like the Drug Abuse Warning Network (DAWN), Drug Use Forecasting (DUF), and Uniformed Crime Reports (UCR), which might reflect altered patterns of drug-related events, such as drug cases in hospital emergency rooms, positive urine drug screens, and drug-related arrests, respectively. The report noted wide variation in these drug-use indicators over time, which suggests inherent lack of precision and limits the manifestation of patterns—if any—relating to needle exchange.

The University of California report also noted that, because needle exchange programs are relatively new, changes in drug use might yet appear with longer follow-up. The report concluded that (Lurie et al., 1993:357) "currently available (national indicator) data provide no evidence of change in overall community levels of drug use associated with needle exchange programs."

The report also noted that the San Francisco and Amsterdam surveys described above provide (Lurie et al., 1993:357) "some evidence that needle exchange programs are not associated with an increase in community levels of injecting or overall drug use."

Increase in Number of Contaminated Needles Unsafely Discarded

The University of California report noted that adverse community responses to needle exchange programs are likely to be centered on the issue of discarded needles and the risk to the public of accidental needlestick injury. However, the report noted that one-for-one exchange rules cannot, in theory, increase the total number of discarded needles, although programs could affect the geographic distribution of discarded syringes. Data on a surveillance project with the Portland, Oregon, needle exchange program noted a decrease in the prevalence of discarded syringes near the program (Lurie et al., 1993:386). Passive surveillance of health or police department reports over time indicated either declines or small increases in needlestick injuries, with the trends due to changes in reporting patterns. The University of California report concluded that needle exchange programs "have not increased the total number of discarded syringes" and, if structured as a one-for-one exchange with no starter needles, "they cannot increase the total number of discarded needles" (Lurie et al., 1993:395).

Summary

Using multiple data sources, the University of California reviewed a number of questions about needle exchange programs. As far as possible positive outcomes are concerned, the report concluded that the data available at the time of the report "do not … provide clear evidence that needle exchange programs decrease HIV infection rates," (p. 20) but that "the



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