DISCARDED NEEDLES DO NOT INCREASE SOON AFTER THE OPENING OF A NEEDLE EXCHANGE PROGRAM

This study examines the effect of a Needle Exchange Program (NEP) on t he quantity and geographic distribution of discarded needles on the st reets of Baltimore, Maryland, and presents methods to survey discarded needles in the community. A random sample of 32 city blocks located w ithin high-drug-use census tracts, stratified by east and west sides o f the city and by proximity to the NEP, was selected for survey. Three teams surveyed the number of needles and the number of drug vials and unbroken glass bottles (''trash'') to control for practice effects. S urveillance was conducted prior to initiation of the NEP in August 199 4 and 1 and 2 months thereafter. Over the three study periods, the abs olute count of discarded needles was 106, 130, and 128, respectively; the number of vials and bottles was 3,048, 3,825, and 3,796, respectiv ely. The initial nonstatistically significant increase in needles (mea n change = 0.38, 95% confidence interval (Cl)-0.18 to 0.93) was offset by accounting for background trash, Regression models fitted with the generalized estimating equation method, which accounted for within-bl ock correlation over time, showed no significant increase in the numbe r of needles after adjustment for trash during:he first 2 months of th e NEP's operation. These data suggest that the initiation of NEPs does not result in an increase in the number of discarded needles on the s treet.