Sharing syringe and other injection equipment places injection drug users (IDUs) at risk for bloodborne infections like HIV and HCV. Needle exchange plus methadone maintenance may lower the chance of these infections, although few studies have examined this possibility. Therefore, researchers in Amsterdam assessed the effects of the combination of these strategies among 714 injection drug users at risk for HIV or HCV.

• Over 20 years of follow-up, neither methadone maintenance alone nor needle exchange alone was significantly associated with HIV or HCV seroincidence, 
• However, daily methadone maintenance of ≥60 mg plus no drug injection or injection only with exchanged needles (all in the past 6 months) significantly reduced both HIV and HCV seroincidence (adjusted incidence rate ratios 0.43 and 0.36, respectively, when compared with no methadone maintenance and drug injection without exchanging needles).

Comments by Tom Delaney, MSW, MPA
This study supports HIV and HCV prevention strategies that include both methadone treatment and needle exchange. Counselors can use these findings as evidence-based advice to clients who may be otherwise inclined to use only methadone treatment or clean needles, but not both.

Comments by Peter D. Friedmann, MD, MPH, Associate Editor of Alcohol, Other Drugs, and Health: Current Evidence
This study provides prospective evidence that a long-term, comprehensive public strategy to reduce bloodborne infections among IDUs must include both syringe exchange and opioid agonist therapy at effective dose levels. Although most relevant to policy in countries with recent outbreaks of HIV and HCV among IDUs, these findings are also applicable to communities in the United States that lack adequate access to opioid treatment programs and/or syringe exchange.