NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
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This project was sponsored by the National Institute on Drug Abuse.
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PANEL ON NEEDLE EXCHANGE AND BLEACH DISTRIBUTION PROGRAMS
LINCOLN MOSES (Chair),
Department of Statistics, Stanford University
RONALD S. BROOKMEYER,
Department of Biostatistics, School of Hygiene and Public Health, The Johns Hopkins University
LAWRENCE S. BROWN, Jr.,
Department of Medicine, Harlem Hospital, College of Physicians and Surgeons, Columbia University and Division of Medical Services Evaluation and Research, Addiction Research and Treatment Corporation, Brooklyn
RICHARD F. CATALANO,
Social Development Research Group, Seattle
DAVID S. CORDRAY,
Vanderbilt Institute for Public Policy Studies and Department of Human Resources, Peabody College, Vanderbilt University
DON C. DES JARLAIS,
Chemical Dependency Institute, National Development and Research Institutes, Inc., Beth Israel Medical Center, New York
CASWELL A. EVANS, Jr.,
Public Health Programs and Services, County of Los Angeles Department of Health Services
MARK B. FEINBERG,
Gladstone Institute of Virology and Immunology, San Francisco
HERBERT D. KLEBER,
Department of Psychiatry, College of Physicians and Surgeons, and Center on Addiction and Substance Abuse, Columbia University
PATRICK M. O'MALLEY,
Institute for Social Research, University of Michigan, Ann Arbor
NANCY S. PADIAN,
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco General Hospital
MARIAN GRAY SECUNDY,
College of Medicine, Department of Community Health and Family Practice, Howard University
DAVID VLAHOV,
School of Hygiene and Public Health, The Johns Hopkins University
W. WAYNE WIEBEL,
AIDS Outreach Intervention Project and School of Public Health, Epidemiology and Biostatistics, University of Chicago at Illinois
DAVID R. WILLIAMS,
Institute for Social Research, University of Michigan, Ann Arbor
National Research Council Staff
SUSANNE M. STOIBER, Division Director (through January 1994)
ALEXANDRA K. WIGDOR, Division Director (from February 1994)
JACQUES L. NORMAND, Study Director
SAHR J. KPUNDEH, Staff Officer
ELAINE McGARRAUGH, Research Associate
SUSAN R. McCUTCHEN, Senior Project Assistant
Institute of Medicine Staff
MICHAEL A. STOTO, Division Director
LESLIE M. HARDY, Program Officer
CONTENTS
PREFACE
The July 1992 ADAMHA Reorganization Act mandated that the Secretary of Health and Human Services, acting through the Director of the National Institute on Drug Abuse, request the National Academy of Sciences to conduct a study on the impact of needle exchange and bleach distribution programs on drug use behavior and the spread of the human immunodeficiency virus. In response to that legislative directive, the National Research Council and the Institute of Medicine of the National Academy of Sciences organized the Panel on Needle Exchange and Bleach Distribution Programs in May 1993, under the auspices of the Committee on AIDS Research and the Behavioral, Social, and Statistical Sciences. Specifically, the panel was asked to: (1) examine the scientific evidence pertaining to the effects of needle exchange and bleach programs on rates of drug use and the behavior of drug users in the United States; (2) evaluate the efficacy of needle exchange and bleach programs in reducing the spread of HIV and other infectious diseases among injecting drug users and their partners, and (3) evaluate the potential risks and benefits associated with the implementation of such programs. The panel is examining related issues of importance to the research and service communities (e.g., characteristics associated with successful programs, community issues, and service delivery issues) and will make recommendations regarding future research directions and appropriate methods for evaluating needle exchange and bleach programs.
In its effort to gather and analyze the relevant scientific evidence, the panel invited both U.S. and foreign experts to participate in a two-day workshop September 27-28, 1993, devoted to the presentation and discussion of recent research on and experience with needle exchange and bleach distribution programs. (A second workshop, held in January 1994, elicited the views of the many communities with a stake in the outcome of the ongoing needle exchange and bleach distribution debate.) The agenda for the workshop was designed to inform the further work of the panel by focusing on particular salient issues to be considered in the establishment of needle exchanges and bleach distribution programs. Because substantial public interest in data on the efficacy of needle exchange and bleach distribution programs has been expressed and most of the presentations made at this workshop summarize ongoing research projects, panel members decided it would be beneficial to publish the papers.
This proceedings is organized to follow the five sessions that constituted the workshop: U.S. needle exchange data, international evaluations of needle exchange programs, legal issues and drug paraphernalia laws, evaluation methods, and bleach distribution programs. Each section consists of the papers that were presented, followed by a brief summary of the presentations by the designated discussant.
Panel members are indebted to the presenters and discussants who participated in this workshop and to the workshop participants who volunteered time to share their insights and expertise. We note with sadness the recent death of Noreen Harris, one of the presenters, and offer our sympathy to her family and colleagues. Noreen's research has contributed greatly to enhancing the knowledge and understanding of critical issues in the areas of HIV/AIDS and drug abuse.
The panel extends its sincere thanks and appreciation to Sander Genser and Peter Hartsock of the National Institute on Drug Abuse and T. Stephen Jones of the Centers for Disease Control and Prevention for their valuable assistance in organizing the workshop.
The panel also benefited from the work of the staffs of the National Research Council and the Institute of Medicine, including Susanne Stoiber, Michael Stoto, and Leslie Hardy, who provided valuable suggestions for this panel activity. Special thanks are due to the panel staff: Jacques Normand, study director; Sahr John Kpundeh, staff officer; Elaine McGarraugh, research associate; and Susan McCutchen, senior project assistant, for their many hours of work expended in bringing this workshop to fruition and producing this proceedings.
Lincoln E. Moses, Chair
Panel on Needle Exchange and Bleach Distribution Programs