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Syringe Exchange Program Successfully Improves Proper Disposal in Community

University of Miami Miller School of Medicine investigators found 49% fewer syringes when they visually inspected South Florida streets with a high number of narcotics-related arrests in 2018 compared to 2009.

From left, David Forrest, Ph.D., Hansel Tookes, M.D., M.P.H., Harry Levine, and Tyler Bartholomew.
From left, David Forrest, Ph.D., Hansel Tookes, M.D., M.P.H., Harry Levine, and Tyler Bartholomew.

At the same time, self-reported inappropriate syringe disposal dropped 27% in surveys of hundreds of people who inject drugs (PWID), supporting a positive effect of Syringe Services Programs like the IDEA (Infectious Disease Elimination Act) needle exchange clinic at the Miller School on local communities.

The study was published online June 29, 2019 in the journal Drug and Alcohol Dependence.

The results successfully demonstrate a sharp decline in improper syringe disposal before and after implementation of the IDEA syringe exchange program in Miami.

“Through this study, we were able to provide evidence that programs like this one can potentially reduce the number of syringes disposed in the streets,” said lead author Harry Levine, an M.D./M.P.H. candidate at the Miller School. “We were both surprised and impressed that, despite the increased number of people who inject drugs, there was a significant decrease in the number of syringes improperly disposed in the streets. We found about half the number of syringes that were found in 2009.”

The researchers walked through and visually identified, geotagged and photographed syringes on sidewalks and in alleys, parks, parking lots and other publicly accessible areas. The search occurred on 775 randomly selected census blocks.

Levine, along with Hansel Tookes, M.D., M.P.H., founder of the IDEA Exchange and assistant professor of clinical medicine in the Division of Infectious Diseases at the Miller School, and their colleagues found a 191 syringes/1,000 blocks between August and December 2018. This contrasts with a higher density of 371 syringes/1,000 blocks between July and December 2009.

Importantly, this 49% drop in improper disposal occurred despite the distribution of 149,989 syringes last year by the IDEA Exchange.

“There is a common misconception regarding syringe exchange programs increasing the number of syringes by ‘enabling’ people who inject drugs,” Levine said. “With this study we showed evidence that this is simply not true, and that, in fact, syringe exchange programs contribute to reducing the number of syringes improperly disposed in the streets.”

To bolster their findings, the researchers also surveyed 448 PWID before and 482 others after the launch of the IDEA Exchange in 2016. Based on their responses, improper syringe disposal dropped from 96.6% in 2009 to 69.5% in 2018.

PWID also were significantly less likely to dispose of syringes in a public place in 2018 — 49.1% versus 68.7% in 2009. Similarly, rates of disposal in the trash dropped to 31.3% in 2018, down from 66.2% nine years earlier.

Nearly 39% of PWID reported syringe disposal directly at the IDEA Exchange last year.

Previous researchers put the annual incidence of community-acquired needle-stick injuries in the United States at 2,000 per year. This costs the health care system an estimated $9.8 million annually.

With the opioid epidemic, “there is a need for a statewide expansion of syringe exchange programs, so we can give access to these lifesaving interventions to the people that need it,” Levine added.

The Florida Senate and House of Representatives recently sent a bill to the governor that would permit expansion of Syringe Service Programs throughout the state.

The study findings carry implications for other communities beyond South Florida considering similar programs. Proper disposal venues could help others reduce syringe sharing and associated risks for HIV, viral hepatitis, skin and soft tissue infections and endocarditis.

In terms of future research, Levine said, “It would be interesting to do a further follow-up of this study to track the changes in the community after IDEA started. It would also be interesting to do similar studies in other cities afflicted by the opioid epidemic.”

The Florida Department of Health’s CDC National HIV Behavioral Surveillance (Grant# NU62PS005082-01-02) and the Consejo Nacional de Ciencia y Tecnologi?a (CVU810654) supported the study.

Tags: IDEA Exchange, needle exchange programs, PWID