1-for-1 needle exchange risky, costly: report
The City of Ottawa should continue to give away clean needles and collect dirty ones separately instead of requiring addicts to bring in a dirty needle for each clean one they receive, says a report from the city's interim medical officer of health.
Dr. Isra Levy presented the findings to city council Thursday after conducting a review of the city's needle exchange program, as requested by a group of councillors in April.
Under the current program, the city provides free, clean needles to addicts to discourage needle sharing and reduce the spread of HIV and hepatitis. It provides separate containers where addicts can drop off used needles.
The councillors felt the current system results in dirty syringes littering parks and sidewalks, and wanted the medical officer of health to look into switching to a one-for-one exchange system.
According to the report, more than 2,000 needles ended up on the streets in 2007, even though the city took in more needles than it gave out. It distributes about 343,000 a year.
A "restricted," one-for-one exchange would have many health and operational disadvantages, said Levy's report, which reviewed 137 medical studies and looked at the context of Ottawa's needle exchange program.
It found that in cities with a restricted system:
- The incidence of HIV increased. In contrast, it decreased in cities with a system like Ottawa's.
- The risk of being infected with HIV was three times higher than in cities with a system like Ottawa's.
- Addicts were more likely to reuse needles.
The report estimated that the City of Ottawa could expect a 33 per cent increase in new infections each year if it switched to a restricted needle exchange.
In addition, the report said such a restricted program would:
- Likely encourage addicts to carry large numbers of discarded needles for a longer period of time, as cocaine addicts can inject the drug 20 to 30 times a day. That could increase the risk of police and paramedics being accidentally stuck with a dirty needle, the report said.
- Cost significantly more, as it would require more staff and infrastructure.
The report recommends instead dealing with the discarded needles by boosting its dirty needle cleanup with an action plan. Under the plan:
- Needles would be treated as an environmental hazard.
- A dedicated hotline would be created for discarded needles.
- The city would map "hot spots" for discarded needles.
- The needle drop box program would be expanded.
A full time public-health trainee and a summer student would be hired to support the program.
Levy has been acting medical officer of health since the resignation of Dr. David Salisbury in May. Salisbury opposed one-for-one exchange, saying that it would boost the spread of disease.