Trends in crime and the introduction of a needle exchange program

Marx, Melissa A.; Crape, Byron; Brookmeyer, Ronald; Junge, Benjamin; Latkin, Carl A.; Vlahov, David; Strathdee, Steffanie A.

doi:10.2105/ajph.90.12.1933

Cited by 50 publications

(17 citation statements)

References 14 publications

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“…This result is in line with other studies that have documented that fears associated with expanded syringe access, such as increased crime, drug use, and even needle stick injuries are unwarranted (Des Jarlais et al, 1995; Guydish et al, 1993; Marx et al, 2000; Stopka et al, 2010). Life-saving interventions such as needle exchange programs, over-the-counter pharmacy sales of needles, and overdose prevention programs for people who inject drugs are often political controversial and unpopular, yet are desperately needed to prevent overdose deaths, HIV and HCV transmissions.…”

Section: Discussionsupporting

confidence: 89%

Drug-related deaths and the sales of needles through pharmacies

Davidson

Martínez

Lutnick

et al. 2015

Drug and Alcohol Dependence

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Background Providing needles to people who inject drugs is a well-proven public health response to the transmission of HIV and other blood borne viruses. Despite over a quarter of a century of research, new concerns about potential unintended negative consequences of needle distribution continue to emerge. Specifically, a claim was recently made that the introduction of pharmacy sales of needles was followed by an increase in overdoses in pharmacy parking lots. If true, this would have serious implications for the design of needle access programs, particularly those involving pharmacy sales of needles. Methods We examine spatial relationships between drug-related deaths and pharmacies in Los Angeles County (population 9·8 million) before and after the 2007 enactment of a California law allowing pharmacy sales of needles without a prescription. 7,049 drug related deaths occurred in Los Angeles county from 2000-2009 inclusive. 4,275 of these deaths could be geocoded, and were found to be clustered at the census tract level. Results We used three methods to examine spatial relationships between overdose death locations and pharmacy locations for two years on either side of the enactment of the pharmacy sales law, and found no statistically significant changes. Among the 711 geocodable deaths occurring in the two years following the change in law, no death was found to occur within 50 meters of a pharmacy which sold needles. Conclusion These results are consistent with prior studies which suggest pharmacy sales of needles improve access to needles without causing increased harms to the surrounding community.

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Section: Discussionsupporting

confidence: 89%

Drug-related deaths and the sales of needles through pharmacies

Davidson

Martínez

Lutnick

et al. 2015

Drug and Alcohol Dependence

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“…The Getis-Ord Gi* analysis was based on a fixed Euclidean distance band of 3000 m. This distance was derived from a previous analysis of this population indicating 3 km to be a natural break point in the data with respect to intra-urban mobility (Brouwer et al 2012). It is also the distance an average person walks in 30–40 minutes (Knoblauch, Pietrucha and Nitzburg 1996; Marx et al 2000), which is how most of our participants travel. Results were corrected for multiple testing using the False Discovery Rate statistic (Benjamini and Hochberg 1995; Castro and Singer 2006).…”

Section: Methodsmentioning

confidence: 99%

Spatial Epidemiology of HIV Among Injection Drug Users in Tijuana, Mexico

Brouwer

Rusch

Weeks

et al. 2012

Annals of the Association of American Geographers

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The northwest border city of Tijuana is Mexico’s fifth largest and is experiencing burgeoning drug use and human immunodeficiency virus (HIV) epidemics. Since local geography influences disease risk, we explored the spatial distribution of HIV among injection drug users (IDUs). From 2006–2007, 1056 IDUs were recruited using respondent-driven sampling, and then followed for eighteen months. Participants underwent semi-annual surveys, mapping, and testing for HIV, tuberculosis, and syphilis. Using Average Nearest Neighbor and Getis-Ord Gi* statistics, locations where participants lived, worked, bought and injected drugs were compared with HIV status and environmental and behavioral factors. Median age was thirty-seven years; 85 percent were male. Females had higher HIV prevalence than males (10.2 percent vs. 3.4 percent; p=0.001). HIV cases at baseline (n=47) most strongly clustered by drug injection sites (Z-Score −6.173; p < 0.001), with a 16 km2 hotspot near the Mexico/U.S. border, encompassing the red-light district. Spatial correlates of HIV included syphilis infection, female gender, younger age, increased hours on the street per day, and higher number of injection partners. Almost all HIV seroconverters injected within a 2.5 block radius of each other immediately prior to seroconversion. Only history of syphilis infection and female gender were strongly associated with HIV in the area where incident cases injected. Directional trends suggested a largely static epidemic until July–December 2008, when HIV spread to the southeast, possibly related to intensified violence and policing that spiked in the latter half of 2008. While clustering allows for targeting interventions, the dynamic nature of epidemics suggests the importance of mobile treatment and harm reduction programs.

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“…Several studies have found that NEPs do not increase drug use (Burring, 1991; Normand, Vlahov, & Moses, 1995; Vlahov et al 2001) or incite youth to start injecting drugs (Marx, Brahmbhatt, Beilenson, et al , 2001). Moreover, NEPs have not been shown to increase numbers of publicly discarded syringes (Doherty, Junge, Rathouz, et al , 2000), crime (Marx, Crape, Brookmeyer et al , 2000), or high risk social networks (Schechter, Strathdee, Cornelisse, et al 1999; Lamothe, Bruneau, Franco, et al , 1998). Yet despite the established effectiveness of NEPs, they must be implemented to scale to achieve population level reductions in HIV incidence.…”

Section: Introductionmentioning

confidence: 99%

Needle exchange and the HIV epidemic in Vancouver: Lessons learned from 15 years of research

Hyshka¹,

Strathdee²,

Wood³

et al. 2012

International Journal of Drug Policy

102

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During the mid-1990s, Vancouver experienced a well characterized HIV outbreak among injection drug users (IDU) and many questioned how this could occur in the presence of a high volume needle exchange program (NEP). Specific concerns were fuelled by early research demonstrating that frequent needle exchange program attendees were more likely to be HIV positive than those who attended the NEP less frequently. Since then, some have misinterpreted this finding as evidence that NEPs are ineffective or potentially harmful. In light of continuing questions about the Vancouver HIV epidemic, we review 15 years of peer-reviewed research on Vancouver’s NEP to describe what has been learned through this work. Our review demonstrates that: 1) NEP attendance is not causally associated with HIV infection, 2) frequent attendees of Vancouver’s NEP have higher risk profiles which explain their increased risk of HIV seroconversion, and 3) a number of policy concerns, as well as the high prevalence of cocaine injecting contributed to the failure of the NEP to prevent the outbreak. Additionally, we highlight several improvements to Vancouver’s NEP that contributed to declines in syringe sharing and HIV incidence. Vancouver’s experience provides a number of important lessons regarding NEP. Keys to success include refocusing the NEP away from an emphasis on public order objectives by separating distribution and collection functions, removing syringe distribution limits and decentralizing and diversifying NEP services. Additionally, our review highlights the importance of context when implementing NEPs, as well as ongoing evaluation to identify factors that constrain or improve access to sterile syringes.

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Trends in crime and the introduction of a needle exchange program

Cited by 50 publications

References 14 publications

Drug-related deaths and the sales of needles through pharmacies

Drug-related deaths and the sales of needles through pharmacies

Spatial Epidemiology of HIV Among Injection Drug Users in Tijuana, Mexico

Needle exchange and the HIV epidemic in Vancouver: Lessons learned from 15 years of research

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