Can syringe exchange serve as a conduit to substance abuse treatment?

To determine how the city-run New Haven syringe exchange program (SEP) expedited requests for entry into treatment, records of the SEP's drug treatment coordinator were analyzed. During the study period, a majority of those requesting treatment did not use the SEP to obtain sterile syringes. Comparisons between the people requesting treatment and those exchanging syringes revealed that those requesting treatment were more likely female and less likely White. Factors associated with failure to enter treatment included long lag times, worse insurance, cocaine use, and requesting primary detoxification only. Majorities of the requests, appointments, and entries came from individuals whose treatment was to be paid through city welfare. A managed care initiative from the city welfare department, which excluded the SEP, halved requests and entries. Subsequent addition of the SEP to the initiative did not significantly increase requests or entries. Although the SEP initially acted as a conduit to treatment, its effectiveness was curtailed by the imposition of bureaucratic restrictions. (C) 1998 Elsevier Science Inc.