• The Surgeon General make the determination called for in P.L. 102-394, section 514, 1993, necessary to rescind the present prohibition against applying any federal funds to support needle exchange programs.

Observe that the panel does not recommend a mandated national program of needle exchange and bleach distribution programs. As documented in this report, regional variations in the prevalence of HIV infection, the extent and kind of drug use, the presence of other AIDS programs, operational characteristics of existing needle exchange programs, and the attitudes and needs of local communities all influence the potential effects of needle exchange programs and militate against such a mandate. The recommendation is to allow communities that desire such programs to institute them, using resources at their disposal and unencumbered by the specific funding handicap that is now in place.

The panel further recommends that:

  • A better monitoring system should be established for assessing long-term societal changes in drug use at the community level due to needle exchange programs.

  • The Assistant Secretary for Health should charge appropriate agencies (i.e., the National Institutes of Health and the Centers for Disease Control and Prevention), in consultation with academic departments of epidemiology, to develop more effective surveillance of drug use, particularly for local areas. The data collected should move beyond gross prevalence estimation of drug use and toward detailed information about users. This should include data on behavioral dynamics (e.g., pattern of drug use, sharing of drugs and drug paraphernalia, social context of drug use) by drugs of choice, routes of administration for each, and the flow of injection drug users into and out of drug treatment programs.

  • Given the serious public health threat associated with HIV infection among injection drug users, their sexual partners, and offspring, the Assistant Secretary for Health should ensure that AIDS prevention efforts targeted to injection drug users are expanded specifically to include behavioral interventions in order to limit the further spread of HIV infection.

  • The Assistant Secretary for Health should cause the disposal issue to be studied and appropriate means of needle disposal to be developed. A task force should be appointed and should include health safety specialists, infectious disease specialists, injection drug use researchers, and community representatives/civic leaders.

  • Legislative bodies should remove legal sanctions for the possession of injection paraphernalia.

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