Critics of such programs say they encourage people to use illegal drugs and result in more needles being dumped in public places.

According to the Centre for Addiction and Mental Health (CAMH), which looked at several surveys, needle exchange programs (NEPs):

• Reduce the transmission of disease in drug users.
• Do not increase injection drug use.
• Do not increase the number of needles discarded (NEPs collect more needles than they give out).

A study published in the Canadian Medical Association Journal in August 1997 concluded that providing sterile needles is an inexpensive means of preventing greater health-care costs. Researchers at McMaster University examined the needle exchange program in Hamilton, which provided more than 14,200 clean syringes to 275 drug users in 1995. The authors of the study estimated the program prevented 24 new HIV infections over five years. The study said the cost of treating HIV and AIDS over a person's lifetime could total $1.3 million in direct costs to the health system.

"What this shows is that [NEPs] are really positive because they are reducing HIV and, secondly, saving money," said Michelle Gold, one of the study's authors.

Sometimes, HIV rates remain the same. Marliss Taylor, executive director of Edmonton's Streetworks needle program, says programs can't control what drug users do.

"While someone might be diligent in exchanging needles and having clean ones when they shoot up, they might not use a condom when they have sex," Taylor told CBC News Online. Streetworks hands out about 835,000 needles a year to about 5,000 addicts.

Taylor says Alberta's HIV rate dropped in 2003, with only 31 new cases. That compares to 70 new cases back in 1998 and 80 new cases in 2000. Taylor says she's not sure what caused the drop but notes that her staff doubled from 2002 to 2003 and they were able to get more needles out in that period.

International studies have supported the creation of syringe exchanges. In Southern Australia, 55 NEPs serving about 1.2 million drug users resulted in no new HIV infections for three consecutive years. In the U.S., a 1997 National Institutes of Health survey demonstrated such programs resulted in a 30 per cent reduction in HIV transmission.

Needle exchange programs also distribute bleach kits for sterilizing needles, and provide testing and referrals for HIV, hepatitis and other sexually transmitted diseases, as well as counselling for other needs such as nutrition or housing.

"It's the other things that they need," says Taylor. "Sometimes, the drug use isn't the problem. Do they have food? A place to stay? Warm clothes?"

Despite the NEPs, HIV rates have been soaring in Vancouver and Toronto. A report prepared by the Canadian HIV/AIDS Legal Network discovered 8.6 per cent of injection drug users in Toronto had HIV in 1997/98, up from 4.8 per cent in 1992/93. In Vancouver, the HIV rate rose from four per cent in 1992/93 to an astonishing 23 per cent by 1997/98. The problem lies with the popularity of crack cocaine. Cocaine users tend to shoot up 20 to 30 times a day, frequently with groups of other users.

In September 2003, Vancouver opened North America's only legal shooting gallery. It's a three-year pilot project funded by Health Canada and the government of British Columbia. After one year, a report assessing the facility said it dealt with 107 overdoses and no one died. The clinic, open 18 hours a day, is located in the heart of the city's drug corridor, the Downtown Eastside. It provides a safe place and clean "tools" for addicts to shoot up. The clinic gets an average of 600 visits a day.

Don McPherson, co-ordinator of Vancouver's drug policy, says the numbers are a good sign.

"The more we can get inside, the better. Better in [the clinic] than in the back alleys," said McPherson in the Globe and Mail (Sept. 24, 2004).

As for needle exchange programs, the Canadian AIDS Task Force says they work best for heroin addicts, whose behaviour is predictable. The challenge comes now in dealing with increasing cocaine use and those mixing heroin and cocaine. The task force recommends:

• Expansion of methadone programs to keep heroin users from using street drugs.
• Giving heroin users a wider berth if they stray from treatment programs; programs kick users out for just one slip.
• Treating drug use as a public health issue and not a criminal one.

Overall, cities need a comprehensive drug strategy, says Patrick Smith, director of clinical programs at CAMH. Smith points to the Vancouver example. The city commissioned a report in 2000 and it recommended a "four pillar" approach to drug use: treatment, prevention, enforcement and harm reduction. The report resulted in the opening of the safe injection site.

Marliss Taylor agrees with a broad strategy for drug use problems.

"We need to rethink a lot of things. Drug use is a complicated issue … it's about helping people address their issues, past issues, mental health issues. They started drug use for a reason. A lot of times, they are self-medicating."