Needle and syringe programmes

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by needle exchange programs, though can be used for training and other program support in the case of a declared public health emergency. In the time between 2010 and 2011 when no ban was in place, at least three programmes were able to obtain federal funds and two-thirds reported planning to pursue such funding. A 1997 study estimated that while the funding ban was in effect, it "may have led to HIV infection among thousands of IDUs, their sexual partners, and their children." US NEPs continue to be funded through a mixture of state and local government funds, supplemented by private donations. The funding ban was effectively lifted for every aspect of the exchanges except the needles themselves in the omnibus spending bill passed in December 2015 and signed by President Obama. This change was first suggested by Kentucky Republicans

528:

legally operated exchange decreased at more than twice the rate of white individuals after the initiation of a police anti-drug operation. These and other findings illustrate a possible mechanism by which racial disparities in law enforcement can translate into disparities in HIV transmission. The majority (56%) of respondents reported not documenting adverse police events; those who did were 2.92 times more likely to report unauthorized syringe confiscation. These findings suggest that systematic surveillance and interventions are needed to address police interference.

992:"...authorities chose to allow illegal drug use and sales at the park, in an effort to contain Zürich's growing drug problem. Police were not allowed to enter the park or make arrests. Clean needles were given out to addicts as part of the Zürich Intervention Pilot Project, or ZIPP-AIDS program. However, lack of control over what went on in the park caused a multitude of problems. Drug dealers and users arrived from all over Europe, and crime became rampant as dealers fought for control and addicts (who numbered up to 20,000) stole to support their habit." 832:

convenient improper discarding of needles when the programs are not open or are not accepting needle returns. Additionally, many programs allow for unlimited access to needles, which opponents argue increases litter to a much higher degree on the basis of increasing total needles in circulation. Portland residents in areas where syringe acquisition is unlimited claim to be "drowning in needles" and picking up upwards of 100 per week. Opposition groups also argue government action in increasing the amount of syringe disposal boxes is slow.

282:

24-hour access to sterile injecting equipment due to the ongoing "widespread, frequent and highly visible" nature of illicit drug use in the areas. Between 2010 and 2012 a four-fold increase in the levels of inappropriately discarded injecting equipment was documented for the two suburbs. In the surrounding City of Yarra, an average of 1,550 syringes per month was collected from public syringe disposal bins in 2012. Paul Dietze stated, "We have tried different measures and the problem persists, so it's time to change our approach".

466:

defense" which permits breaking of a law to prevent an imminent harm. In other jurisdictions where syringe possession without a prescription remained illegal, physician-based prescription programmes have shown promise. Epidemiological research demonstrating that syringe access programmes are both effective and cost-effective helped to change state and local NEP-operation laws, as well as the status of syringe possession more broadly. For example, between 1989 and 1992, three exchanges in

731:, and sufficient evidence that it reduces self-reported risky injecting behaviour. In a comment Palmateer warned politicians not to use her team's review of reviews as a justification to close existing programmes or to hinder the introduction of new needle-exchange schemes. The weak evidence on the programmes' disease prevention effectiveness is due to inherent design limitations of the reviewed primary studies and should not be interpreted as the programmes lacking preventive effects. 819:

drop boxes were associated with an overall decrease of improper syringe disposal (over 98% decrease) and going further from said syringe exchange sites increases the amount of improperly disposed needles. Other ethnographic studies find evidence that criminal related drug possession laws further serve to increase improperly disposed of needles, and decreasing the severity of possession laws may positively impact proper syringe disposal, this corroborates the

78: 571: 169: 680: 315: 584: 38: 1011:, United States, and some of its clients. The program Prevention Point allows anyone presenting syringes to exchange for the same quantity without limitation and this has led to drug addicts selling clean syringes to other drug addicts to make drug money. Some drug dealers use the needle exchange to obtain a supply of large quantities of needles to sell or give to their drug buyers. 955:, aimed to block the use of CEQA to challenge SEPs. The provision states that "Needle and syringe exchange services application submissions, authorizations, and operations performed pursuant to this chapter shall be exempt from review under the California Environmental Quality Act, Division 13 (commencing with Section 21000) of the Public Resources Code." 748:

alone on HIV incidence was limited and inconclusive, given "myriad design and methodological issues noted in the majority of studies." Four studies that associated needle exchange with reduced HIV prevalence failed to establish a causal link, because they were designed as population studies rather than assessing individuals.

855:

A 2003 Australian bi-partisan Federal Parliamentary inquiry published recommendations, registering concern about the lack of accountability of Australia's needle exchanges, and lack of a national program to track needle stick injuries. Community concern about discarded needles and needle stick injury

785:

According to a 2022 study by Vanderbilt University economist Analisa Packham, syringe exchange programs reduce HIV rates by 18.2 percent but lead to greater drug use. Syringe exchange programmes increased drug-related mortality rates by 11.7 percent and opioid-related mortality rates by 21.6 percent.

755:

Tilson (2007) concluded that only comprehensive packages of services in multi-component prevention programmes can be effective in reducing drug-related HIV risks. In such packages, it is unclear what the relative contribution of needle exchange may be to reductions in risk behavior and HIV incidence.

540:

Even police officers with accurate knowledge of the law, however, reported intention to confiscate syringes from drug users as a way to address problematic substance use. Police also reported anxiety about accidental needle sticks and acquiring communicable diseases from IDUs, but were not trained or

448:

led Congress to enact a prohibition on the use of federal funds to encourage drug abuse. The ban was briefly lifted in 2009, reinstated in 2010, and partially lifted again in 2015. Currently, federal funds can still not be used for the purchase of needles and syringes or other injecting paraphernalia

397:

hands out syringes to addicts who do not present any to exchange. The exchange programme reports 70% of their users are transients who experience "homelessness or unstable housing" It was reported that during the fiscal year 2015–2016, the county dispensed 2,478,362 syringes and received 2,394,460, a

179:

Needle-exchange programmes can be traced back to informal activities undertaken during the 1970s. The idea is likely to have been rediscovered in multiple locations. The first government-approved initiative (Netherlands) was undertaken in the early to mid-1980s, followed closely by initiatives in the

903:

Proponents of harm reduction argue that the provision of a needle exchange provides a social benefit in reducing health costs and also provides a safe means to dispose of used syringes. For example, in the United Kingdom, proponents of SEPs assert that, along with other programmes, they have reduced

818:

Activist groups claim there is no way to ensure SEP users will be properly disposed of. Peer reviewed studies suggest that there are less improperly disposed of syringes in cities with needle exchange programs than in cities without. Other studies of similar design find that syringe exchange program

772:

Lemon and Shah presented a 2013 paper at the International Congress of Psychiatrists that highlighted lack of training for needle exchange workers and also showed the workers performing a range of tasks beyond contractual obligations, for which they had little support or training. It also showed how

561:

According to a 2011 survey, 20% of US NEPs reported training police during the previous year. Covered topics included the public health rationale behind NEPs (71%), police occupational health (67%), needle stick injury (62%), NEPs' legal status (57%), and harm reduction philosophy (67%). On average,

527:

NEPs serving predominantly IDUs of color may be almost four times more likely to report frequent client arrest en route to or from the program and almost four times more likely to report unauthorized syringe confiscation. A 2005 study in Philadelphia found that African-Americans accessing the city's

498:

Removal of legal barriers to the operation of NEPs and other syringe access initiatives has been identified as an important part of a comprehensive approach to reducing HIV transmission among IDUs. Legal barriers include both "law on the books" and "law on the streets", i.e., the actual practices of

357:

at UK needle exchanges. NICE previously published needle exchange guidelines in 2009, in which needle and syringe services were not advised for people under 18, but the organisation's director Professor Mike Kelly explained that a "completely different group" of people were presenting at programmes.

252:

In the United States, where the One-for-one system still dominates, some 25% of injecting drug users are living positive with HIV; in Australia, which hands out equipment for free to anyone needing it (only charging a small fee for some more expensive equipment, like wheel filters and higher-quality

759:

Multiple examples can be cited showing the relative ineffectiveness of needle exchange programmes alone in stopping the spread of blood-borne disease. Many needle exchange programmes do not make any serious effort to treat drug addiction. For example, David Noffs of the Life Education Center wrote,

510:

Although most US NEPs operate legally, many report some form of police interference. In a 2009 national survey of 111 US NEP managers, 43% reported at least monthly client harassment, 31% at least monthly unauthorized confiscation of clients' syringes, 12% at least monthly client arrest en route to

473:

By 2012, legal syringe exchange programmes existed in at least 35 states. In some settings, syringe possession and purchase is decriminalized, while in others, authorized NEP clients are exempt from certain drug paraphernalia laws. However, despite the legal changes, gaps between the formal law and

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Many states criminalized needle possession without a prescription, arresting people as they left underground needle exchange efforts. In some jurisdictions, such as New York, needle exchange activists challenged the laws in court, with judges ruling that their actions were justified by a "necessity

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after the area's drug culture continued to grow after more than ten years of intense law enforcement efforts. The institute's research concluded that public injecting behaviour is frequent in the area and injecting paraphernalia has been found in carparks, parks, footpaths, and drives. Furthermore,

200:

Needle and syringe programs operate differently in different parts of the world; the first NSPs in Europe and Australia gave out sterile equipment to drug users, having begun in the context of the early AIDS epidemic. The United States took a far more reluctant approach, typically requiring IDUs to

983:

NSPs may concentrate drug activity into communities in which they operate. Only a small number of short-term studies considered whether NSPs have such effects. To the extent that this happens, they may negatively affect property values, increase localized crime rates and damage broader perceptions

414:

in 1993, the San Francisco Department of Public Health has been responsible for the management of syringe access and the proposed disposal of these devices in the city. This sanction, which was originally executed as a state of emergency to address the HIV epidemic, allowed SEPs to provide sterile

763:

A 2013 systematic review found support for the use of NEPs to prevent and treat HIV and HCV infection. A 2014 systematic review and meta-analysis found evidence that NEPs were effective in reducing HIV transmission among injection drug users, but that other harm reduction programmes have probably

358:

In the updated guidance, NICE recommended the provision of specialist services for "rapidly increasing numbers of steroid users", and that needles should be provided to people under the age of 18—a first for NICE—following reports of 15-year-old steroid injectors seeking to develop their muscles.

297:

1 invested in NSPs in Australia, $ 4 was saved in direct healthcare costs, and if productivity and economic benefits are included, the programs returned a staggering $ 27 for every $ 1 invested. The study notes that over a longer time horizon than that considered (10 years) the cost-benefit ratio

281:

are locations in which the use and dealing of heroin has been concentrated. The Burnet Institute research organisation completed the 2013 'North Richmond Public Injecting Impact Study' in collaboration with the Yarra Drug and Health Forum and North Richmond Community Health Centre and recommended

831:

On the other hand, there is data to suggest SEPs do increase improper syringe disposal. Opposition groups contribute their own proof through photographic evidence of increased needle litter, additionally, opponents argue that programs which do not mandate a 1:1 needle exchange encourage the more

747:

evaluated the conflicting evidence of both Drs Wodak and Käll in their Geneva session and concluded that although multicomponent HIV prevention programmes that include needle and syringe exchange reduced intermediate HIV risk behavior, evidence regarding the effect of needle and syringe exchange

734:

The second of the Palmateer team's 'review of reviews' scrutinised 10 previous formal reviews of needle exchange studies, and after critical appraisal only four reviews were considered rigorous enough to meet the inclusion criteria. Those were done by the teams of Gibson (2001), Wodak and Cooney

514:

A detailed 2011 analysis of NEP client experiences in Los Angeles suggested that as many as 7% of clients report negative encounters with security officers in any given month. Given that syringes are not prohibited in the jurisdiction and their confiscation can only occur as part of an otherwise

536:

Police interference with legal NEP operations may be partially explained by training defects. A study of police officers in an urban police department four years after the decriminalization of syringe purchase and possession in the US state of Rhode Island suggested that up to a third of police

477:

Colorado allows covert syringe exchange programmes to operate. Current Colorado laws leave room for interpretation over the requirement of a prescription to purchase syringes. Based on such laws, the majority of pharmacies do not sell syringes without a prescription and police arrest people who

431:

As of 2011, at least 221 programmes operated in the US. Most (91%) were legally authorized to operate; 38.2% were managed by their local health authorities. The CDC reported in 1993 that the most significant expenses for the NSPs is personnel cost, which reports it represents 66% of the budget.

518:

Similar findings have emerged internationally. For example, despite instituting laws protecting syringe access and possession and adopting NEPs, IDUs and sex workers in Mexico's Northern Border regions report frequent syringe confiscation by law enforcement personnel. In this region as well as

915:

Other promoted benefits of these programmes include providing a first point of contact for formal drug treatment, access to health and counselling service referrals, the provision of up-to-date information about safe injecting practices, access to contraception and sexual health services and

435:

More than 36 million syringes were distributed annually, mostly through large urban programmes operating a stationary site. More generally, US NEPs distribute syringes through a variety of methods including mobile vans, delivery services and backpack/pedestrian routes that include secondary

515:

authorized arrest, almost 40% of those who reported syringe confiscation were not arrested. This raises concerns about extrajudicial confiscation of personal property. Approximately 25% of the encounters detailed by respondents involved private security personnel, rather than local police.

511:

or from NEP and 26% uninvited police appearances at program sites at least every six months. In multivariate modeling, legal status of the program (operating legally vs illegally) and jurisdiction's syringe regulation environment were not associated with frequency of police interference.

843:

Some NSPs hands outs needles without an expectation of used syringes being returned. One NSP in Portland, Oregon, hands out syringes without question. Neighbors near the NSP are routinely finding discarded syringes and the neighborhood organization to which they are a part of, the

916:

providing a means for data collection from users about their behaviour and/or drug use patterns. SEP outlets in some settings offer basic primary health care. These are known as 'targeted primary health care outlets', because they primarily target people who inject drugs and/or '

3340:

Palmateer N, Kimber J, Hickman M, Hutchinson S, Rhodes T, Goldberg D (May 2010). "Evidence for the effectiveness of sterile injecting equipment provision in preventing hepatitis C and human immunodeficiency virus transmission among injecting drug users: a review of reviews".

870:

may be neglected because of drug dependence. IDUs are typically reluctant to use conventional health services. Such reluctance/neglect implies poorer health and increased use of emergency services, creating added costs. Harm reduction based health care centres, also known as

970:

In a 1993 mortality study among 415 injection drug users in the Philadelphia area, over four years, 28 died: 5 from HIV-related causes; 7 from overdose, 5 from homicide, 4 from heart disease, 3 from renal failure, 2 from liver disease, 1 from suicide and 1 from cancer.

265:(WHO) found a "compelling case that NSPs substantially and cost effectively reduce the spread of HIV among IDUs and do so without evidence of exacerbating injecting drug use at either the individual or societal level." WHO's findings have also been supported by the 920:', because they reduce common barriers to health care from the conventional health care outlets,. Clients frequently visit SEP outlets for help accessing sterile injecting equipment. These visits are used opportunistically to offer other health care services. 738:

The Wodak and Cooney review had, from 11 studies of what they determined as demonstrating acceptable rigour, found 6 that were positive regarding the effectiveness of NSPs in preventing HIV, 3 that were negative and 2 inconclusive. However a review by Käll

943:

was blocked from operating in October, 2019 by an Orange County lawsuit which charged the program with creating hazardous conditions and litter for residents. The OCNEP contests that public needle litter still exists after the shutdown of their program.

839:

The few studies that specifically evaluated the effects of NEPs produced "modest" evidence of no impact on improper needle discards and injection frequency and "weak" evidence on lack of impact on numbers of drug users, high-risk user networks and crime

519:

elsewhere, reports of syringe confiscation are correlated with increases in risky behaviors, such as groin injecting, public injection and utilization of pharmacies. These practices translate to risk for HIV and other blood-borne diseases.

393:, was the first city in nation to expend public funds on a NSP which opened in 1989. It is also one of the longest running programme in the country. Despite the word "exchange" in the programme name, the Portland needle exchange operated by 1542: 4449:

Islam MM, Topp L, Day CA, Dawson A, Conigrave KM (2012). "The accessibility, acceptability, health impact and cost implications of primary healthcare outlets that target injecting drug users: A narrative synthesis of literature".

562:

training was seen as moderately effective, but only four programmes reported conducting any formal evaluation. Assistance with training police was identified by 72% of respondents as the key to improving police relations.

751:

NEPs successfully serve as one component of HIV prevention strategies. Multi-component HIV prevention programmes that include NSE reduce drug-related HIV risk behaviors and enhance the impact of harm reduction services.

3518: 894:

As of 2011, CDC estimated that every HIV infection prevented through a needle exchange program saves an estimated US$ 178,000+. Separately it reported an overall 30 percent or more reduction in HIV cases among IDUs.

4824:

Islam MM, Reid SE, White A, Grummett S, Conigrave KM, Haber PS (2012). "Opportunistic and continuing health care for injecting drug users from a nurse-run needle syringe program-based primary health-care clinic".

378:

confirm that needle exchange is an effective strategy for the prevention of HIV. The NIH estimated in 2002 that in the United States, 15–20% of injection drug users have HIV and at least 70% have hepatitis C. The

478:

possess syringes without a prescription. Boulder County health department reports between January 2012 and March 2012, the group received over 45,000 dirty needles and distributed around 45,200 sterile syringes.

2432:

Beletsky L, Burris S, Macalino GE (2005). "Attitudes of Police Officers Towards Syringe Access, Occupational Needle-Sticks, and Drug Use: A Qualitative Study of One City Police Department in the United States".

1209: 419:. Since then, it was approximated that from July 1, 2017, to December 31, 2017, only 1,672,000 out of the 3,030,000 distributed needles (60%) were returned to the designated sites. In April 2018, acting Mayor 298:

grows even further. In terms of infections averted and lives saved, the study finds that, between 2000 and 2009, 32,000 HIV infections and 96,667 hepatitis C infections were averted, and approximately 140,000

238:

The practices and policies vary between needle and syringe program sites. In addition to exchange, there is a model called "needs-based" where the syringes are handed out without requiring any to be returned.

220:, also uses the volume system. United Nations Office on Drugs and Crime for South Asia suggests visual estimation or asking the client how many they brought back. The volume-based method left potential for 253:

tourniquets), only 1% of the IDU population is HIV-positive as of 2015, compared to over 20% in the late 1980s when NSP programs began to spread nationally and became accessible to most of the population.

557:

concerns. Preliminary evidence also suggests that training can shift police knowledge and attitudes regarding NEPs specifically and public health-based approaches towards problematic drug use in general.

995:

In Australia, which is considered a leading proponent of harm reduction, a survey showed that one-third of the public believed that NSPs encouraged drug use, and 20% believed that NSPs dispensed drugs.

4952:"ADOPT AN ORDINANCE ADDING ARTICLE XV (SYRINGE EXCHANGE PROGRAMS) TO CHAPTER 18 OF THE SANTA ANA MUNICIPAL CODE ( HEALTH AND SANITATION) PROHIBITING SYRINGE EXCHANGE PROGRAMS IN THE CITY OF SANTA ANA" 4033:

Tookes, Hansel E.; Kral, Alex H.; Wenger, Lynn D.; Cardenas, Gabriel A.; Martinez, Alexis N.; Sherman, Recinda L.; Pereyra, Margaret; Forrest, David W.; Lalota, Marlene; Metsch, Lisa R. (2012-06-01).

4789:

Islam MM, Topp L, Day CA, Dawson A, Conigrave KM (2012). "Primary healthcare outlets that target injecting drug users: Opportunity to make services accessible and acceptable to the target group".

1533: 1478: 1063: 735:(2004), Tilson (2007) and Käll (2007). The Palmateer team judged that their conclusion in favour of NSP effectiveness was not consistent with the results from the HIV studies they reviewed. 656:

Needle exchange programmes have faced opposition on both political and moral grounds. Advocacy groups including the National District Attorneys Association (NDAA), Drug Watch International,

5281: 242:

According to a report published in 1994, Montreal's CACTUS exchange which has a policy of one-for-one, plus one needle with a limit of 15 had a return rate of 75-80% between 1991 and 1993.

4302: 1087:

Ritter, A and Cameron, J (2006) A Systematic Review of Harm Reduction, Drug Policy Modeling Project, Monograph 06, Turning Point Alcohol and Drug Center, University of Melbourne, December.

5341:"Addicts use needle swap to buy drugs; Abuse: The city health commissioner concedes that the needle exchange program is flawed but maintains that its benefits far outweigh its drawbacks" 1197:

That left room to game the system, to which Stuerzbecher devoted significant time. "Kerstin spent hours measuring and counting needles in those disposal bins with markings on the side...

3547: 2575: 4332: 980:

NSP effectiveness studies usually focused on addict health effects; the United States National District Attorneys Association argues that they neglect effects on the broader community.

760:"I have visited sites around Chicago where people who request info on quitting their habit are given a single sheet on how to go cold turkey—hardly effective treatment or counseling." 3289: 2660:

Beletsky L, Sorensen A, Wagner K, Davidson P (2011). "The State of the Row: Syringe Exchange Client's Experiences with Police and Private Security Personnel in Downtown Los Angeles".

3665: 2348:

Programs, National Research Council (US) and Institute of Medicine (US) Panel on Needle Exchange and Bleach Distribution; Normand, Jacques; Vlahov, David; Moses, Lincoln E. (1995).

935:(CEQA) as a means to bar syringe exchange programs from operating, citing the environmental impact of improper syringe disposals. Most notably SEP opposition within Santa Cruz, and 1020:

in February 2000 revealed that they sell some of the new syringes obtained from the exchange in order to make drug money and did not always stop needle sharing among drug addicts.

908:

users. These supposed benefits have led to an expansion of these programmes in most jurisdictions that have introduced them, increasing geographical coverage and operating hours.

2028:"Bundling occupational safety with harm reduction information as a feasible method for improving police receptiveness to syringe access programs: Evidence from three U.S. Cities" 882:

NSP staff facilitate connections among people who use drugs and medical facilities, thereby exposing them to voluntary physical, psychological and emotional treatment programmes.

384: 3751:

Abdul-Quader, Abu S.; Feelemyer, Jonathan; Modi, Shilpa; Stein, Ellen S.; Briceno, Alya; Semaan, Salaam; Horvath, Tara; Kennedy, Gail E.; Des Jarlais, Don C. (22 August 2013).

3522: 4546: 1895: 350: 773:

needle exchange workers were a common first contact for distressed drug users. Perhaps the most concerning finding was that workers were not legally allowed to provide

594: 4362: 3711: 3240: 1439: 1413: 1101:

Public Health Impact of Needle Exchange Programs in the United States and Abroad. (1993). United States: University of California, Berkeley, School of Public Health

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can be ineffective in reducing such barriers if police continue to treat syringe possession as a crime or participation in NEP as evidence of criminal activity.

866:

IDUs risk multiple health problems from non-sterile injecting practices, drug complications and associated lifestyle choices. Unrelated health problems such as

4705:

Islam MM, Stern T, Conigrave KM, Wodak A (January 2008). "Client satisfaction and risk behaviours of the users of syringe dispensing machines: a pilot study".

537:

officers were not aware that the law had changed. This knowledge gap parallels other areas of public health law, underscoring pervasive gaps in dissemination.

3055: 1162: 4280: 5138:

Williams, C. T.; Ouellet, L. J. (2010). "Misdirected opposition: Evidence opposing "not in my back yard" arguments against syringe exchange programmes".

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Kimber J, Palmateer N, Hutchinson S, Hickman M, Goldberg D, Rhodes T, EMCDDA Monograph 10 'Harm Reduction – Impacts, Evidences and Challenges, Chapter 5

3145: 820: 371: 3802:"Are needle and syringe programmes associated with a reduction in HIV transmission among people who inject drugs: a systematic review and meta-analysis" 3092: 216:

in 2019, it is a common practice not to count the number of exchanged needles exactly, but rather to estimate the number based on a container's volume.

5348: 3613: 4181: 2102:

Lurie, P; Drucker, E (1 March 1997). "An opportunity lost: HIV infections associated with lack of a national needle-exchange programme in the USA".

1467: 1052: 3725: 5288: 3800:

Aspinall, EJ; Nambiar, D; Goldberg, DJ; Hickman, M; Weir, A; Van Velzen, E; Palmateer, N; Doyle, JS; Hellard, ME; Hutchinson, SJ (February 2014).

3638: 2146: 4310: 3923: 743:

disagreed with the Wodak and Cooney review, reclassifying the studies on NSP effectiveness to 3 positive, 3 negative and 5 inconclusive. The US

4006: 3588: 2956:"Prevalence, characteristics, and predictors of police training initiatives by US SEPs: Building an evidence base for structural interventions" 667:

In the United States NEP programmes have proliferated, despite lack of public acceptance. Internationally, needle exchange is widely accepted.

3753:"Effectiveness of Structural-Level Needle/Syringe Programs to Reduce HCV and HIV Infection Among People Who Inject Drugs: A Systematic Review" 3562: 1694: 836:

NSPs that strictly adhere to one-for-one policy and do not furnish starter syringes/needles do not increase the number of them in circulation.

764:

also contributed to the decrease in HIV incidence. NEPs appear to be as effective in low- and middle-income countries as in high-income ones.

4348: 3680: 1190: 4511:

Des Jarlais, D. C.; McKnight, C.; Goldblatt, C.; Purchase, D. (2009). "Doing harm reduction better: Syringe exchange in the United States".

3312: 1112: 474:

environment mean that many programmes continue to face law enforcement interference and covert programmes continue to exist within the U.S.

3686: 932: 5314: 4206: 4156: 1565: 285:

On 28 May 2013, the Burnet Institute stated that it recommended 24-hour access to sterile injecting equipment in the Melbourne suburb of

4035:"A comparison of syringe disposal practices among injection drug users in a city with versus a city without needle and syringe programs" 2376:"The roles of law, client race and program visibility in shaping police interference with the operation of US syringe exchange programs" 2213: 383:(CDC) reports one-fifth of all new HIV infections and the vast majority of hepatitis C infections are the result of injection drug use. 2680:"Syringe confiscation as an HIV risk factor: the public health implications of arbitrary policing in Tijuana and Ciudad Juarez, Mexico" 541:

equipped to deal with this occupational risk; this anxiety was intertwined with negative attitudes towards syringe access initiatives.

261:

Programs providing sterile needles and syringes currently operate in 87 countries around the world. IA comprehensive 2004 study by the

3177: 2729:"Social and structural factors associated with HIV infection among female sex workers who inject drugs in the Mexico-US border region" 2521: 646: 606: 4554: 4342: 1778: 845: 624: 349:

from the Bristol Drugs Project advocated for needle exchanges to be established in the United Kingdom. The British public body, the

4230: 1975: 2878:

Burris S, Beletsky L, Burleson J, Case P, Lazzarini Z (2007). "Do Criminal Laws Influence HIV Risk Behavior? An Empirical Trial".

1725: 444:

In the United States, a ban on federal funding for needle exchange programs began in 1988, when republican North Carolina Senator

5079: 1926: 1251:

Programs, National Research Council (US) and Institute of Medicine (US) Panel on Needle Exchange and Bleach Distribution (1994).

917: 3976: 5416: 2835:

Iguchi MY, Bell J, Ramchand RN, Fain T (2005). "How criminal system racial disparities may translate into health disparities".

1951:"The Public Health Impact of Needle Exchange Programs in the United States and Abroad Summary, Conclusions and Recommendations" 1842:"Life After the Ban: An Assessment of US Syringe Exchange Programs' Attitudes About and Early Experiences with Federal Funding" 823:

own guidelines on syringe disposal, which claim "Studies have found that syringe litter is more likely in areas without SSPs".

4951: 4670:

Islam MM, Conigrave KM (2007). "Syringe vending machines as a form of needle syringe program: Advantages and Disadvantages".

1629:"National Institutes of Health Consensus Development Conference Statement: Management of hepatitis C: 2002--June 10–12, 2002" 3430:"Effectiveness of syringe exchange programs in reducing HIV risk behavior and HIV seroconversion among injecting drug users" 2173:"Arrests and incarceration of injection drug users for syringe possession in Massachusetts: implications for HIV prevention" 3892:

Lemon, T. I.; Shah, R. (2013). "Needle exchanges: An important yet forgotten outpost in suicide and self-harm prevention".

3843:"High coverage needle/syringe programs for people who inject drugs in low and middle income countries: a systematic review" 2551: 3244: 375: 299: 209: 5099:"Community support for needle exchange programs and pharmacy sale of syringes: A household survey in Baltimore, Maryland" 4989: 4376:

McCoy, C. B.; Metsch, L. R.; Chitwood, D. D.; Miles, C. (2001). "Drug use and barriers to use of health care services".

3215: 952: 642: 266: 415:

syringes, take back used devices, and operate as a service for health education to support individuals struggling with

5406: 5386: 5376: 380: 278: 1318:

Yoast, R.; Williams, M. A.; Deitchman, S. D.; Champion, H. C. (2001). "Report of the Council on Scientific Affairs".

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Lune, H (December 2002). "Weathering the Storm: Non-profit Organization Survival Strategies in a Hostile Climate".

145: 3152: 852:, and she was handed 100 syringes without question. The City Council in Chico is discussing banning the operation. 4419:

McDonald, P (2002). "From streets to sidewalks: developments in primary care services for injecting drug users".

1029: 936: 650: 482: 420: 262: 5426: 5401: 848:

park neighborhood association, desires the needle handout operation to stop. A local resident visited a NSP in

638: 394: 201:

already have used needles to exchange for sterile ones - this "One-for-one" system is where the same number of

4092:"State syringe and drug possession laws potentially influencing safe syringe disposal by injection drug users" 2788:"Effects of an Intensive Street-Level Police Intervention on Syringe Exchange Program Use in Philadelphia, PA" 353:(NICE), introduced a recommendation in April 2014 due to an increase in the number of young people who inject 3642: 5396: 5340: 5174: 1136: 923:

A clinical trial of needle exchange found that needle exchange did not cause an increase in drug injection.

657: 3377: 5421: 5411: 5189: 1753: 1504: 416: 269:(AMA), which in 2000 adopted a position strongly supporting NSPs when combined with addiction counseling. 232: 217: 3476:"Effectiveness of Sterile Needle and Syringe Programming in Reducing HIV/AIDS Among Injecting Drug Users" 1294:"Effectiveness of Sterile Needle and Syringe Programming in Reducing HIV/AIDS Among Injecting Drug Users" 504: 5381: 3729: 3266: 962:. There is no part of the bill which explicitly addresses the environmental concerns of the plaintiffs. 856:

led Australia to allocate $ 17.5 million in 2003/4 to investigating retractable technology for syringes.

744: 3475: 1293: 3959: 249:, implemented a one-for-one with four starter needles and reported an exchange rate of 89.1% in 1992. 5391: 4625:

McDonald, D. (2009). "The evaluation of a trial of syringe vending machines in Canberra, Australia".

3406: 2740: 1668: 885:

Social services for addicts can be organized around needle exchanges, increasing their accessibility.

423:

allocated $ 750,000 towards the removal of abandoned needles littering the streets of San Francisco.

129: 5194: 2602:"Addressing the 'Risk Environment' for Injection Drug Users: The Mysterious Case of the Missing Cop" 1889: 1887: 1885: 550: 286: 2907:"Police training to align law enforcement and HIV prevention: preliminary evidence from the field" 2510: 5263: 5207: 4891: 4730: 4687: 4401: 4356: 3951: 3705: 2860: 2552:"Needle exchanges have been proved to work against opioid addiction. They're banned in 15 states" 2493: 2450: 2127: 1992: 1806: 1343: 481:

As of 2017, NSPs are illegal in 15 states. NSPs are prohibited by local regulations in cities in

4157:"Needle exchanges help combat the opioid crisis. So why was the one in Orange County shut down?" 1835: 1833: 1831: 1829: 1827: 1234: 3964: 3924:"Syringe exchange programs and harm reduction: New evidence in the wake of the opioid epidemic" 3117: 470:

tagged syringes to help demonstrate rates of return prior to the legalization of the approach.

77: 5255: 5155: 5120: 5061: 4932: 4883: 4842: 4806: 4771: 4722: 4652: 4607: 4528: 4467: 4393: 4338: 4119: 4111: 4072: 4054: 3984: 3943: 3874: 3823: 3782: 3676: 3451: 3358: 3012: 2985: 2936: 2887: 2852: 2817: 2768: 2709: 2639: 2631: 2458: 2405: 2330: 2278: 2221: 2194: 2119: 2059: 2005: 1997: 1918: 1871: 1650: 1606: 1394: 1335: 1186: 1180: 1016: 849: 724: 716: 294: 246: 221: 133: 4990:"Bill Text - AB-1344 State Department of Public Health: needle and syringe exchange services" 2891: 2643: 2462: 2294: 2292: 1268: 290:

people who inject drugs have broken into syringe disposal bins to reuse discarded equipment.

5245: 5199: 5147: 5110: 5051: 4922: 4873: 4834: 4798: 4761: 4714: 4679: 4642: 4634: 4597: 4589: 4520: 4459: 4428: 4385: 4103: 4062: 4046: 3935: 3901: 3864: 3854: 3813: 3772: 3764: 3441: 3350: 3304: 2975: 2967: 2926: 2918: 2844: 2807: 2799: 2758: 2748: 2699: 2691: 2621: 2613: 2485: 2442: 2395: 2387: 2320: 2312: 2268: 2258: 2184: 2111: 2049: 2039: 1987: 1910: 1861: 1853: 1640: 1384: 1374: 1327: 1182:

Fighting for Space: How a Group of Drug Users Transformed One City's Struggle with Addiction

905: 800: 390: 172: 168: 3181: 2525: 1950: 570: 3639:"Meeting 1: Prevention of HIV Infection among Injecting Drug Users in High Risk Countries" 2576:"Court order all but bans mobile needle exchange program in Costa Mesa, other O.C. cities" 1695:"A legal site in Portland to inject heroin? Elected officials, advocates explore the idea" 985: 959: 931:

Within California, those opposed to syringe exchange programs have frequently invoked the

909: 661: 554: 500: 454: 2600:

Burris S, Blankenship KM, Donoghoe M, Sherman S, Vernick JS, Case P, et al. (2004).

2369: 2367: 2365: 2363: 2361: 1594: 4862:"Needle Syringe Program-Based Primary Health Care Centers: Advantages and Disadvantages" 4283:. Australian House of Representatives Standing Committee on Family and Community Affairs 4281:"Road to recovery: Report on the inquiry into substance abuse in Australian communities" 3548:"The Effectiveness of Needle Exchange Programmes for HIV Prevention - A Critical Review" 2744: 2245:

GE Macalino; D Dhawan Sachdev; JD Rich; C Becker; LJ Tan; L Beletsky; S Burris. (2009).

1363:"Syringe access for the prevention of blood borne infections among injection drug users" 715:

Two 2010 'reviews of reviews' by a team originally led by Norah Palmateer that examined

51:

Please help update this article to reflect recent events or newly available information.

17: 5234:"Needle Syringe Program-Based Primary HealthCare Centers: Advantages and Disadvantages" 4766: 4749: 4602: 4577: 4067: 4034: 3869: 3842: 3841:

Des Jarlais, DC; Feelemyer, JP; Modi, SN; Abdul-Quader, A; Hagan, H (19 January 2013).

3777: 3752: 2980: 2955: 2931: 2906: 2812: 2787: 2763: 2728: 2704: 2679: 2626: 2601: 2400: 2375: 2325: 2301:"The legal strategies used in operating syringe exchange programs in the United States" 2300: 2273: 2246: 2054: 2027: 1866: 1841: 1741:

Multnomah County will give up to 10 syringes to an individual who has none to exchange.

1235:"North Dakota Department of Health Syringe Service Program Requirements & Guidance" 192:, the AIDS pandemic motivated the rapid adoption of these programmes around the world. 181: 141: 125: 5083: 4107: 2115: 1389: 1362: 679: 549:

US NEPs have successfully trained police, especially when framed as addressing police

314: 5370: 5115: 5098: 4927: 4910: 4838: 4524: 4050: 3955: 3905: 3446: 3429: 3354: 2971: 2655: 2653: 2617: 2497: 2391: 2189: 2172: 1914: 804: 720: 467: 346: 137: 5211: 4734: 4691: 4405: 4331:

Latt, N.; Conigrave, K.; Marshall, J.; Saunders, J.; Marshall, J.; Nutt, D. (2009).

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Burris, Scott; Welsh, Joseph; Ng, Mitzi; Li, Mei; Ditzler, Alyssa (November 2002).

1509: 1008: 948: 912:

that automatically dispense injecting equipment have been successfully introduced.

808: 411: 4138: 3939: 2427: 2425: 2423: 2421: 2419: 2247:"A national physician survey on prescribing syringes as an HIV prevention measure" 5151: 4802: 4638: 4463: 2753: 2446: 5097:

Keyl, P. M.; Gruskin, L.; Casano, K.; Montag, H.; Junge, B.; Vlahov, D. (1998).

5056: 5039: 4255: 3589:"Do needle syringe programmes assist control of HIV among injecting drug users?" 3030: 2349: 2316: 1252: 445: 189: 5014:"CEQA lawsuits are blocking needle exchange programs. A new law will stop that" 4911:"Needle exchange and injection drug use frequency: a randomized clinical trial" 4007:"Needle Exchanges Are Targets of Eco-Rooted Lawsuits. A New Law Will Stop That" 1534:"NICE: Needle exchanges should supply safe equipment to under-18 steroid users" 1468:"Evaluating the cost-effectiveness of needle and syringe programs in Australia" 723:

on the topic found insufficient evidence that NSP prevents transmission of the

5203: 4718: 4683: 4593: 3768: 3546:

Käll, K.; Hermansson, U.; Amundsen, E. J.; Rönnbäck, K.; Rönnberg, S. (2007).

2695: 450: 367: 5250: 5233: 4878: 4861: 4115: 4058: 3988: 3947: 2922: 2803: 2489: 2225: 2001: 1857: 653:

and many others endorsed low-threshold programmes including needle exchange.

4139:"Needs-Based Syringe Distribution and Disposal at Syringe Services Programs" 4091: 3859: 3519:"Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries" 3308: 660:, Drug Free Australia, and so forth and religious organizations such as the 503:

officers, which may or may not reflect relevant law. Changes in syringe and

399: 387:

reports 7%, or 2,400 cases of HIV infections in 2018 were among drug users.

225: 185: 157: 5259: 5159: 4936: 4887: 4846: 4810: 4726: 4656: 4611: 4532: 4485: 4471: 4397: 4123: 4076: 3878: 3827: 3786: 3455: 3362: 2989: 2940: 2856: 2821: 2772: 2713: 2635: 2409: 2282: 2263: 2077: 2063: 2044: 2009: 1922: 1875: 1654: 1645: 1628: 1610: 1398: 1379: 1339: 989: 5124: 5065: 4775: 4748:

Brooner R, Kidorf M, King V, Beilenson P, Svikis D, Vlahov D (June 1998).

3267:"Holy See opposes condoms, needle-exchange programs in fight against AIDS" 3016: 2905:

Beletsky L, Agrawal A, Moreau B, Kumar P, Weiss-Laxer N, Heimer R (2011).

2848: 2334: 2198: 2123: 1331: 1210:"Discarded needles may be unintended side effect of needle access program" 293:

A study commissioned by the Australian Government revealed that for every

4389: 4256:"Some Residents, Officials Gang Up Against Syringe Exchange in Chico, CA" 3818: 3801: 3178:"Drug Watch International Position Statement: Needle Handouts to Addicts" 867: 774: 410:

Since the full sanction of syringe exchange programs (SEP) by then-Mayor

402:

needle exchange program sees "mostly white suburban kids ages 18 to 25".

153: 1007:

interviewed a syringe exchange program Prevention Point Philadelphia in

98: 5103:

Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology

3407:"Harm reduction among injecting drug users — evidence of Effectiveness" 1779:"Needle exchange program sees mostly white suburban kids ages 18 to 25" 354: 202: 149: 4647: 3077:

Stapleton, Stephanie (1997). "AMA endorses needle-exchange programs".

2351:

Needle Exchange and Bleach Distribution Programs in the United States

1113:"What we learned from looking at Santa Cruz County's needle exchange" 188:

by 1986. While the initial programme was motivated by an outbreak of

4432: 1896:"Doing harm reduction better: syringe exchange in the United States" 5282:"Community consulted for the first time on attitudes towards drugs" 3673:

EMCDDA Monographs: Harm reduction: evidence, impacts and challenges

1414:"Syringe machine push for addicts in Melbourne's heroin hot spots" 569: 167: 45:

Parts of this article (those related to Legal Aspects) need to be

4750:"Drug abuse treatment success among needle exchange participants" 3290:"Clean Needles and Bad Blood: Needle Exchange as Morality Policy" 1593:

Centers for Disease Control and Prevention (CDC) (15 July 2005).

5315:"Needle Exchange Program Creates Black Market In Clean Syringes" 1807:"S.F. Pins Down Its Needle Problem - April 25, 2018 - SF Weekly" 485:, even though it is not disallowed by state law in California. 91:

Syringe-exchange programme (SEP), needle exchange program (NEP)

1004: 728: 674: 577: 545:

Training and interventions to address law enforcement barriers

398:

shortage of 83,902 needles. In 2016, it was reported that the

309: 277:

The Melbourne, Australia, inner-city suburbs of Richmond, and

31: 5082:. Ontario Harm Reduction Distribution Program. Archived from 4182:"Those needles littering the streets? The city gave them out" 593:

deal primarily with the United States and do not represent a

1894:

Des Jarlais DC, McKnight C, Goldblatt C, Purchase D (2009).

1440:"Drug experts propose needle vending machines for Footscray" 1137:"How needle exchange program needles get counted in Holyoke" 1053:"Australia commemorates 20 years of needle syringe programs" 4231:"University Park residents fed up with crime, drugs, trash" 3675:. European Monitoring Centre for Drugs and Drug Addiction. 2021: 2019: 4303:"Drug-injecting hotspot near Collingwood childcare center" 2678:

Beletsky L, Lozada R, Gaines T, et al. (April 2013).

1566:"Brian Weil, 41, Photographer Who Founded Needle Exchange" 1361:

Stancliff, S.; Agins, B.; Rich, J. D.; Burris, S. (2003).

1163:"Needle syringe exchange program for injecting drug users" 1062:. Australian National Council on Drugs. 17 December 2014. 4909:

Fisher DG, Fenaughty AM, Cagle HH, Wells RS (June 2003).

4578:"The biopolitics of needle exchange in the United States" 3151:. National District Attorneys Association. Archived from 3056:"ABA Urges Federal Support for Syringe Exchange Programs" 2954:

Beletsky L, Grau LE, White E, Bowman S, Heimer R (2011).

2786:

Davis CS, Burris S, Becher J, Lynch K, Metzger D (2005).

2374:

Beletsky L, Grau LE, White E, Bowman S, Heimer R (2011).

1840:

Green TC, Martin E, Bowman S, Mann M, Beletsky L (2012).

4207:"Used syringes litter Portland as needle exchanges grow" 2727:

Strathdee SA, Lozada R, Martinez G, et al. (2011).

958:

The provision was passed on the basis of curtailing the

235:

in Ohio weigh the returned sharps rather than counting.

27:

Method of providing drug users with uninfected equipment

2214:"Needle-Exchangers Had Right to Break Law, Judge Rules" 691: 602: 326: 140:

at little or no cost. It is based on the philosophy of

3614:"What science tells us about needle exchange programs" 727:, tentative evidence that it prevents transmission of 4965: 3521:. United States Institute of Medicine. Archived from 1622: 1620: 1588: 1586: 1254:

Evaluating Montréal's Needle Exchange CACTUS-Montréal

940: 879:

for IDUs have been established to address this issue.

385:

United States Department of Health and Human Services

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Retrovirol 2078:"Federal Funding for Syringe Services Programs" 228:devoted significant effort to game the system. 5238:Journal of Primary Care & Community Health 5175:"Finding a place for needle exchange programs" 5173:Strike, C. J.; Myers, T.; Millson, M. (2004). 4866:Journal of Primary Care & Community Health 3666:"Chapter 1: Harm reduction and the mainstream" 3555:The Journal of Global Drug Policy and Practice 3093:"Needle Exchange Programs: Position Statement" 1269:"Global State of Harm Reduction - 2021 Update" 4966:"Orange County Needle Exchange Program: Home" 3977:"America's syringe exchanges kill drug users" 3400: 3398: 947:Legislation in California signed by governor 637:Organizations ranging from the NIH, CDC, the 591:The examples and perspective in this section 132:drug users (IDUs) to obtain clean and unused 8: 4361:: CS1 maint: multiple names: authors list ( 3710:: CS1 maint: multiple names: authors list ( 3512: 3510: 3508: 3506: 3504: 3502: 3500: 3498: 3496: 3469: 3467: 3465: 3123:. Joint United Nations Programme on HIV/AIDS 1993:10.1001/journalofethics.2016.18.3.hlaw1-1603 814:NSPs Do Not Increase Litter: Broad Arguments 3140: 3138: 927:California Environmental Quality Act (CEQA) 3378:"Do needle-exchange programs really work?" 3180:. Drug Watch International. Archived from 609:, or create a new section, as appropriate. 372:Centers for Disease Control and Prevention 76: 5249: 5193: 5114: 5055: 5040:"Causes of Death in Injection-Drug Users" 4926: 4877: 4765: 4646: 4601: 4066: 3868: 3858: 3817: 3776: 3445: 2979: 2930: 2811: 2762: 2752: 2703: 2625: 2399: 2324: 2272: 2262: 2188: 2053: 2043: 1991: 1865: 1644: 1388: 1378: 984:about the host community. In 1987 in the 625:Learn how and when to remove this message 175:(for safe disposal of hypodermic needles) 4547:"Needle exchange options; pros and cons" 2478:Nonprofit and Voluntary Sector Quarterly 827:NSPs Do Increase Litter: Broad Arguments 3541: 3539: 3297:Journal of Sociology and Social Welfare 1041: 4950:Ridge, Kristine (September 15, 2020). 4354: 4000: 3998: 3703: 1801: 1799: 1462: 1460: 1047: 1045: 67: 5038:Woody, G. E.; Metzger, D. S. (1993). 3917: 3915: 3806:International Journal of Epidemiology 3637:Tilson, H. (committee chair) (2005). 3243:. Drug Free Australia. Archived from 2673: 2671: 2545: 2543: 1969: 1967: 1719: 1717: 1715: 939:—whose only syringe exchange program 7: 5140:International Journal of Drug Policy 4791:International Journal of Drug Policy 4627:International Journal of Drug Policy 4486:"Needle Exchange and Harm Reduction" 4452:International Journal of Drug Policy 4421:Australian Journal of Primary Health 3098:. American Psychological Association 2435:International Journal of Drug Policy 1097: 1095: 1093: 933:California Environmental Quality Act 5339:Levine, Daniel (February 6, 2000). 2524:. Bouldercounty.org. Archived from 2171:Case P, Meehan T, Jones TS (1998). 2026:Davis, C. S.; Beletsky, L. (2009). 1111:Guzman, Kara Meyberg (2019-05-24). 1014:Some participants interviewed by a 457:, according to their spokespeople. 94: 1754:"Questions about Syringe Exchange" 1724:Hewitt, Lindsey (April 18, 2017). 1595:"Update:Syringe Exchange Programs" 1564:Smith, Roberta (8 February 1996). 1484:from the original on 23 March 2023 1412:Lucie Van Den Berg (20 May 2013). 1069:from the original on 10 March 2023 647:American Psychological Association 574:"Clean Needles Save Lives" t-shirt 25: 5351:from the original on May 24, 2020 4180:Ross, Matier & (2018-05-09). 4108:10.1331/1086-5802.42.0.s94.burris 3894:Journal of Psychosomatic Research 3241:"Needle Exchange and Hepatitis C" 3203:Loconte, Joe (July–August 1998). 2792:American Journal of Public Health 1974:Weinmeyer, Richard (2016-03-01). 1693:Hayes, Elizabeth (May 15, 2018). 918:low-threshold health care outlets 82:Contents of a needle-exchange kit 5313:Jacobs, Emma (January 3, 2015). 5116:10.1097/00042560-199802001-00015 4928:10.1097/00126334-200306010-00014 4839:10.1111/j.1465-3362.2011.00390.x 4525:10.1111/j.1360-0443.2008.02465.x 4051:10.1016/j.drugalcdep.2011.12.001 3906:10.1016/j.jpsychores.2013.03.057 3664:Rhodes, T.; Hedrich, D. 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(2004). 1161:Thangsing, Chinkholal (2012). 300:disability-adjusted life years 1: 3940:10.1016/j.jpubeco.2022.104733 3376:Amy Norton (March 11, 2010). 3036:. Centers for Disease Control 2116:10.1016/S0140-6736(96)05439-6 1444:Herald Sun Maribyrnong Leader 1320:Journal of Addictive Diseases 1179:Lupick, Travis (2018-06-05). 494:Conflict with law enforcement 376:National Institutes of Health 210:Santa Cruz County, California 71:Needle and syringe programmes 5152:10.1016/j.drugpo.2010.02.003 4803:10.1016/j.drugpo.2011.11.001 4639:10.1016/j.drugpo.2008.06.004 4464:10.1016/j.drugpo.2011.08.005 4155:Lopez, German (2018-05-29). 4005:Bluth, Rachel (2021-10-06). 3728:. PBS Online. 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American Bar Association 798: 224:and an exchange agency in 5204:10.1080/09581590400004386 4719:10.1080/09595230701711199 4684:10.1080/14659890701249640 4594:10.1080/09581591003653124 3922:Packham, Analisa (2022). 3769:10.1007/s10461-013-0593-y 2880:Arizona State Law Journal 2696:10.1007/s11524-012-9741-3 1699:Portland Business Journal 1599:MMWR Morb Mortal Wkly Rep 1030:Supervised injection site 790:Arguments for and against 651:World Health Organization 483:Orange County, California 436:(peer-to-peer) exchange. 263:World Health Organization 95: 75: 5251:10.1177/2150131910369684 4879:10.1177/2150131910369684 4672:Journal of Substance Use 2923:10.2105/AJPH.2011.300254 2804:10.2105/AJPH.2003.033563 2490:10.1177/0899764002238096 1858:10.2105/AJPH.2011.300595 1505:"Maggie Telfer obituary" 904:the spread of HIV among 639:American Bar Association 257:International experience 18:Syringe exchange program 4860:Islam, MM (July 2010). 4186:San Francisco Chronicle 3860:10.1186/1471-2458-13-53 3309:10.15453/0191-5096.3669 3214:: 14–22. Archived from 3118:"Drug use and HIV/AIDS" 3005:NIH Consensus Statement 658:The Heritage Foundation 427:General characteristics 417:substance use disorders 118:needle exchange program 5417:Prevention of HIV/AIDS 5287:. Anex. Archived from 5182:Critical Public Health 5080:"Needle Exchange FAQs" 4582:Critical Public Health 2264:10.1186/1747-597X-4-13 2045:10.1186/1477-7517-6-16 2032:Harm Reduction Journal 1646:10.1002/hep.1840360703 1380:10.1186/1471-2458-3-37 1185:. arsenal pulp press. 575: 233:Columbus Public Health 218:Holyoke, Massachusetts 176: 5232:Islam, M. M. (2010). 5086:on December 30, 2011. 4102:(6 Suppl 2): S94–98. 4011:California Healthline 3288:Bowen, E. A. (2012). 3269:. 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(2005). 3568:on 18 October 2015 3184:on 3 December 2008 2218:The New York Times 2183:(Suppl 1): S71–5. 1570:The New York Times 1216:. 20 November 2017 890:Cost effectiveness 717:systematic reviews 690:. You can help by 576: 325:. You can help by 231:Some, such as the 205:must be returned. 177: 173:"Sharps" container 134:hypodermic needles 5345:The Baltimore Sun 5018:Los Angeles Times 4754:Public Health Rep 3847:BMC Public Health 3757:AIDS and Behavior 3692:on 9 October 2012 3682:978-92-9168-419-9 3612:Käll, K. (2005). 3440:(11): 1329–1341. 3221:on 12 August 2014 3011:(2): 1–41. 1997. 2917:(11): 2012–2015. 2606:Milbank Quarterly 1669:"U.S. Statistics" 1367:BMC Public Health 1192:978-1-55152-713-0 1017:The Baltimore Sun 850:Chico, California 725:hepatitis C virus 708: 707: 635: 634: 627: 343: 342: 247:Boulder, Colorado 222:gaming the system 116:), also known as 106: 105: 66: 65: 16:(Redirected from 5434: 5361: 5360: 5358: 5356: 5336: 5330: 5329: 5327: 5325: 5310: 5304: 5303: 5301: 5299: 5293: 5286: 5278: 5272: 5271: 5253: 5229: 5223: 5222: 5220: 5218: 5197: 5179: 5170: 5164: 5163: 5135: 5129: 5128: 5118: 5094: 5088: 5087: 5076: 5070: 5069: 5059: 5035: 5029: 5028: 5026: 5025: 5010: 5004: 5003: 5001: 5000: 4986: 4980: 4979: 4977: 4976: 4962: 4956: 4955: 4947: 4941: 4940: 4930: 4906: 4900: 4899: 4881: 4857: 4851: 4850: 4827:Drug Alcohol Rev 4821: 4815: 4814: 4786: 4780: 4779: 4769: 4745: 4739: 4738: 4707:Drug Alcohol Rev 4702: 4696: 4695: 4667: 4661: 4660: 4650: 4622: 4616: 4615: 4605: 4573: 4567: 4566: 4564: 4562: 4543: 4537: 4536: 4519:(9): 1441–1446. 4508: 4502: 4501: 4499: 4497: 4482: 4476: 4475: 4446: 4437: 4436: 4416: 4410: 4409: 4384:(6–7): 789–806. 4373: 4367: 4366: 4360: 4352: 4347:. Archived from 4328: 4322: 4321: 4319: 4318: 4307:Melbourne Leader 4299: 4293: 4292: 4290: 4288: 4277: 4271: 4270: 4268: 4267: 4252: 4246: 4245: 4243: 4242: 4227: 4221: 4220: 4218: 4217: 4202: 4196: 4195: 4193: 4192: 4177: 4171: 4170: 4168: 4167: 4152: 4146: 4145: 4143: 4134: 4128: 4127: 4087: 4081: 4080: 4070: 4045:(1–3): 255–259. 4030: 4021: 4020: 4018: 4017: 4002: 3993: 3992: 3973: 3967: 3963: 3958:. Archived from 3919: 3910: 3909: 3889: 3883: 3882: 3872: 3862: 3838: 3832: 3831: 3821: 3797: 3791: 3790: 3780: 3763:(9): 2878–2892. 3748: 3742: 3741: 3739: 3737: 3722: 3716: 3715: 3709: 3701: 3699: 3697: 3691: 3685:. Archived from 3670: 3661: 3655: 3653: 3651: 3650: 3641:. Archived from 3634: 3628: 3626: 3624: 3623: 3618: 3609: 3603: 3601: 3599: 3598: 3593: 3584: 3578: 3577: 3575: 3573: 3567: 3552: 3543: 3534: 3533: 3531: 3530: 3514: 3491: 3490: 3488: 3486: 3480: 3471: 3460: 3459: 3449: 3425: 3419: 3418: 3416: 3414: 3402: 3393: 3392: 3390: 3388: 3373: 3367: 3366: 3337: 3328: 3327: 3325: 3323: 3317: 3311:. Archived from 3294: 3285: 3279: 3278: 3276: 3274: 3263: 3257: 3256: 3254: 3252: 3237: 3231: 3230: 3228: 3226: 3220: 3209: 3200: 3194: 3193: 3191: 3189: 3174: 3168: 3167: 3165: 3163: 3157: 3150: 3142: 3133: 3132: 3130: 3128: 3122: 3114: 3108: 3107: 3105: 3103: 3097: 3089: 3083: 3082: 3074: 3068: 3067: 3065: 3063: 3052: 3046: 3045: 3043: 3041: 3035: 3027: 3021: 3020: 3000: 2994: 2993: 2983: 2966:(1–2): 145–149. 2951: 2945: 2944: 2934: 2902: 2896: 2895: 2875: 2869: 2868: 2832: 2826: 2825: 2815: 2783: 2777: 2776: 2766: 2756: 2724: 2718: 2717: 2707: 2675: 2666: 2665: 2657: 2648: 2647: 2629: 2597: 2591: 2590: 2588: 2587: 2572: 2566: 2565: 2563: 2562: 2547: 2538: 2537: 2535: 2533: 2518: 2512: 2508: 2502: 2501: 2473: 2467: 2466: 2429: 2414: 2413: 2403: 2371: 2356: 2355: 2345: 2339: 2338: 2328: 2296: 2287: 2286: 2276: 2266: 2242: 2236: 2235: 2233: 2232: 2209: 2203: 2202: 2192: 2168: 2162: 2161: 2159: 2157: 2142: 2136: 2135: 2099: 2093: 2092: 2090: 2089: 2074: 2068: 2067: 2057: 2047: 2023: 2014: 2013: 1995: 1971: 1962: 1961: 1955: 1947: 1941: 1940: 1938: 1937: 1931: 1925:. Archived from 1900: 1891: 1880: 1879: 1869: 1837: 1822: 1821: 1819: 1818: 1803: 1794: 1793: 1791: 1790: 1775: 1769: 1768: 1766: 1765: 1758:Multnomah County 1750: 1744: 1743: 1738: 1736: 1730:Portland Tribune 1721: 1710: 1709: 1707: 1705: 1690: 1684: 1683: 1681: 1680: 1665: 1659: 1658: 1648: 1624: 1615: 1614: 1590: 1581: 1580: 1578: 1576: 1561: 1555: 1554: 1552: 1550: 1536: 1528: 1522: 1521: 1519: 1517: 1500: 1494: 1493: 1491: 1489: 1483: 1472: 1464: 1455: 1454: 1452: 1450: 1435: 1429: 1428: 1426: 1424: 1409: 1403: 1402: 1392: 1382: 1358: 1352: 1351: 1315: 1309: 1308: 1306: 1304: 1298: 1289: 1283: 1282: 1280: 1279: 1265: 1259: 1258: 1248: 1242: 1241: 1239: 1231: 1225: 1224: 1222: 1221: 1206: 1200: 1199: 1176: 1170: 1169: 1167: 1158: 1152: 1151: 1149: 1148: 1133: 1127: 1126: 1124: 1123: 1117:Santa Cruz Local 1108: 1102: 1099: 1088: 1085: 1079: 1078: 1076: 1074: 1068: 1057: 1049: 975:Community issues 910:Vending machines 906:intravenous drug 801:Biomedical waste 703: 700: 682: 675: 630: 623: 619: 616: 610: 586: 585: 578: 395:Multnomah County 391:Portland, Oregon 345:From the 1980s, 338: 335: 317: 310: 214:Santa Cruz Local 148:for blood-borne 99:edit on Wikidata 80: 68: 61: 58: 52: 40: 39: 32: 21: 5442: 5441: 5437: 5436: 5435: 5433: 5432: 5431: 5427:Public services 5402:Medical hygiene 5367: 5366: 5365: 5364: 5354: 5352: 5338: 5337: 5333: 5323: 5321: 5312: 5311: 5307: 5297: 5295: 5294:on 28 July 2014 5291: 5284: 5280: 5279: 5275: 5231: 5230: 5226: 5216: 5214: 5195:10.1.1.495.4618 5177: 5172: 5171: 5167: 5137: 5136: 5132: 5096: 5095: 5091: 5078: 5077: 5073: 5037: 5036: 5032: 5023: 5021: 5012: 5011: 5007: 4998: 4996: 4988: 4987: 4983: 4974: 4972: 4964: 4963: 4959: 4949: 4948: 4944: 4908: 4907: 4903: 4859: 4858: 4854: 4823: 4822: 4818: 4788: 4787: 4783: 4747: 4746: 4742: 4704: 4703: 4699: 4669: 4668: 4664: 4624: 4623: 4619: 4575: 4574: 4570: 4560: 4558: 4545: 4544: 4540: 4510: 4509: 4505: 4495: 4493: 4484: 4483: 4479: 4448: 4447: 4440: 4433:10.1071/PY02010 4418: 4417: 4413: 4375: 4374: 4370: 4353: 4345: 4330: 4329: 4325: 4316: 4314: 4301: 4300: 4296: 4286: 4284: 4279: 4278: 4274: 4265: 4263: 4254: 4253: 4249: 4240: 4238: 4229: 4228: 4224: 4215: 4213: 4204: 4203: 4199: 4190: 4188: 4179: 4178: 4174: 4165: 4163: 4154: 4153: 4149: 4141: 4136: 4135: 4131: 4089: 4088: 4084: 4032: 4031: 4024: 4015: 4013: 4004: 4003: 3996: 3975: 3974: 3970: 3921: 3920: 3913: 3891: 3890: 3886: 3840: 3839: 3835: 3799: 3798: 3794: 3750: 3749: 3745: 3735: 3733: 3724: 3723: 3719: 3702: 3695: 3693: 3689: 3683: 3668: 3663: 3662: 3658: 3648: 3646: 3636: 3635: 3631: 3621: 3619: 3616: 3611: 3610: 3606: 3596: 3594: 3591: 3586: 3585: 3581: 3571: 3569: 3565: 3550: 3545: 3544: 3537: 3528: 3526: 3516: 3515: 3494: 3484: 3482: 3478: 3473: 3472: 3463: 3427: 3426: 3422: 3412: 3410: 3405: 3403: 3396: 3386: 3384: 3375: 3374: 3370: 3339: 3338: 3331: 3321: 3319: 3318:on 27 July 2014 3315: 3292: 3287: 3286: 3282: 3272: 3270: 3265: 3264: 3260: 3250: 3248: 3239: 3238: 3234: 3224: 3222: 3218: 3207: 3202: 3201: 3197: 3187: 3185: 3176: 3175: 3171: 3161: 3159: 3155: 3148: 3144: 3143: 3136: 3126: 3124: 3120: 3116: 3115: 3111: 3101: 3099: 3095: 3091: 3090: 3086: 3076: 3075: 3071: 3061: 3059: 3054: 3053: 3049: 3039: 3037: 3033: 3029: 3028: 3024: 3002: 3001: 2997: 2953: 2952: 2948: 2904: 2903: 2899: 2877: 2876: 2872: 2834: 2833: 2829: 2785: 2784: 2780: 2726: 2725: 2721: 2684:J. Urban Health 2677: 2676: 2669: 2659: 2658: 2651: 2599: 2598: 2594: 2585: 2583: 2574: 2573: 2569: 2560: 2558: 2549: 2548: 2541: 2531: 2529: 2520: 2519: 2515: 2509: 2505: 2475: 2474: 2470: 2431: 2430: 2417: 2373: 2372: 2359: 2347: 2346: 2342: 2298: 2297: 2290: 2244: 2243: 2239: 2230: 2228: 2211: 2210: 2206: 2170: 2169: 2165: 2155: 2153: 2144: 2143: 2139: 2110:(9052): 604–8. 2101: 2100: 2096: 2087: 2085: 2076: 2075: 2071: 2025: 2024: 2017: 1973: 1972: 1965: 1953: 1949: 1948: 1944: 1935: 1933: 1929: 1898: 1893: 1892: 1883: 1839: 1838: 1825: 1816: 1814: 1805: 1804: 1797: 1788: 1786: 1777: 1776: 1772: 1763: 1761: 1752: 1751: 1747: 1734: 1732: 1723: 1722: 1713: 1703: 1701: 1692: 1691: 1687: 1678: 1676: 1667: 1666: 1662: 1626: 1625: 1618: 1592: 1591: 1584: 1574: 1572: 1563: 1562: 1558: 1548: 1546: 1539:The Independent 1530: 1529: 1525: 1515: 1513: 1502: 1501: 1497: 1487: 1485: 1481: 1470: 1466: 1465: 1458: 1448: 1446: 1437: 1436: 1432: 1422: 1420: 1411: 1410: 1406: 1360: 1359: 1355: 1317: 1316: 1312: 1302: 1300: 1296: 1291: 1290: 1286: 1277: 1275: 1267: 1266: 1262: 1250: 1249: 1245: 1237: 1233: 1232: 1228: 1219: 1217: 1208: 1207: 1203: 1193: 1178: 1177: 1173: 1165: 1160: 1159: 1155: 1146: 1144: 1135: 1134: 1130: 1121: 1119: 1110: 1109: 1105: 1100: 1091: 1086: 1082: 1072: 1070: 1066: 1055: 1051: 1050: 1043: 1038: 1026: 1002: 986:Platzspitz park 977: 968: 960:opioid epidemic 929: 901: 892: 863: 846:University Park 829: 816: 811: 797: 795:Needle disposal 792: 783: 770: 768:Worker training 713: 704: 698: 695: 688:needs expansion 673: 662:Catholic Church 631: 620: 614: 611: 600: 587: 583: 568: 555:human resources 547: 534: 525: 523:Racial gradient 501:law enforcement 496: 491: 489:Law enforcement 463: 455:Mitch McConnell 442: 429: 408: 364: 339: 333: 330: 323:needs expansion 308: 275: 259: 245:An exchange in 198: 166: 136:and associated 102: 83: 62: 56: 53: 50: 41: 37: 28: 23: 22: 15: 12: 11: 5: 5440: 5438: 5430: 5429: 5424: 5419: 5414: 5409: 5404: 5399: 5397:Harm reduction 5394: 5389: 5384: 5379: 5369: 5368: 5363: 5362: 5331: 5305: 5273: 5244:(2): 100–103. 5224: 5188:(3): 261–275. 5165: 5146:(5): 437–439. 5130: 5089: 5071: 5030: 5005: 4981: 4957: 4942: 4921:(2): 199–205. 4901: 4872:(2): 100–103. 4852: 4833:(1): 114–115. 4816: 4797:(2): 109–110. 4781: 4740: 4697: 4662: 4633:(4): 336–339. 4617: 4568: 4538: 4503: 4477: 4438: 4411: 4368: 4351:on 2011-06-04. 4343: 4323: 4294: 4272: 4247: 4222: 4211:joomlakave.com 4197: 4172: 4147: 4129: 4082: 4022: 3994: 3968: 3962:on 2023-05-12. 3911: 3900:(6): 551–552. 3884: 3833: 3792: 3743: 3717: 3681: 3656: 3629: 3604: 3579: 3535: 3492: 3461: 3420: 3394: 3382:Reuters Health 3368: 3329: 3303:(2): 121–141. 3280: 3258: 3232: 3195: 3169: 3134: 3109: 3084: 3069: 3047: 3022: 2995: 2946: 2897: 2870: 2827: 2798:(2): 233–236. 2778: 2719: 2667: 2649: 2612:(1): 125–156. 2592: 2567: 2539: 2528:on 6 June 2008 2513: 2503: 2468: 2441:(4): 267–274. 2415: 2386:(2): 357–365. 2357: 2340: 2288: 2237: 2204: 2163: 2137: 2094: 2069: 2015: 1986:(3): 252–257. 1963: 1942: 1881: 1823: 1795: 1770: 1745: 1711: 1685: 1660: 1616: 1582: 1556: 1523: 1495: 1456: 1430: 1418:The Australian 1404: 1353: 1310: 1284: 1260: 1243: 1226: 1201: 1191: 1171: 1153: 1128: 1103: 1089: 1080: 1040: 1039: 1037: 1034: 1033: 1032: 1025: 1022: 1001: 998: 997: 996: 993: 981: 976: 973: 967: 964: 928: 925: 900: 897: 891: 888: 887: 886: 883: 880: 862: 859: 858: 857: 853: 841: 837: 828: 825: 815: 812: 796: 793: 791: 788: 782: 779: 769: 766: 712: 709: 706: 705: 685: 683: 672: 669: 633: 632: 597:of the subject 595:worldwide view 590: 588: 581: 567: 564: 546: 543: 533: 530: 524: 521: 495: 492: 490: 487: 462: 459: 441: 438: 428: 425: 407: 404: 363: 360: 341: 340: 320: 318: 307: 306:United Kingdom 304: 274: 271: 258: 255: 197: 194: 182:United Kingdom 165: 162: 142:harm reduction 126:social service 104: 103: 96: 93: 92: 89: 85: 84: 81: 73: 72: 64: 63: 44: 42: 35: 26: 24: 14: 13: 10: 9: 6: 4: 3: 2: 5439: 5428: 5425: 5423: 5422:Public policy 5420: 5418: 5415: 5413: 5412:Medical waste 5410: 5408: 5405: 5403: 5400: 5398: 5395: 5393: 5390: 5388: 5385: 5383: 5380: 5378: 5375: 5374: 5372: 5350: 5346: 5342: 5335: 5332: 5320: 5316: 5309: 5306: 5290: 5283: 5277: 5274: 5269: 5265: 5261: 5257: 5252: 5247: 5243: 5239: 5235: 5228: 5225: 5213: 5209: 5205: 5201: 5196: 5191: 5187: 5183: 5176: 5169: 5166: 5161: 5157: 5153: 5149: 5145: 5141: 5134: 5131: 5126: 5122: 5117: 5112: 5108: 5104: 5100: 5093: 5090: 5085: 5081: 5075: 5072: 5067: 5063: 5058: 5053: 5049: 5045: 5041: 5034: 5031: 5019: 5015: 5009: 5006: 4995: 4991: 4985: 4982: 4971: 4967: 4961: 4958: 4953: 4946: 4943: 4938: 4934: 4929: 4924: 4920: 4916: 4912: 4905: 4902: 4897: 4893: 4889: 4885: 4880: 4875: 4871: 4867: 4863: 4856: 4853: 4848: 4844: 4840: 4836: 4832: 4828: 4820: 4817: 4812: 4808: 4804: 4800: 4796: 4792: 4785: 4782: 4777: 4773: 4768: 4763: 4759: 4755: 4751: 4744: 4741: 4736: 4732: 4728: 4724: 4720: 4716: 4712: 4708: 4701: 4698: 4693: 4689: 4685: 4681: 4678:(3): 203–12. 4677: 4673: 4666: 4663: 4658: 4654: 4649: 4644: 4640: 4636: 4632: 4628: 4621: 4618: 4613: 4609: 4604: 4599: 4595: 4591: 4587: 4583: 4579: 4572: 4569: 4556: 4552: 4548: 4542: 4539: 4534: 4530: 4526: 4522: 4518: 4514: 4507: 4504: 4491: 4487: 4481: 4478: 4473: 4469: 4465: 4461: 4458:(2): 94–102. 4457: 4453: 4445: 4443: 4439: 4434: 4430: 4426: 4422: 4415: 4412: 4407: 4403: 4399: 4395: 4391: 4387: 4383: 4379: 4372: 4369: 4364: 4358: 4350: 4346: 4344:9780199539338 4340: 4336: 4335: 4327: 4324: 4312: 4308: 4304: 4298: 4295: 4282: 4276: 4273: 4261: 4257: 4251: 4248: 4236: 4232: 4226: 4223: 4212: 4208: 4201: 4198: 4187: 4183: 4176: 4173: 4162: 4158: 4151: 4148: 4140: 4133: 4130: 4125: 4121: 4117: 4113: 4109: 4105: 4101: 4097: 4093: 4086: 4083: 4078: 4074: 4069: 4064: 4060: 4056: 4052: 4048: 4044: 4040: 4036: 4029: 4027: 4023: 4012: 4008: 4001: 3999: 3995: 3990: 3986: 3982: 3981:The Economist 3978: 3972: 3969: 3966: 3961: 3957: 3953: 3949: 3945: 3941: 3937: 3933: 3929: 3925: 3918: 3916: 3912: 3907: 3903: 3899: 3895: 3888: 3885: 3880: 3876: 3871: 3866: 3861: 3856: 3852: 3848: 3844: 3837: 3834: 3829: 3825: 3820: 3815: 3812:(1): 235–48. 3811: 3807: 3803: 3796: 3793: 3788: 3784: 3779: 3774: 3770: 3766: 3762: 3758: 3754: 3747: 3744: 3731: 3727: 3721: 3718: 3713: 3707: 3688: 3684: 3678: 3674: 3667: 3660: 3657: 3645:on 2013-07-03 3644: 3640: 3633: 3630: 3615: 3608: 3605: 3590: 3583: 3580: 3564: 3560: 3556: 3549: 3542: 3540: 3536: 3525:on 2010-08-01 3524: 3520: 3513: 3511: 3509: 3507: 3505: 3503: 3501: 3499: 3497: 3493: 3477: 3470: 3468: 3466: 3462: 3457: 3453: 3448: 3443: 3439: 3435: 3431: 3424: 3421: 3408: 3401: 3399: 3395: 3383: 3379: 3372: 3369: 3364: 3360: 3356: 3352: 3349:(5): 844–59. 3348: 3344: 3336: 3334: 3330: 3314: 3310: 3306: 3302: 3298: 3291: 3284: 3281: 3268: 3262: 3259: 3247:on 4 May 2013 3246: 3242: 3236: 3233: 3217: 3213: 3212:Policy Review 3206: 3199: 3196: 3183: 3179: 3173: 3170: 3158:on 2010-11-25 3154: 3147: 3141: 3139: 3135: 3119: 3113: 3110: 3094: 3088: 3085: 3080: 3073: 3070: 3057: 3051: 3048: 3032: 3026: 3023: 3018: 3014: 3010: 3006: 2999: 2996: 2991: 2987: 2982: 2977: 2973: 2969: 2965: 2961: 2957: 2950: 2947: 2942: 2938: 2933: 2928: 2924: 2920: 2916: 2912: 2908: 2901: 2898: 2893: 2889: 2885: 2881: 2874: 2871: 2866: 2862: 2858: 2854: 2850: 2846: 2842: 2838: 2831: 2828: 2823: 2819: 2814: 2809: 2805: 2801: 2797: 2793: 2789: 2782: 2779: 2774: 2770: 2765: 2760: 2755: 2750: 2746: 2742: 2739:(4): e19048. 2738: 2734: 2730: 2723: 2720: 2715: 2711: 2706: 2701: 2697: 2693: 2690:(2): 284–98. 2689: 2685: 2681: 2674: 2672: 2668: 2663: 2656: 2654: 2650: 2645: 2641: 2637: 2633: 2628: 2623: 2619: 2615: 2611: 2607: 2603: 2596: 2593: 2581: 2577: 2571: 2568: 2557: 2553: 2546: 2544: 2540: 2527: 2523: 2517: 2514: 2511: 2507: 2504: 2499: 2495: 2491: 2487: 2484:(4): 463–83. 2483: 2479: 2472: 2469: 2464: 2460: 2456: 2452: 2448: 2444: 2440: 2436: 2428: 2426: 2424: 2422: 2420: 2416: 2411: 2407: 2402: 2397: 2393: 2389: 2385: 2381: 2377: 2370: 2368: 2366: 2364: 2362: 2358: 2353: 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