Improving public health

Injection drug use is associated with 75% of hepatitis C cases and 10 – 12% of HIV cases when risks are identified. 1 2 3 As this enormous disease burden is due to sharing contaminated supplies, providing clean equipment can reduce the risk of contracting disease. It's that simple — and many studies have proven that this technique is highly effective. 4 5 6 7 8 9 10 11 12 Direct measurement shows that needle exchanges can lead to a 33% reduction in overall HIV rates (and a 70% reduction in the HIV rate attributable to injection drug use), 61% reduction in hepatitis B rates, and 65% reduction in hepatitis C rates among clients. 13 14 15 16

Orange County has the fourth-highest number of HIV+ patients in California (doubling in less than 10 years) and has nearly 1,000 cases of hepatitis C. 17 18 19 Based on the above evidence, establishing a needle exchange program is essential to reduce these infections and improve the public health of our community.

Needle exchanges are about more than just syringes. Most new cases of hepatitis C are caused by sharing supplies other than needles. 20 Providing HIV testing and safer sex supplies is essential to reducing the spread of HIV and other sexually-transmitted diseases, as are connecting people to medical, social, psychological, and housing services if clients desire them. More than 3/4 of injection drug users receive all of their health services from needle exchanges when they are available. 21 Available data shows that 49% of needle exchange referrals result in successful admissions. 22 Programs such as OCNEP are thus critical social safety nets as well as being effective public health interventions.

Making communities safer

Wherever a needle exchange exists, dirty syringes are being safely removed from the community. Without such programs, these needles would otherwise be in the public trash, parks, and beaches. Improper disposal can be more than halved in areas with needle exchanges. 23 24 25 26 This has a demonstrable improvement in safety, with reported reductions in needlestick injuries around 67%. 27 In cities without a needle exchange, improper disposal can be 800% higher. 28

Needle exchanges decrease drug use and improve access to services. 29 14 30 31 Needle sharing decreases and even injection frequency decreases when a needle exchange is operating. 32 The explanation for this is simple: by treating injection drug users with respect and compassion while providing needed health services, enrollment in those services dramatically increases and many harms are prevented. 33

The presence of a needle exchange doesn't increase crime. 34 35 36 Needle exchanges don't encourage drug use in children. 37 No negative outcomes have ever been shown to come from needle exchange programs, making them incredibly safe, effective ways to combat infectious diseases and benefit communities.

Highly cost-efficient

Every case of HIV costs over $300,000. 38 Hepatitis C treatments cost $1,000 for a single pill and average $65,000 per case. 39 40 Opiate overdose costs $20.4 billion nationally. 41 Each of these figures demonstrates costs many times the annual budget of our needle exchange — syringes cost only 9¢. Based on the statistics above, this means that conservative cost savings from programs like OCNEP are in the tens of thousands of dollars.

Needle exchanges are capable of preventing up to an estimated $538 million in national preventable HIV cases. 42 This enormous cost does not include prevented cases of hepatitis A, B, or C, reduced emergency department visits, overdose prevention, reduced abscesses, skin infections, needlestick injuries, or other harms that needle exchanges lessen. This also does not include the societal benefits associated with better access to social services and drug treatment when people seek them. It is thus of no surprise that needle exchanges generate high value per dollar. 43 44

Our research

We are an evidence-based program and are committed to improvement and the actual needs of Orange County drug users. Accordingly, we are studying the outcomes of our program and the needs of the people who use it to be as effective as we possibly can. In conjunction with faculty from UC Irvine and USC — experts in sociology, public health, and needle exchanges — we are developing a research protocol that by 2016 will improve the publicly-available data on injection drug use, quantify our impact, and suggest improvements for infectious disease and drug treatment strategies in Orange County.


  1. Centers for Disease Control and Prevention (2012). Surveillance for Viral Hepatitis – United States, 2012. Accessed December 14, 2014.

  2. Centers for Disease Control and Prevention (2012). HIV Surveillance Report, 2012; volume 24. Accessed December 14, 2014.

  3. Prejean J, Song R, Hernandez A, Ziebell R, Green T, Walker F, Lin LS, An Q, Mermin J, Lansky A, Hall HI, HIV Incidence Surveillance Group (2011). Estimated HIV incidence in the United States, 2006-2009. PLoS One, 6(8): e17502.

  4. Des Jarlais DC, Perlis T, Arasteh K, Torian LV, Hagan H, Beatrice S, Smith L, Wethers J, Milliken J, Mildvan D, Yancovitz S, Friedman SR (2005). Reductions in hepatitis C virus and HIV infections among injecting drug users in New York City, 1990 – 2001. AIDS, 19(Suppl 3): S20 – S25.

  5. Des Jarlais DC, Perlis T, Arasteh K, Torian LV, Beatrice S, Milliken J, Mildvan D, Yancovitz S, Friedman SR (2005). HIV incidence among injection drug users in New York City, 1990 to 2002: use of serologic test algorithm to assess expansion of HIV prevention services. American Journal of Public Health, 95(8): 1439 – 1444.

  6. Monterroso ER, Hamburger ME, Vlahov D, Des Jarlais DC, Ouellet LJ, Altice FL, Byers RH, Kerndt PR, Watters JK, Bowser BP, Fernando MD, Holmberg SD (2000). Prevention of HIV infection in street-recruited injection drug users. Journal of Acquired Immune Deficiency Syndromes, 25(1): 63 – 70.

  7. Santibanez SS, Garfein RS, Swartzendruber A, Purcell DW, Paxton LA, Greenberg AE (2006). Update and overview of practical epidemiologic aspects of HIV/AIDS among injection drug users in the United States. Journal of Urban Health, 83(1): 86 – 100.

  8. Hall HI, Song R, Rhodes P, Prejean J, An Q, Lee LM, Karon J, Brookmeyer R, Kaplan EH, McKenna MT, Janssen RS (2008). Estimation of HIV incidence in the United States. Journal of the American Medical Association, 300(5): 520 – 529.

  9. Drucker E, Lurie P, Wodak A, Alcabes P (1998). Measuring harm reduction: the effects of needle and syringe exchange programs and methadone maintenance on the ecology of HIV. AIDS, 12(Suppl A): S217 – S230.

  10. Hurley SF, Jolley DJ, Kaldor JM (1997). Effectiveness of needle-exchange programmes for prevention of HIV infection. Lancet, 349(9068): 1797 – 1800.

  11. Aspinall EJ, Nambiar D, Goldberg DJ, Hickman M, Weir A, Van Velzen E, Palmateer N, Doyle JS, Hellard ME, Hutchinson SJ (2014). Are needle and syringe programmes associated with a reduction in HIV transmission among people who inject drugs: a systematic review and meta-analysis. International Journal of Epidemiology, 43(1): 235 – 248.

  12. Rich JD, Adashi EY (2015). Ideological anachronism involving needle and syringe exchange programs: lessons from the Indiana HIV outbreak. Journal of the American Medical Association, 314(1): 23 – 24.

  13. Kaplan EH (1994). A method for evaluating needle exchange programmes. Statistics in Medicine, 13(19 – 20): 2179 – 2187.

  14. Vlahov D, Junge B (1998). The role of needle exchange programs in HIV prevention. Public Health Reports, 113(Suppl 1): 75 – 80. 2

  15. Hagan H, Jarlais DC, Friedman SR, Purchase D, Alter MJ (1995). Reduced risk of hepatitis B and hepatitis C among injection drug users in the Tacoma syringe exchange program. American Journal of Public Health, 85(11): 1531 – 1537.

  16. Ruiz MS, O'Rourke A, Allen ST (2015). Impact evaluation of a policy intervention for HIV prevention in Washington, DC. AIDS and Behavior, 20(1): 22 – 28.

  17. Office of AIDS, HIV/AIDS Surveillance Section, California Department of Public Health (2014). HIV/AIDS Surveillance in California. Accessed December 14, 2014.

  18. Orange County Health Care Agency (2013). 2013 HIV Disease Fact Sheet. Accessed December 14, 2014.

  19. California Department of Public Health, Sexually Transmitted Diseases Control Branch, Office of Viral Hepatitis Prevention (2011). California Local Health Jurisdiction Chronic Viral Hepatitis Data Summaries. Accessed December 14, 2014.

  20. Thorpe LE, Ouellet LJ, Hershow R, Bailey SL, Williams IT, Williamson F, Monterroso ER, Garfein RS (2002). Risk of hepatitis C virus infection among young adult injection drug users who share injection equipment. American Journal of Epidemiology, 155(7): 645 – 653.

  21. Heinzerling KG, Kral AH, Flynn NM, Anderson RL, Scott A, Gilbert ML, Asch SM, Bluthenthal RN (2006). Unmet need for recommended preventive health services among clients of California syringe exchange programs: implications for quality improvement. Drug and Alcohol Dependence, 81(2): 167 – 178.

  22. Howard H (2010). New Jersey Syringe Access Program Demonstration Project Interim Report. Accessed July 27, 2015.

  23. Doherty MC, Junge B, Rathouz P, Garfein RS, Riley E, Vlahov D (2000). The effect of a needle exchange program on numbers of discarded needles: a 2-year follow-up. American Journal of Public Health, 90(6): 936 – 939.

  24. Quinn B, Chu D, Wenger L, Bluthenthal RN, Kral AH (2014). Syringe disposal among people who inject drugs in Los Angeles: the role of sterile syringe source. International Journal of Drug Policy, 25(5): 905 – 910.

  25. Wenger LD, Martinez AN, Carpenter L, Geckeler D, Colfax G, Kral AH (2011). Syringe disposal among injection drug users in San Francisco. American Journal of Public Health, 101(3): 484 – 486.

  26. Doherty MC, Garfein RS, Vlahov D, Junge B, Rathouz PJ, Galai N, Anthony JC, Beilenson P (1997). Discarded needles do not increase soon after the opening of a needle exchange program. American Journal of Epidemiology, 145(8): 730 – 737.

  27. Groseclose SL, Weinstein B, Jones TS, Valleroy LA, Fehrs LJ, Kassler WJ (1995). Impact of increased legal access to needles and syringes on practices of injecting-drug users and police officers – Connecticut, 1992-1993. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 90(12): 1933 – 1936.

  28. Tookes HE, Kral AH, Wenger LD, Cardenas GA, Martinez AN, Sherman RL, Pereyra M, Forrest DW, LaLota M, Metsch LR (2012). A comparison of syringe disposal practices among injection drug users in a city with versus a city without needle and syringe programs. Drug and Alcohol Dependence, 123(1 – 3): 255 – 259.

  29. Hagan H, McGough JP, Thiede H, Hopkins S, Duchin J, Alexander ER (2000). Reduced injection frequency and increased entry and retention in drug treatment associated with needle-exchange participation in Seattle drug injectors. Journal of Substance Abuse Treatment, 19(3): 247 – 252.

  30. Watters JK, Estilo MJ, Clark GL, Lorvick J (1994). Syringe and needle exchange as HIV/AIDS prevention for injection drug users. Journal of the American Medical Association, 271(1): 115 – 120.

  31. Strathdee SA, Celentano DD, Shah N, Lyles C, Stambolis VA, Macalino G, Nelson K, Vlahov D (1999). Needle-exchange attendance and health care utilization promote entry into detoxification. Journal of Urban Health, 76(4): 448 – 460.

  32. Vlahov D, Junge B, Brookmeyer R, Cohn S, Riley E, Armenian H, Beilenson P (1997). Reductions in high-risk drug use behaviors among participants in the Baltimore needle exchange program. Journal of Acquired Immune Deficiency Syndrome and Human Retrovirology, 16(5): 400 – 406.

  33. McNeil R, Small W (2014). 'Safer environment interventions': a qualitative synthesis of the experiences and perceptions of people who inject drugs. Social Science and Medicine, 106: 151 – 158.

  34. Marx MA, Crape B, Brookmeyer RS, Junge B, Latkin C, Vlahov D, Strathdee SA (2000). Trends in crime and the introduction of a needle exchange program. American Journal of Public Health, 90(12): 1933 – 1936.

  35. Galea S, Ahern J, Fuller C, Freudenberg N, Vlahov D (2001). Needle exchange programs and experience of violence in an inner city neighborhood. Journal of Acquired Immune Deficiency Syndromes, 28(3): 282 – 288.

  36. Lurie P, Reingold AL, Bowser B, Chen D, Foley J, Guydish J, Kahn JG, Lane S, Sorensen J, DeCarlo P, Harris N, Jones TS (1993). The public health impact of needle exchange programs in the United States and abroad. Accessed December 14, 2014.

  37. Marx MA, Brahmbhatt H, Beilenson P, Brookmeyer RS, Strathdee SA, Alexander C, Vlahov D (2001). Impact of needle exchange programs on adolescent perceptions about illicit drug use. AIDS and Behavior, 5(4): 379 – 386.

  38. Schackman BR, Gebo KA, Walensky RP, Losina E, Muccio T, Sax PE, Weinstein MC, Seage GR III, Moore RD, Freedberg KA (2006). The lifetime cost of current human immunodeficiency virus care in the United States. Medical Care, 44(11), 990 – 997.

  39. Razavi H, Elkhoury AC, Elbasha E, Estes C, Pasini K, Poynard T, Kumar R (2013). Chronic hepatitis C virus (HCV) disease burden and cost in the United States. Hepatology, 57(6): 2164 – 2170.

  40. Zhang S, Bastian ND, Griffin PM (2015). Cost-effectiveness of sofosbuvir-based treatments for chronic hepatitis C in the US. BioMed Central Gastroenterology, 15:98.

  41. Inocencio TJ, Carroll NV, Read EJ, Holdford DA (2013). The economic burden of opioid-related poisoning in the United States. Pain Medicine, 14(10): 1534 – 1547.

  42. Lurie P, Drucker E (1997). An opportunity lost: HIV infections associated with lack of a national needle-exchange programme in the USA. Lancet, 349(9052): 604 – 608.

  43. Holtgrave DR, Pinkerton SD, Jones TS, Lurie P, Vlahov D (1998). Cost and cost-effectiveness of increasing access to sterile syringes and needles as an HIV prevention intervention in the United States. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 18(Suppl 1): S133 – S138.

  44. Lurie P, Gorsky R, Jones TS, Shomphe L (1998). An economic analysis of needle exchange and pharmacy-based programs to increase sterile syringe availability for injection drug users. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 18(Suppl 1): S126 – S132.