Pubdate:  August 1, 1997
Source:   The Globe and Mail, page A7
Contact:  Art: Needle exchange saves drugs users, study finds

Prevention program may reduce health costs

By Jane Coutts, Health Policy Reporter

Needleexchange programs can save the Canadian health care
system millions of dollars by preventing the spread of HIV
among injection drug users, a new study shows.

In a study published today in the Canadian Medical
Association Journal, researchers in Hamilton, Ont., say
needleexchange programs  the efficacy of which has been
sometimes questioned  save money as well as avert
suffering.

Drug users have a high and rapidly increasing rate of AIDS
and HIV infection, because they often share needles to
inject drugs such as heroin and cocaine. Infection occurs
when traces of contaminated blood remain in the needle when
it is handed on.

In needleexchange programs, intravenous drug users are
provided with clean, sterile syringes while their used 
and possibly contaminated  syringes are collected and
destroyed.

Using the example of a needleexchange program in Hamiltion,
which in 1995 provided 14,207 clean syringes to an estimated
275 drug users, the researchers concluded that the program
was able to prevent 24 new HIV infections over five years.

At a cost of $76,775 per year to run the program, and using
the most conservative estimates of the cost of treating HIV
and AIDS over a lifetime, the study found the Hamilton
needleexchange program would save $1.29 million in direct
health care costs over five years.

"Not included in our estimates were the indirect costs of
illness such as the loss of human capital; that is, the
future economic burden to society of lost productivity
because of premature death," the study says, and adds that
the cost of informal care  outofpocket, emotional and
physical demands on informal caregivers  should not be
ignored.

The study's findings should encourage the development of
more needleexchange programs, said Michelle Gold, a
researcher at McMaster University.

The programs have sometimes been controversial, both because
people feared providing needles would encourage drug use,
and because there was no proof they actually contained the
spread of AIDS and HIV.

However changing druguse patterns are increasingly a threat
to efforts to control the spread of HIV among drug users,
the head of the Canadian AIDS Task Force says.

Catherine Hankins said needleexchange programs work best
for heroin addicts, whose behavior is quite predictable.
Increasingly, however, drug users are injecting cocaine, or
a mixture of heroin and cocaine, and that's a challenge for
needleexchange programs, she said.

An epidemiologist with the Montreal Regional Public Health
Department, Dr. Hankins said cocaine has long been the drug
of choice with injection drug users in Montreal, but other
cities are starting to see the same problem.

Cocaine injectors, Dr. Hankins said, may shoot up 20 to 30
times a day, and frequently with groups of other users. In
such situations, it's hard to keep track of whose needles
are whose.

"Needleexchange programs are key [to containing the spread
of HIV], but they're not enough," she said.