Pubdate: August 1, 1997 Source: The Globe and Mail, page A7 Contact: Art: Needle exchange saves drugs users, study finds Prevention program may reduce health costs By Jane Coutts, Health Policy Reporter Needleexchange programs can save the Canadian health care system millions of dollars by preventing the spread of HIV among injection drug users, a new study shows. In a study published today in the Canadian Medical Association Journal, researchers in Hamilton, Ont., say needleexchange programs the efficacy of which has been sometimes questioned save money as well as avert suffering. Drug users have a high and rapidly increasing rate of AIDS and HIV infection, because they often share needles to inject drugs such as heroin and cocaine. Infection occurs when traces of contaminated blood remain in the needle when it is handed on. In needleexchange programs, intravenous drug users are provided with clean, sterile syringes while their used and possibly contaminated syringes are collected and destroyed. Using the example of a needleexchange program in Hamiltion, which in 1995 provided 14,207 clean syringes to an estimated 275 drug users, the researchers concluded that the program was able to prevent 24 new HIV infections over five years. At a cost of $76,775 per year to run the program, and using the most conservative estimates of the cost of treating HIV and AIDS over a lifetime, the study found the Hamilton needleexchange program would save $1.29 million in direct health care costs over five years. "Not included in our estimates were the indirect costs of illness such as the loss of human capital; that is, the future economic burden to society of lost productivity because of premature death," the study says, and adds that the cost of informal care outofpocket, emotional and physical demands on informal caregivers should not be ignored. The study's findings should encourage the development of more needleexchange programs, said Michelle Gold, a researcher at McMaster University. The programs have sometimes been controversial, both because people feared providing needles would encourage drug use, and because there was no proof they actually contained the spread of AIDS and HIV. However changing druguse patterns are increasingly a threat to efforts to control the spread of HIV among drug users, the head of the Canadian AIDS Task Force says. Catherine Hankins said needleexchange programs work best for heroin addicts, whose behavior is quite predictable. Increasingly, however, drug users are injecting cocaine, or a mixture of heroin and cocaine, and that's a challenge for needleexchange programs, she said. An epidemiologist with the Montreal Regional Public Health Department, Dr. Hankins said cocaine has long been the drug of choice with injection drug users in Montreal, but other cities are starting to see the same problem. Cocaine injectors, Dr. Hankins said, may shoot up 20 to 30 times a day, and frequently with groups of other users. In such situations, it's hard to keep track of whose needles are whose. "Needleexchange programs are key [to containing the spread of HIV], but they're not enough," she said.