charged with improving the quality and availability of substance abuse and mental health prevention, treatment, and rehabilitation services, has a critical role in leading efforts to address the interrelated epidemics of substance abuse, mental illness, and HIV. In addition, collaborations among a multitude of federal, state, and local agencies and private insurers that fund and administer drug abuse treatment programs will be necessary to reduce the treatment gap and change social and cultural norms and beliefs about drug abuse and addiction.

Therefore, the Committee recommends that:

Federal agencies (including the Substance Abuse and Mental Health Services Administration, the Health Care Financing Administration, the Office of National Drug Control Policy, the Department of Veterans Affairs, and the National Institute on Drug Abuse), state and local agencies, and private insurers that fund, administer, or conduct research on drug abuse treatment programs should collaborate to develop mechanisms to: (1) increase drug treatment resources to the level needed for all of those requesting access; and (2) integrate and link these services with appropriate psychiatric and HIV prevention and treatment services.

Access to Sterile Drug Injection Equipment

Drug abuse treatment is not a panacea for the drug epidemic, however. Regardless of the availability of treatment opportunities, a certain portion of drug users will continue to inject drugs. For those who cannot or will not stop injecting drugs, the one-time use of sterile needles and syringes remains the safest and most effective method for preventing HIV transmission. Indeed, a recent study produced similar results, suggesting that expanded provision of needle exchange programs in the United States could have averted between 10,000 and 20,000 new infections over the past decade (Lurie and Drucker, 1997).

Although many communities and law enforcement officials have expressed concern that increasing availability of injection equipment will lead to increased drug use, criminal activity, and discarded contaminated syringes, studies have found no scientifically reliable evidence of these negative effects (GAO, 1993). Studies also have shown that needle exchange programs serve as an important link to other medical and social services, particularly drug abuse treatment and counseling programs (Lurie and Reingold, 1993; Heimer, 1998). A review by the National Research Council and the Institute of Medicine concluded that needle exchange programs reduced risk behaviors, such as multi-person reuse of



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