Sponsored by Drug Policy Alliance New Jersey16 West Front Street, Suite 101A, Trenton, NJ 08608 • Phone: 609-396-8613 • Fax: 609-396-9478

Email:nj@drugpolicy.org

Syringe Access: Questions & Answers

Why do we need sterile syringe access in New Jersey? • New Jersey has the 5th highest number of adult HIV/AIDS cases, the 3rd highest number of pediatric HIV/AIDS cases, and the highest proportion of women infected with HIV in the nation.1 And the rate of HIV infection related to the sharing of contaminated syringes is significantly above the national average.2 Nationally about 25% of HIV infections are related to the sharing of contaminated syringes, in New Jersey, 41% of infections are related to the sharing of contaminated syringes.3 And now the state is facing a new epidemic of hepatitis C infections.

• Communities of color have been particularly affected. Seventy-five percent of HIV/AIDS cases are among minorities.4

In New Jersey, 1 in 65 African Americans is living with HIV/AIDS compared to 1 in 837 whites.

Are sterile syringes available in other states and cities to prevent the spread of disease? • Yes. Most states allow some type of access to sterile syringes to prevent the spread of HIV/AIDS, hepatitis C and

other blood-borne diseases either through syringe access programs or non-prescription sale of syringes in pharmacies.5

Until the passage of the Blood-borne Disease Harm Reduction Act in December 2006, New Jersey was the only state to allow no access New Jersey has sterile syringe access programs in five cities around the state (Atlantic City, Camden, Jersey City, Paterson and Newark).

whatsoever to clean needles to prevent the spread of HIV and other blood-borne diseases. Now

• New Jersey is one of only two states that require a prescription to purchase a syringe in a pharmacy.6

• The first sterile syringe access program in the United States was started in Tacoma, Washington in 1988.7 As of 1999 there were over 160 syringe exchange programs in 39 U.S. states, the District of Columbia and Puerto Rico.8

Is sterile syringe access effective in reducing the spread of HIV, hepatitis C, and other blood-borne diseases? • Yes. Every scientific, medical, and professional organization to study the issue has concluded that sterile syringe access reduces the spread of HIV, hepatitis C, and other blood-borne diseases.

• A worldwide survey found that HIV rates among injection drug users decreased by 5.8% per year in cities with syringe access programs, and increased by 5.9% a year in cities without syringe access programs.9

• In New York City, injection drug users who used sterile syringe access programs were 2/3 less likely to become infected with HIV than those who did not.10

• Syringe access programs reduce the spread of hepatitis. Participants in a Tacoma, Washington syringe access program were 6 to 7 times less likely to contract hepatitis B or C.11 A New Haven, Connecticut syringe access program was associated with a 33% reduction in HIV incidence and a similar reduction in hepatitis B.12

Who supports sterile syringe access? • National organizations that endorse sterile syringe access as a means to reduce the spread of HIV and other blood- borne diseases include the National Institutes of Health Consensus Panel, the National Academy of Sciences, the American Medical Association, the American Foundation for AIDS Research, the American Nurses Association, the American Public Health Association, the American Academy of Pediatrics, the Association of State and Territorial Health Officials and the National Conference of Mayors.

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Sponsored by Drug Policy Alliance New Jersey16 West Front Street, Suite 101A, Trenton, NJ 08608 • Phone: 609-396-8613 • Fax: 609-396-9478

Email:nj@drugpolicy.org

Syringe Access: Questions & Answers continued

Who supports sterile syringe access? • New Jersey organizations that endorse sterile syringe access include the Medical Society of New Jersey, the New Jersey State Nurses Association, the New Jersey Academy of Family Physicians, Hyacinth AIDS Foundation, the Black Ministers Council of New Jersey, the AIDS Resource Foundation for Children, the National Association of Social Workers-New Jersey Chapter, the Garden State Pharmacy Owners, the New Jersey Council of Chain Drug Stores, the New Jersey Pharmacists Association, the Independent Pharmacy Alliance, the Licensed Practical Nurse Association of New Jersey, the New Jersey Women and AIDS Network, the New Jersey Hospice and Palliative Care Organization, the New Jersey Association of Mental Health Agencies, and the Dogwood Center.

Does sterile syringe access encourage drug use? • No. Seven U.S. government funded studies concur that access to sterile syringes reduces the spread of HIV and does not increase drug use.13

• Donna Shalala, former United States Secretary of Health and Human Services wrote in 1998, “A meticulous scientific review has now proven that needle exchange programs can reduce the transmission of HIV and save lives without losing ground in the battle against illicit drugs.”14

• Former U.S. Surgeon General Dr. David Satcher wrote in a report in 2000 that, “After reviewing all of the research to date, the senior scientists of the Department and I have unanimously agreed that there is conclusive scientific evidence that syringe exchange programs, as part of a comprehensive HIV prevention strategy, are an effective public health intervention that reduces the transmission of HIV and does not encourage the use of illegal drugs.”15

Does sterile syringe access increase the number of improperly discarded syringes? • No. In fact, some neighborhoods report a decrease in improperly discarded syringes after syringe access programs open. Studies in Portland, Oregon and Baltimore, Maryland found similar or decreased numbers of improperly discarded syringes after the implementation of sterile syringe access programs.16

• A major evaluation was done by the New York Academy of Medicine after New York State changed its law to allow for non-prescription sale of syringes in pharmacies. The report found no increase in improperly discarded syringes, no increase in accidental needle sticks among law enforcement or sanitation workers, no increase in criminal activity and no increase in drug use after the law changed.17

Does sterile syringe access hinder other drug treatment efforts? • No. In fact sterile syringe access programs provide a bridge to drug treatment and other social services for drug users. Staff at syringe access programs are trained to work with injection drug users and provide them referrals to drug treatment, medical services, and other social services.

• A 1993 study of a Tacoma, Washington syringe access program found that it was the single largest source of referrals to county drug treatment programs. A large percentage of those seeking treatment had never before been in treatment.18

• A 1998 study found that 76% of the clients of a Baltimore syringe access program who entered drug treatment as a result of a referral from the program remained in treatment for at least three months and achieved good treatment outcomes, i.e. reductions in both drug use and criminal activity. The majority of those who entered treatment were unemployed, middle-aged, African American males who had never been in a drug treatment program.19

• A 1994 study of a syringe access program in New Haven, Connecticut documented that syringe access programs facilitate drug users entry into drug treatment.20

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Sponsored by Drug Policy Alliance New Jersey16 West Front Street, Suite 101A, Trenton, NJ 08608 • Phone: 609-396-8613 • Fax: 609-396-9478

Email:nj@drugpolicy.org

Syringe Access: Questions & Answers continued

Do syringe access programs increase crime or criminal activity in areas where they are operated? • No. No study has ever found an increase in crime associated with the establishment of a syringe access program. A 1993 review of 16 syringe access programs reported no evidence of increased crime.21

• In 2000, another study in Baltimore compared arrest rates in areas with syringe access programs and those without such programs. In all cases there was no significant increase in arrest rates in the areas with syringe access programs compared to the areas without programs.22

• A detailed analysis of syringe access programs in New York City in 2001 found no relationship between reports on robberies or assaults and the proximity to local syringe access programs.23

What is the economic impact of sterile syringe access? • Sterile syringe access programs save New Jersey money. A cost benefit analysis of sterile syringe the firm Ne

access byw Jersey Economics found that New Jersey could realize savings similar to that of other

that have implemented sterile syringe access programs. The report found that New jurisdictions

Jersey could save up to $16 for every $1 spent on sterile syringe access.24

• A 2000 study from Australia estimated that between 1990 and 2000 the country realized a savings of between $1.3 billion and $4.2 billion on an $83 million investment in syringe access programs. The savings resulted from reduced rates of HIV and hepatitis C.25

• Laws that allow for non-prescription sale of syringes in pharmacies have the added advantage of needing no private or public funding—individuals at risk from injection related diseases use their own money to protect their own health.

• A clean needle costs about 10¢ wholesale and 50¢ retail. Lifetime AIDS care for one person costs about $618,000.26

1 New Jersey Department of Health, New Jersey HIV/AIDS Report, June 30, 2002.2 New Jersey Department of Health, New Jersey HIV/AIDS Report, June 30, 2002; CDC, HIV/AIDS Surveillance Report, 2002, Volume 14, Cases of HIV Infection and AIDS in the United States, 2002.3 New Jersey Department of Health, New Jersey HIV/AIDS Report, December 31, 20074 New Jersey Department of Health, New Jersey HIV/AIDS Report, Dec. 30, 20055 Scott Burris, Steffanie A. Strathdee, Jon S. Vernick. Lethal Injections: The Law, Science, and Politics of Syringe Access for Injection Drug Users. University of San Francisco Law Review. Summer 2003.6 Scott Burris, Steffanie A. Strathdee, Jon S. Vernick. Syringe Access Law in the United States: A State of the Art Assessment of Law and Policy, November, 2002.7 Id.8 Id.9 S.F. Hurley, D. J. Jolley, J.M. Kaldor, Effectiveness of Needle-Exchange Programmes for Prevention of HIV Infection, Lancet 349:1797 (1997).10 D.C Des Jarlais, M. Marmor, D. Paone. HIV Incidence Among Injecting Drug Users in New York Syringe-Exchange Programmes. Lancet. 348:987-991 (1996).11 H. Hagen, D.C. Des Jarlais, S. R. Friedman, D Purchases, M.J. Alter. Reduced Risk of Hepatitis B and Hepatitis C Among Injection Drug Users in the Tacoma Syringe Exchange Program. American Journal of Public Health. 85:1531-1537 (1995).12 E.H. Kaplan. Probability Models of Needle Exchange. Operations Research. 43:558-569 (1995); R. Heimer, K. Khoshnood, F.B. Jariwala, B. Duncan. Y. Harima. Hepatitis in Used Syringes: The Limits of Sensitivity of Techniques to Detect HBV DNA, HCV RNA, and Antibodies to HB Core and HCV Antigens. Journal of Infectious Diseases. 173:997-1000 (1996).13 National Commission on AIDS, The Twin Epidemics of Substance Abuse and HIV (Washington DC: National Commission on AIDS, 1991); General Accounting Office, Needle Exchange Programs: Research Suggests Promise as an AIDS Prevention Strategy (Washington DC: US Government Printing Office, 1993); Lurie, P. & Reingold, A.L., et al., The Public Health Impact of Needle Exchange Programs in the United States and Abroad (San Francisco, CA: University of California, 1993); Satcher, David, MD, (Note to Jo Ivey Bouffard), The Clinton Administration's Internal Reviews of Research on Needle Exchange Programs (Atlanta, GA: Centers for Disease Control, December 10, 1993); National Research Council and Institute of Medicine, Normand, J., Vlahov, D. & Moses, L. (eds.), Preventing HIV Transmission: The Role of Sterile Needles and Bleach (Washington DC: National Academy Press, 1995); Office of Technology Assessment of the U.S. Congress, The Effectiveness of AIDS Prevention Efforts (Springfield, VA: National Technology Information Service, 1995); National Institutes of Health Consensus Panel, Interventions to Prevent HIV Risk Behaviors (Kensington, MD: National Institutes of Health Consensus Program Information Center, February 1997).14 Shalala, D.E., Secretary, Department of Health and Human Services, Press release from Department of Health and Human Services (April 20, 1998).15 US Surgeon General Dr. David Satcher, Department of Health and Human Services, Evidence-Based Findings on the Efficacy of Syringe Exchange Programs: An Analysis from the Assistant Secretary for Health and Surgeon General of the Scientific Research Completed Since April 1998 (Washington, DC: Dept. of Health and Human Services, 2000).16 J. Normand, D. Vahov, L.E. Moses, eds. Preventing HIV Transmission: The Role of Sterile Needles and Bleach. Washington, DC: National Academy Press; 1995237; K.J. Oliver, S.R. Friedman, H. Maynard, L. Magnusson, D.C. Des Jarlais. Impact of a Needle Exchange Program on Potentially Infectious Syringes in Public Places. Journal of Acquired Immune Deficiency Syndromes. 5:380 (1992); P. Lurie, A. Reingold. The Public Health Impact of Needle Exchange Programs in the United States and Abroad (prepared for the Centers for Disease Control and Prevention). Berkeley, CA: University of California, School of Public Health, and San Francisco, CA: University of California, Institute for Health Policy Studies; 1993:388; M.C. Doherty, R.S. Garfein, D. Vlahov, et al. Discarded Needles Do Not Increase Soon After the Opening of a Needle Exchange Program. American Journal of Epidemiology. 145:730-737 (1997).17 New York Academy of Medicine. New York State Expanded Syringe Access Demonstration Program Evaluation. January 15, 2003.18 H. Hagan, D.C. Des Jarlais, D. Purchase, S.R. Friedman, et al. An Interview Study of Participants in the Tacoma, Washington, Syringe Exchange. Addiction. 88:1694-1695 (1993).19 R. Brooner, M. Kidorf, et al. A Drug Abuse Treatment Success Among Needle Exchange Participants. Public Health Reports. 113(supplement 1):130-139 (1998).20 R. Heimer, M. Lopes. Needle Exchange in New Haven Reduces HIV Risks, Promotes Entry Into Drug Treatment, and Does Not Create New Drug Injectors. Journal of the American Medical Association. 271:1825-1826 (1994).21 P. Lurie, A.L. Reingold, B. Bowser (eds). The Public Health Impact of Needle Exchange Programs in the United States and Abroad: Summary, Conclusions and Recommendations (1993).22 M.A. Marx, B. Crape, R.S. Bookmeyer, B. Junge, et al. Trends in Crime and the Introduction of a Needle Exchange Program. American Journal of Public Health 90:1933 (2000).23 S. Galea, J Ahern, C. Fuller, N. Freudenberg, D. Vlahov. Needle Exchange Programs and Experience of Violence in an Inner City Neighborhood. Journal of Acquired Immune Deficiency Syndromes. 28:282 (2001).24 New Jersey Economics. Access to Sterile Syringes and Public Health Costs in New Jersey: Suggestions for Public Policy. 2003.25 Australian Commonwealth Department of Health and Aging. Return on Investment in Needle and Syringe Programs in Australia. 2002.26 Schackman, Bruce R., et al. The Lifetime Cost of Current Human Immunodeficiency Virus Care in the United States. Medical Care. 44 (11):990-997 (2006).