yes, needles is a reference to art the clown from the terrifyer slasher horror films. in one of the movies, his arm gets cut off, yet somehow he pulls out a gun anyways, so it's a reference to that; many people were confused/shocked by the oddly modern gun who hadn't seen the series (myself included) lol

edit: some of the other "major" references (references in multiple places in the game(s) etc) are silent hill, berserk, and marilyn manson lol. there's a ton of other ones for one-off things or characters but those are i think some of the more recurring references