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Suggested Citation:"FRONT MATTER." Institute of Medicine and National Research Council. 1994. Proceedings--Workshop on Needle Exchange and Bleach Distribution Programs. Washington, DC: The National Academies Press. doi: 10.17226/4552.
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Proceedings Workshop on Needle Exchange and Bleach Distribution Programs

PANEL ON NEEDLE EXCHANGE AND BLEACH DISTRIBUTION PROGRAMS

Commission on Behavioral and Social Sciences and Education

National Research Council and

Institute of Medicine

NATIONAL ACADEMY PRESS
Washington, D.C.
1994

Suggested Citation:"FRONT MATTER." Institute of Medicine and National Research Council. 1994. Proceedings--Workshop on Needle Exchange and Bleach Distribution Programs. Washington, DC: The National Academies Press. doi: 10.17226/4552.
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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.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that require it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievement of engineers. Dr. Robert M. White is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Robert M. White are chairman and vice chairman, respectively, of the National Research Council.

This project was sponsored by the National Institute on Drug Abuse.

Library of Congress Catalog Card No. 94-67632

International Standard Book Number 0-309-05084-7

Additional copies of this report are available from:
National Academy Press
2101 Constitution Avenue N.W. Washington, D.C. 20418 Call 800-624-6242 or 202-334-3313 (in the Washington Metropolitan Area).

B349

Printed in the United States of America

Copyright 1994 by the National Academy of Sciences. All rights reserved.

Suggested Citation:"FRONT MATTER." Institute of Medicine and National Research Council. 1994. Proceedings--Workshop on Needle Exchange and Bleach Distribution Programs. Washington, DC: The National Academies Press. doi: 10.17226/4552.
×

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

Suggested Citation:"FRONT MATTER." Institute of Medicine and National Research Council. 1994. Proceedings--Workshop on Needle Exchange and Bleach Distribution Programs. Washington, DC: The National Academies Press. doi: 10.17226/4552.
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Suggested Citation:"FRONT MATTER." Institute of Medicine and National Research Council. 1994. Proceedings--Workshop on Needle Exchange and Bleach Distribution Programs. Washington, DC: The National Academies Press. doi: 10.17226/4552.
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Suggested Citation:"FRONT MATTER." Institute of Medicine and National Research Council. 1994. Proceedings--Workshop on Needle Exchange and Bleach Distribution Programs. Washington, DC: The National Academies Press. doi: 10.17226/4552.
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Suggested Citation:"FRONT MATTER." Institute of Medicine and National Research Council. 1994. Proceedings--Workshop on Needle Exchange and Bleach Distribution Programs. Washington, DC: The National Academies Press. doi: 10.17226/4552.
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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.

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Suggested Citation:"FRONT MATTER." Institute of Medicine and National Research Council. 1994. Proceedings--Workshop on Needle Exchange and Bleach Distribution Programs. Washington, DC: The National Academies Press. doi: 10.17226/4552.
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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

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This book reports on research on and experience with needle exchange and bleach distribution programs and their effects on rates of drug use, the behavior of injection drug users, and the spread of HIV and other infectious diseases among injection drug users. It discusses U.S. needle exchange data, international evaluations of needle exchange programs, legal issues and drug paraphernalia laws, evaluation methods, and bleach distribution programs.

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