NEEDLE-EXCHANGE PROGRAMMES IN THE USA: TIME TO ACT NOW.

Sir--Respecting your editorial on NEPs in the USA, in the mid 1980s, HIV-1
was identified as a potential threat to intravenous-drug users. In Southern
Derbyshire in the UK, preventive measures taken included education and
needle/syringe schemes, which also contributed to a reduction in acute
cases of hepatitis B--from 17 cases in 1986 to two in 1996.

It was, therefore, noteworthy when six intravenous-drug users in the
district were diagnosed with acute hepatitis B between December, 1996, and
February, 1997. All six lived in inner-city Derby, and were aged in their
mid 20s. The first case had recently moved to the area from a neighbouring
county, and at the time of diagnosis was living in a hostel.

The first case was identified after the local drug agency moved premises in
December, 1996. At the time of the move, and for several months after,
fewer clients used the agency's needle and syringe exchange scheme. This
decline was attributed to the fact that clients did not seem to know where
the new building was sited despite previous publicity. At the same time,
there were also problems in some parts of Derby City with an insufficient
number of syringes and needles available for the community pharmacy needle
and syringe exchange.

A community pharmacist reported that there had been an increase in the
amount of bleach being sold to intravenous-drug users in the winter months.
It was also reported that users in the area pooled their resources to buy
drugs and used several premises as communal meeting places. It seems that
although they used clean needles, the syringe barrels were reused after
being cleaned with bleach from a bowl used by all the drug users present.
Results of the virus typing were received from the Public Health
Laboratory, Colindale, and showed that five of the cases were related.

This outbreak of acute hepatitis B in a well-defined group of
intravenous-drug users raises a number of issues. Programmes for needle and
syringe exchanges should be adequately funded and alternative supplies well
publicised if any disruption to the service is anticipated. Any information
or advice provided about the sharing of drug-taking equipment should
emphasise the fact that it involves all injecting equipment and not just
needles. Bleach should not be promoted as a way of disinfecting needles and
syringes nor should any other method of cleaning, as there is no
satisfactory alternative to single-use sterile equipment.

*K A Ward, M Newlands, D W Bullock *Department of Public Health, Southern
Derbyshire Health Authority, Derby DE1 2FZ, UK; and Derbyshire Royal
Infirmary, Derby

1 Editorial. Needle-exchange programmes in the USA: time to act now.
Lancet 1998; 351: 75.