A study of New Haven's Syringe Exchange Program (SEP) conducted by a School of Medicine scientist provides evidence that the program is not only effective in curbing the spread of HIV infection but also reduces substance abuse. The findings are reported in the current issue of the Journal of Substance Abuse Treatment.
Created in November 1990 to provide new sterile syringes in a one-for-one exchange for old ones, the New Haven SEP also offers referrals for entry into substance abuse programs. Robert Heimer, associate professor of epidemiology and lecturer in pharmacology, undertook his research to determine how many participants in the New Haven SEP also used that referral service.
Heimer found that in the first eight months of the center's operation, approximately 20 people per month asked for referrals to treatment programs. When the program hired a drug treatment coordinator in September of 1992, the number of referrals increased to an average of one per day. During the next 18 months, a total of 473 requests for treatment were made.
"This study shows that syringe exchange programs, if properly administered, can have a positive impact on the dual epidemics of HIV and substance abuse," says Heimer, whose study received input from the AIDS Division of the city's Department of Health. "New Haven's program has been effective in reducing substance abuse community-wide by serving as a conduit to treatment programs."
The study, which was funded by the National Institute on Drug Abuse and the Drug Policy Foundation, showed that most of the people who got referrals from the New Haven SEP were not exchanging syringes. In fact, Heimer says he was surprised to find that only 27 percent of those requesting referrals were known to use the SEP to exchange syringes. Many people requesting referrals were not drug injectors, but they were seeking treatment for addiction to crack cocaine or to alcohol.
In an analysis of the program's records, Heimer found that 60 percent of drug abusers kept their appointments to enter treatment programs. Factors associated with failure to keep appointments included long waiting times, forms of insurance coverage that limited treatment options and use of cocaine.
Taking steps to decrease waiting time, increasing options for those without private insurance, and developing programs to treat cocaine addiction would improve the ability of SEP to act as a stronger link to substance abuse treatment, contends Heimer.
"These results highlight how a program combining syringe exchange and drug treatment referral services encourages drug users to behave in healthy ways," he says. "The operation of the New Haven Syringe Exchange Program decreased drug users' chances of becoming infected with HIV and also improved the chances of ending their addiction."
William P. Quinn, director of health for the City of New Haven,
concurs, "This study documents the important role SEP's have in substance
abuse treatment and prevention."
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