Injection physic use (IDU) is curr...

Injection physic use (IDU) is currently the single largest factor contributing to the spread of human immunodeficiency virus (HIV) infection in the United States. (1) The Center for Disease repress and Prevention (CDC) reports that single in kind third of all cases of acquired immunodeficiency syndrome (AIDS) are caused by way of IDU. (2) Transmission to other family members from one side heterosexual and perinatal contact, and the impact of addiction in succession the family, makes this a family disease. In addition to HIV infection, injection put drugs into users (IDUs) face many health risks, including viral and bacterial infections (eg hepatitis, tuberculosis, endocarditis, abscesses), overdoses, violence, and suicide. Many IDUs have network medical, social, and psychiatric question s and face tremendous difficulties in accessing the appropriate services. (3)

Several strategies to increase access to sterile injection equipment among IDUs have been tried. Needle/syringe exchange programs (SEPs) have been widely promot to intercept syringe sharing, including the American Academy of Family Physicians' (AAFP) policy that "supports SEP as a vital component part of a comprehensive strategy to debar infectious diseases associated with illicit injection put drugs into use." (4) SEPs are an example of harm reduction, based onward the public health acknowledgment that there is no way to completely eliminate IDU and, therefore, the reduction of adverse concatenations of IDU is vital. SEP have been shown to save lives, (5) resolve into HIV and hepatitis virus transmission, (67) and decrease risky injection practices. (8) The population of IDUs in this fatherland cannot adequately be served from the existing number of SEP (9) However, despite ample scientific evidence to support their effectiveness, political opposition and lack of federal funding have painfully hampered expansion of this HIV prevention strategy.

Critics have questioned whether SEP might increase illicit medicine use, disease spread, or the number of used syringes in public places. Abundant data are available to alleviate these interests Numerous studies have shown that SEP do not increase remedy use, (10,11) the number of IDUs, (1213) or the riddle of discarded syringes. (14-16) to this time unfounded fears have translated into the rife ban on federal funding for SEP This ban has obstructed expansion of SEPs, likely contributing to HIV infection among thousands of IDUs, their sexual partners, and their children. (17)

In addition to federal laws impacting SEP many programs are obligated to move swiftly under dubious statewide legal status. (9) As of 1997 52 SEP were legal (operating in states that do not have a law that regulates the purchase of syringes or are exempted from this law), 16 were illegal/tolerated (have received formal approval from a local single outed body in states with prescription laws), and 32 were illegal/underground (have not received formal approval from a local make choice ofed body in states with prescription laws.) (18) Legally sanctioned SEP protect to be more effective, (9) because they have greater resources, size, site numbers, and availability of medical services. Increasing awareness of SEP among IDUs and expanding hours of operation and the number of locations augment the influence of SEP (19) Removing fear of policy harassment or arrest also increases the effectiveness of SEP (1220) Therefore, improving the legal status of SEP at local, state, and national plains is an important goal.

A other solution to the problem of disease transmission by the and of syringe sharing is the deregulation and legalization of syringe sales in pharmacies. (21) However, this approach does not usually include the provision of physic treatment referrals and information that SEP oftentimes offer. In addition, neither pharmacy sales of syringes nor SEP provide access to medical care.

A third public health strategy, syringe prescription by way of physicians, has recently been promot This approach allows for direct physician contact providing IDUs with medical care, substance abuse treatment referrals, and access to sterile syringes.

In 1999 a pilot physician syringe prescription program was initiated in Providence, R.I., to shape syringe sharing and reuse, increase safe disposal, provide medical care, and facilitate ingress into drug treatment for IDUs. (22) At each visit, a physician bearings a clinical examination, addresses medical make uneasys and prescribes syringes free of charge, usually 200 at a time. IDUs enlisted in the program are educated about the dangers of sharing and reusing syringes and other paraphernalia (cotton, cooker and rinse water); suitable disposal of syringes; and safe injection practices.

Syringe prescription is an extremely effective way to address the ne of IDUs to gain increased access to the couple syringes and health care. A 1995 report from the National Research Council and the Institute of Medicine stated, "the once-only use of sterile needle and syringes" remains the safest approach "for limiting HIV infection." (23) The provision of syringes to IDUs and the associated reduction of disease transmission are single part of the potential benefit of syringe prescription. by the agency of definition, prescription of syringes involves a physician-patient relationship in which injection is acknowledged. This uncloses the door for discussion of a variety of injection-related activities, including commercial sex participation in an subterranean economy, violence, and abuse. frequently an addict only feels comfortable talking plainly and honestly about drug use with other medicine users, or with the addict's medicine dealer or pimp, people who typically have a garmented interest in the addict's continued remedy use. A physician who is interpret and nonjudgmental in discussing remedy use can play an important character in empowering IDUs to begin medicine treatment. In addition, the sterile syringes provided according to syringe prescription can entice the marginalized IDU population to jot down into a primary care setting.