Public Health - Seattle & King County Needle Exchange Program

Needle exchange is a public health program for drug users. It is an important component of a comprehensive set of programs designed to reduce the spread of HIV/AIDS and other blood-borne infections among injection drug users, their families and communities. Nationally, over 1/2 of all new HIV infections stem from injection drug users: 2/3 of these from sharing needles, and the rest either from unprotected sex with an injection drug user or transmission from an infected mother to her fetus or newborn child.

Needle exchange programs provide new, sterile syringes in a one-for-one exchange for used, contaminated syringes. But needle exchange programs are not just about syringes. They also help drug users get into drug treatment and health care and provide important risk reduction information. Other services include counseling and testing for HIV infection, distribution of condoms, and safe disposal of contaminated equipment.

Seattle's program began operating in 1989. Currently, Public Health conducts exchange programs at three sites within Seattle and two sites in South King County. Two additional sites are operated by community-based service agencies in the University and Broadway Districts. Exchanges are staffed by paid Public Health employees and volunteers from the community.

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Why are needle exchange programs offered?

Needle exchange is one of the most effective AIDS prevention programs currently available for injection drug users who are not in treatment. Without a vaccine or a cure, prevention is the only tool we have to control the spread of HIV. Public Health runs a needle exchange program for four basic reasons:

Needle exchange reduces blood-borne diseases in our communities without increasing drug use. Studies have shown decreases in both the number of persons who become infected with HIV and the number of people who get hepatitis in communities that have needle exchange programs.
Preventing HIV infection in injection drug users also prevents HIV in women and newborn children. Many women are at risk for HIV because of their own injection drug use or because they are sexual partners of injection drug users.
By working with injection drug users, we can help them get into drug treatment.
Finally, Public Health safely disposes of all contaminated syringes turned in to the exchange. This reduces the number of discarded syringes on our sidewalks and in our bus stops, yards, parks and play grounds. Our goal is to get used syringes out of circulation as quickly as possible. The longer a syringe remains in circulation, the more opportunities there are for that syringe to pass on a blood-borne disease.

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Are needle exchange programs successful?

Yes. A recent study compared cities that had low rates of HIV infection among drug injectors with cities in which drug injectors had high rates of infection. The study found that each of the low rate cities had started needle exchange and prevention outreach programs early in the AIDS epidemic before AIDS could get a foothold. Most cities that responded early in the epidemic by implementing comprehensive needle exchange programs have kept infection rates among drug injectors below 5%, while rates of infection in cities like New York and Miami (where needle exchange began late or not at all) are between 40% and 60%. Infection rates among injection drug users in Seattle have remained stable over the last seven years. Public Health estimates that 2 to 4% of local drug injectors are infected with HIV.

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How much does needle exchange cost?

Combined total cost for needle exchange programs in Seattle-King County in 2001 is $775,000. This compares with $120,000 to $150,000 in medical costs to care for just one person with AIDS from the time of infection to death. By preventing infections in just five people per year, the needle exchange more than pays for itself. By preventing HIV infections in just 1% of the injection drug users in King County, the program saves over $18 million in AIDS-related medical costs. In this light, the exchange provides both a public health and an economic benefit to the residents of Seattle and King County.

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Who pays for the needle exchange?

The needle exchange is funded by disease prevention funds provided by Washington State, King County and the City of Seattle. Relying on volunteer staff helps keep the cost of the needle exchange program low.

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Is it legal to give out syringes?

Public Health doesn't give out syringes, we EXCHANGE them. And exchanging them was ruled legal by Washington State’s Supreme Court in 1992. In a case filed by Spokane County, the court held that exchange programs are an appropriate HIV prevention measure and are legally sanctioned within the broad powers given to Public Health Officers to control disease in communities.

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Is there any reason to think that needle exchange increases drug use?

No. An independent panel convened by the National Institute of Health in 1997 concluded that needle exchange does not increase needle injecting behavior among current drug users and does not encourage people to begin using drugs. More recent studies confirm these findings and further suggest that needle exchange programs are successful in attracting injectors who are at highest risk. Every needle exchange in the United States recruits drug users into treatment. In Tacoma, the needle exchange is the single largest source of treatment referrals in all of Pierce County. In the last two years, Seattle’s needle exchange has helped more than 400 people get into treatment.

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Do most people support the syringe exchange program?

Yes. Since 1988, Washington State Department of Health has conducted biannual random telephone surveys of Washington State residents over 18 years of age to describe people’s knowledge, attitudes and beliefs about AIDS. When state residents were asked if they would support a needle exchange program, 60% of persons interviewed in 1998 and 2000 said yes. In King County, 72% of those interviewed reported support for needle exchange.

Virtually every scientific body that has studied needle exchange programs supports them: the U.S. Centers for Disease Control and Prevention, National Research Council, National Commission on AIDS, General Accounting Office, National Academy of Sciences, American Medical Association, American Psychiatric Association and the American Public Health Association.

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