While many injection drug users in Baltimore rely on needle exchange programs to obtain sterile syringes, the majority also use needles obtained from other sources, according to a study conducted at the Bloomberg School of Public Health. Researchers found that 85 percent of injection drug users reported getting needles from sellers on the streets. While these needles may look new, there is no guarantee that they are not contaminated with HIV or other diseases. The study, which examined factors associated with the use of needle exchange programs, or NEPs, in Baltimore, appears in the Aug. 1 issue of the Journal of Acquired Immune Deficiency Syndromes.

"Needle exchange programs serve an important health function by offering free, sterile needles to injection drug users. They provide an incentive for returning used needles, which gets contaminated needles out of circulation," explains lead author Carl Latkin, an associate professor of health policy and management at the Bloomberg School. "However, NEP sites and hours are limited, and our study suggests injectors are drawn to the convenience of getting needles on the streets."

Data for this study were collected as part of SHIELD, an experimental HIV prevention project called Self-Help In Eliminating Life Threatening Diseases. During baseline interviews for the project, 741 of the 1,637 respondents reported injection drug use within the previous six months and were eligible for this study. Prior to the project, the 741 participants were asked questions about where they obtained needles, how far they traveled to obtain needles, if they sold needles or drug paraphernalia, their HIV status and their drug habits.

Only 4 percent of the participants reported obtaining their needles exclusively from the NEP, although twice as many obtained all their needles from sources considered by researchers to be moderately safe, including NEPs, pharmacies, hospitals and diabetics. Nearly one-third indicated obtaining needles from at least four different sources, and an alarming 85 percent reported obtaining some needles from sellers on the street.

Slightly more than one-quarter of the participants reported selling needles. The researchers interviewed a subsample of these needle sellers and found that four out of five considered it to be relatively easy to fool buyers into believing a used needle was new, and two of the five admitted to cleaning needles and selling them as used. While half the sellers obtained some needles through the NEP, the majority also obtained needles through potentially unsafe sources.

Almost half (44 percent) of the injectors reported obtaining needles from diabetic patients. While this is considered relatively safe, insulin needles are not individually sealed and could be contaminated. The researchers also point out that it is possible that injectors, one-quarter of whom in this study were HIV-positive, may use a needle from a diabetic patient and then return it contaminated, putting the diabetic at risk.

The authors conclude the study with a recommendation:

"At this time, individually sealed syringes are available, but they are more expensive. By requiring manufacturers to produce safety seals or individually package all syringes, much like other health products, there will be no guessing whether or not a needle is new," Latkin says. "Such a change may cost a bit more but clearly has the potential to decrease transmission of HIV and other blood-borne diseases, and save lives."

Financial support for this study was provided by the United States National Institute on Drug Abuse.