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We analyzed data on all drug-treatment admissions in San Francisco County over a 4-year period (n = 35460) to evaluate the potential negative effects of the San Francisco needle-exchange program.Admissions in the 2 years preceding implementation of the exchange program (1987–1988) were compared with admissions in the 2 years following implementation (1989–1990).No negative consequences of needle exchange were detected. Specifically, the presence of the exchange program was not associated with (1) increases in injection drug use, (2) increases in needle-sharing behavior, or (3) changing drug-use behavior from non-injection to injection. We also compared high-drug-use neighborhoods with and without local needle-exchange sites. Neighborhoods without needle-exchange sites showed a greater increase in proportion of admissions for injection drug use, and in frequency of injection, over time.Because of methodological limitations, our findings are preliminary. Longitudinal studies comparing needle-exchange and non-exchange cohorts are needed to further evaluate effects of this intervention.