algae, such as agar, helps rebuild their connective tissues.

References:

[Des Jarlais, 1996]	Des Jarlais DC et al. HIV incidence among injecting drug users in New York City syringe-exchange programmes. Lancet. 1996; 348: 987-91.
[Bruneau, 1997]	Bruneau J et al. High Rates of HIV Infection among Injection Drug Users Participating in Needle Exchange Programs in Montreal: Results of a Cohort Study. American Journal of Epidemiology. 1997; 146(12): 994-1002.
[Strathdee, 1997]	Strathdee SA et al. Needle exchange is not enough: lessons from the Vancouver injecting drug use study. AIDS. 1997 Jul 11; 11(8): F60-5.
[Schechter, 1999]	Schechter MT et al. Do needle exchange programmes increase the spread of HIV among injection drug users?: An investigation of the Vancouver outbreak. AIDS. 1999; 13(6): F45-51.
[Hagan, 1999]	Hagan H et al. Syringe exchange and risk of infection with hepatitis B and C viruses. Am J Epidemiol. 1999; 149: 203-13.
[Sterk, 1988]	Sterk C. Cocaine and HIV seropositivity. Lancet. 1988 May 7; 1052-3.