Needle-exchange programs should be implemented and expanded in areas with high rates of intravenous drug abuse. Although data are still preliminary, they support a public health intervention that is inexpensive

(especially in comparison with the societal costs of treating those with HIV) and likely to reduce the transmission of fatal bloodborne infection among drug users, their sexual partners, and their children. These programs should include education and counseling, referral for drug and medical treatment, HIV and hepatitis testing, and condom distribution. Needle-exchange programs should be voluntary, anonymous, and accessible and should strive to recapture all needles distributed to reduce the risk to the public. All

needle-exchange programs should have an ongoing evaluative component to assess efficacy and need. Additionally, the College supports a repeal of the federal funding ban on needle-exchange programs and instead supports targeting federal monies to programs with well-designed evaluative methodologies. Although needle-exchange programs show promise in reducing needle sharing and acquisition of hepatitis and HIV, these

programs are not a panacea for the complex problems of drug use and associated infections. Needle-exchange programs should not substitute for a comprehensive approach to drug treatment and prevention.

• See the entire ACPM recommendation at:

Needle Exchange Programs to Reduce Drug-Associated Morbidity and Mortality. Rebecca Ferrini, MD, MPH, University of California/California State University.