importantly, HIV transmission. These data also clearly show that in-treatment injection drug users will continue to inject on occasion. Moreover, other studies have found drug treatment experience (i.e., past history of exposure to treatment) to be related to higher levels of HIV risk behaviors for certain injection drug users (Siegal et al., 1995; Ross et al., 1993; Chitwood and Morningstar, 1985).

Federal Regulations

Few treatment programs in the United States have instituted training on how to effectively decontaminate needles or provide information on how to legally obtain sterile needles. Federal regulations governing some forms of drug abuse treatment also are obstacles to drug treatment providers and their patients to make use of needle exchange and bleach distribution programs.

For example, federal regulations concerning take-home medication for patients receiving methadone therapy [21 CFR, part 291.505 (d) (6) (iv) (B) (1)] require clinicians to consider the ''absence of recent abuse of drugs (narcotic and nonnarcotic), including alcohol" in determining whether to grant the privilege of reduced clinic attendance and the provision of doses of methadone (take-home medication) for the days when the patient does not attend the clinic. Consequently, for patients who have relapsed and who may consider using needle exchange and bleach distribution programs to more safely inject drugs, this federal regulation is a disincentive to admit to recent needle exchange and bleach distribution program participation. Such an admission would result in denial or revocation of reduced clinic attendance (or take-home medication) privileges.

In a similar manner, a counselor cannot advise a patient who is receiving or is eligible for take-home medication privileges to continue to abstain from any drug use, while also suggesting participation in needle exchange and bleach distribution programs if drug use does occur. Knowledge of needle exchange and bleach distribution program participation or any other activity that may be indicative of drug use would require—because of federal regulations—drug treatment clinicians to consider denying or revoking the take-home medication status of a patient.

Condoning Drug Use

As we document more fully in Chapter 7, reviews of the empirical data show no evidence to support the charge that needle availability promotes drug use among current or potential users (Schwartz, 1993; Karpen, 1990; Watters et al., 1994; U.S. General Accounting Office, 1993; Lurie and Chen, 1993). Moreover, in considering the current knowledge base on the etiology

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