Introduction: Injection drug use with previously used and shared needle syringes is a major cause of infectious diseases and represents a worldwide public health problem. The infectious diseases associated with needle syringe sharing have high levels of morbidity and mortality for people who are injecting drug users and include bacterial infections such as endocarditis as well as viral infections such as HIV, hepatitis B and hepatitis C. It is estimated that one third of all AIDS cases and one half of hepatitis C cases are directly or indirectly linked to injection drug use. Many decades of public health research have unequivocally shown that programs developed to increase access to clean needles and syringes decrease rates of infectious disease among injecting drug users and is widely accepted around the world as an appropriate method for disease prevention.

Policy Statement: The American Academy of Addiction Psychiatry (AAAP) supports the funding and development of programs that assist people, who are injecting drug users, to have increased access to clean needles and syringes in order to help them eliminate all reusing and sharing of needle syringes. Examples of such programs include: community-based needle syringe exchange programs; pharmacy-based distribution of needle syringes; and the availability of physician prescriptions for needle syringes for injecting drug users.

Programs that provide clean needles and syringes should offer: education to injection drug users on practices that prevent infectious diseases, such as not sharing any injection equipment, including cotton or water; education regarding the value and availability of abstinence based treatment; and referrals for substance abuse treatment services for all participants who request assistance in stopping their drug use. All programs that provide clean needle syringes should also develop strategies for the return of used needle syringes and provide education regarding correct methods for disposal.

The AAAP also supports the elimination of legal barriers at the community, state, and federal level that restrict the development and practice of clean needle syringe delivery programs and used needle syringe collection programs. This should include the elimination of restrictive laws directed toward people receiving these services, such as laws used to arrest drug users with needle syringes for possession of drug paraphernalia, and towards staff who provide these critical public health services, such as charges of distribution of drug paraphernalia or conspiracy to distribute drug paraphernalia.

Background: This policy updates and replaces the "Council on Addiction Psychiatry – American Psychiatric Association Policy Guideline on Clean Needle and Syringe Exchange" which was endorsed by the AAAP Board of Directors in April 1994. In updating this policy the AAAP joins a large number of organizations endorsing increased clean needle syringe access for people who inject drugs including: the American Medical Association, the American Pharmaceutical Association, the Infectious Diseases Society of America, the United States Public Health Service and the Surgeon General of the United States.