Newsletter Articles

A Public Health Perspective on Discarded Needles

Discarded needles make people feel unsafe or have negative feelings about places where people use drugs, and about people who inject drugs.

Discarded needles in the community are the result of outdoor injection drug use. This is made worse by poor access to housing and lack of options or spaces to be in among people who use drugs.

Many people don’t want to carry used needles back to an exchange site as they usually travel on foot and do not want to be hassled by the police for being found with them.

Needle exchange programs are torn between what they know is most effective in reducing the risk of infection among people who inject drugs, and public concern about discarded needles.

Winnipeg is not alone in these concerns. Most cities experience issues with discarded needles.

How harmful are discarded needles?

While the perceived risk of discarded needles is significant, the health risk from discarded needles is actually very small.

Community needle stick injuries are rare and carry a minor risk of hepatitis C transmission. There has been no reported HIV transmission from needle injuries in the community.

Still, the health system takes unsafely discarded needles very seriously and is actively increasing options for safe disposal and retrieval of used needles.

Canadian Pediatric Society (November 2018). Position Statement: Needle stick injuries in the community. https://www.cps.ca/en/documents/position/needle-stick-injuries-in-the-community

Communicable Disease Control (n.d.). Estimated Per-Act Probability of Acquiring HIV from an Infected Source, by Exposure Act. https://www.cdc.gov/hiv/risk/estimates/riskbehaviors.html

Kordy, F., Petrich, A., Read, S., & Bitnun, A. (2017). Childhood exposures to discarded needles and other objects potentially contaminated with blood-borne pathogens in Toronto, Canada. Paediatrics & Child Health, 22(7), 372-376. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5804656/

Moore, D. (2018). Needle stick injuries in the community. Paedriatics & Child Health, 23(8), 532-538. https://academic.oup.com/pch/article/23/8/532/5193228

Papenburg, J., Blais, D., Moore, D., Al-Hosni, M., Laferriere, C., Tapiero, B. and Quach, C. (2008). Pediatric Injuries from needles discarded in the community: Epidemiology and risk of seroconversion. Pediatrics, 122(2):e487-e492.

Patel, P., Borkowf. C., Brooks, J., Lasry, A., Lansky, A., and Mermin, J. (2014). Estimating per-act HIV transmission risk: a systematic review. AIDS, 28(10), 1509-1519. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6195215/

Tookes, H., Kral, A., Wenger, L., Cardenas, G., Martinez, A., Sherman, R.,…Metsch, L. (2012). A comparison of syringe disposal practices among injection drug users in a city with versus a city without needle and syringe programs. Drug and Alcohol Dependence, 123(1-3), 255-259. https://www.ncbi.nlm.nih.gov/pubmed/22209091

Why distribute needles to people who inject drugs?

Current rises in blood borne communicable infections (hepatitis B and C) in the Winnipeg Health Region are directly related to shared injection drug use equipment.

There are also rises in other health harms, such as skin infections, and heart and respiratory illnesses that are directly related to injection drug use and non-sterile technique.

Public funding of syringe exchanges is associated with lower rates of human immunodeficiency virus (HIV) infection, and hepatitis C; reduced unsafe injection practices; greater numbers of syringes distributed; and greater numbers of health and social services provided.

Unlimited needle and syringe distribution is supported by Harm Reduction best practice recommendations.

Sterile needle distribution to people who inject drugs is an ethical necessity. People have a right to health services whether or not they use drugs.

The cost-effectiveness of needle and syringe distribution programs for reducing HIV among people who inject drugs (PWID) has been well-established. It costs much less to prevent an HIV infection with sterile needle distribution than to treat an infection with medications.

Abdul-Quader, A.S., Feelemyer, J., Modi, S., Stein, E., Briceno, A., Semaan, S.,… Jarlais, D. (2013). Effectiveness of structural-level needle/syringe program to reduce HCV and HIV infection among people who inject drugs: A systematic review. AIDS and Behavior, 17(9), 2878-2892. https://www.ncbi.nlm.nih.gov/pubmed/23975473

Aspinall, E., Nambiar, D., Goldberg, D., Hickman, M., Weir, A., Van Velzen, E., …, Hutchison, S. (2013). Are needle and syringe programmes associated with a reduction in HIV transmission among people who inject drugs: a systematic review and meta-analysis. International Journal of Epidemiology, 43(1), 235-48. Available from: http://ije.oxfordjournals.org/content/43/1/235.full.pdf

Bramson, H., Des Jarlais, D., Arasteh, K., Nugent, A., Guirdino, V., Feelemyer, J., & Hodel, D. (2015). State laws, syringe exchange, and HIV among persons who inject drugs in the United States: History and effectiveness. Journal of Public Health Policy, 36(2), 212-230.

British Columbia Centre for Disease Control (2008). Best practices for British Columbia’s harm reduction supply distribution program. http://www.bccdc.ca/resource-gallery/Documents/Guidelines%20and%20Forms/Guidelines%20and%20Manuals/Epid/Other/BestPractices.pdf

Fernandes, R., Cary, M., Duarte, G., Jesus, G., Alarcão, J., Torre, C., ... & Carneiro, A. (2017). Effectiveness of needle and syringe programmes in people who inject drugs – An overview of systematic reviews. BMC public health, 17(1), 309. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5387338/

Gibson, D., Flynn, N. & Perales, D. (2001). Effectiveness of syringe exchange programs in reducing HIV risk behavior and HIV seroconversion among injecting drug users. AIDS, 15 (11), 1329-1341.

Ksobiech, K. (2003). A meta-analysis of needle sharing, lending, and borrowing behaviors of needle exchange program attenders. AIDS Education and Prevention, 15(3), 257-268.

Strike C, et al. (2013). Best Practice Recommendations for Canadian Harm Reduction Programs that

Provide Service to People Who Use Drugs and are at Risk for HIV, HCV, and Other Harms: Part 1. Toronto, ON: Working Group on Best Practice for Harm Reduction Programs in Canada. https://www.catie.ca/ga-pdf.php?file=sites/default/files/BestPracticeRecommendations_HarmReductionProgramsCanada_Part1_August_15_2013.pdf

Strike, C., Leonard, L., Millson, M., Anstice, S., Berkeley, N., and Medd, E. (2006). Ontario needle exchange programs: best practice recommendations. Toronto: Ontario Needle Exchange Coordinating Committee. http://www.ohrdp.ca/wp-content/uploads/pdf/Best_Practices_Report.pdf

Wodak, A., & Cooney, A. (2006). Do needle syringe programs reduce HIV infection among injecting drug users: a comprehensive review of the international evidence. Substance use & misuse, 41(6-7), 777-813.

World Health Organization. (2004). Policy Brief: provision of sterile injecting equipment to reduce HIV transmission. https://www.unodc.org/documents/hiv-aids/provision%20of%20sterile%20injecting%20equipment.pdf

Do needle distribution programs increase the number of discarded needles in the community?

Needle distribution programs have been found to not increase the number of needles discarded in the community.

In some cases these programs have been shown to reduce the number of discarded needles in the community overall.

Closing down needle distribution programs has been associated with outbreaks of HIV and increase overdose with no effect on drug use rates or discarded needles.

Despite the mass of scientific evidence on the effectiveness, and cost-effectiveness of needle exchange programs, they continue to face opposition.

Research indicates that needle exchange programs do not increase the use of drugs among their participants.

In many cases, a decrease in injection frequency has been observed among those attending these programs.

Allen, S., Grieb, S., O’Rourke, A., Yoder, R., Planchet, E., Hamilton White, R., and Sherman, S. (2019). Understanding the public health consequences of suspending a rural syringe services program: a qualitative study of the experiences of people who inject drugs. Harm Reduction Journal, 16:33.

Broadhead, R. , Van Hulst, Y., & Heckathorn, D. (1999). Termination of an established needle-exchange: a study of claims and their impact. Social Problems, 46(1), 48-66.

Doherty, M., Junge, B., Rathouz, P., Garfein, R., Riley, E. and Vlahov, D. (2000). The effect of a needle exchange program on numbers of discarded needles: A 2-year follow-up. American Journal of Public Health, 90(6), 936-9. https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.90.6.936

Goode, L. (2015). Indiana State ban on Needle Share programmes faces challenge of an IDU-fuelled HIV spike [Web log post]. http://blogs.bmj.com/sti/2015/04/20/indiana-state-ban-on-needle-share-programmes-faces-challenge-of-an-idu-fuelled-hiv-spike

Public Health Agency of Canada (2006). I-Track: Enhanced Surveillance of Risk Behaviours Among People who Inject Drugs. Phase I Report. Surveillance and Risk Assessment Division, Centre for Infectious Disease Prevention and Control, Ottawa: Public Health Agency of Canada, Retrieved from: http://librarypdf.catie.ca/PDF/P36/23687.pdf

Quinn, B., Chu, D., Wenger, L., Bluthenthal, R, Kral, A. (2014). Syringe disposal among people who inject drugs in Los Angeles: The role of sterile syringe source. International Journal of Drug Policy 25(5): 905-910.

Satcher, D. (2000). Evidence-based findings on the efficacy of syringe exchange programs: an analysis of the scientific research completed since April 1998. U.S. Department of Health and Human Services. Retrieved from: http://web.archive.org/web/20130729152027/http://home.mchsi.com/~apclc/8fedstudies2.pdf

What happens to the needles Street Connections gives out?

Winnipeg is on track to distribute approximately 2.2 million needles in 2019. While this number sounds alarming, Saskatchewan distributes double these numbers annually with a smaller provincial population.

Street Connections collects back approximately 2,000 needles per day from people who inject drugs, which is much more than all needle pick-up programs combined. There are many other available options for safe disposal, including many health centres, private businesses, pharmacies, and public sites that have needle drop boxes in their facilities. Discarding needles unsafely in public is a rare practice. The vast majority of people who inject drugs discourage this and pick up discarded needles themselves. Discarded needle numbers are difficult estimate but generally make up less than 2% of the total number of needles distributed annually. Therefore, over 95% of all distributed needles end up safely discarded.

A greater proportion of needles distributed in Winnipeg are being taken out of the city for use. A short survey of Street Connections clients in 2016 found that 47% of clients reported taking some of their needles out of Winnipeg; often to communities where needle distribution is not available.

Street Connections has surveyed clients to find out what they do with their used needles.

Over a third of the respondents (36%) put their used needles into a puncture proof container (non-approved sharps container) and disposed the container in the municipal garbage. Over a quarter respondents returned their needles to the Street Connections office. This was followed by 16% who said to return their needles to Street Connections van. While only 46% of clients reported returning their needles to Street Connections, the vast majority of respondents disposed of their needles safety by other means. Only 2% of respondents reported unsafely discarding their needles.

Further, people who inject drugs in Winnipeg have shared that they are highly opposed to the practice of discarding needles and help out their communities by collecting and disposing of them.

Ksobiech, K. (2004). Return rates for needle exchange programs: a common criticism answered. Harm reduction journal, 1(1), 2. https://harmreductionjournal.biomedcentral.com/articles/10.1186/1477-7517-1-2

Marshall, S.G. (2018). Social context matters: a focused ethnography of Talwin and Ritalin injection in Winnipeg, Manitoba. MSpace Theses and Dissertations. http://hdl.handle.net/1993/33497

What is public health doing about discarded needles?

Street Connections:

Provides sharps containers to community supply distribution and needle pick-up partners, and community clean-up efforts;
Maintains a series of outdoor needle drop boxes;
Conducts needle pick-up on private property;
Provides information for the public on how to pick-up needles.
Works across systems and sectors to increase safe needle disposal options

If you're looking for a past article or for a paper copy of the Street Connections newsletter, please email us.

Menu