Pointed Debate over Needle Exchange Programs

By. Makebra M. AndersonNNPA National Correspondent WASHINGTON (NNPA) – One of the most intense debates over curbing drug addiction and AIDS centers around the practice of exchanging an addict’s dirty needles for clean ones. On side of the debate are activists who say that providing clean needles is a way of protecting those not yet ready to give up their habit. Opponents counter that instead of helping solve the problem, giving away needles encourages drug use. Can the two sides co-exist? Not if you listen to proponents and opponents. “People misunderstand [needle exchange programs]. It is not about encouraging drug abuse, it’s about treatment. One goal is to stop HIV and the other is to get them help,” Patricia Hawkins, associate executive director of the Washington-based Whitman-Walker Clinic, says. Michael Orsi, former member of the Governors Advisory Council on AIDS, disagrees. In a column, he writes: “The root problem of the spread of HIV through needle sharing is drugs. Remember, this is a major part of the drug culture. Not to recognize the real problem – and to increase the number of needles in circulation – will only add to the AIDS epidemic in the long term.” Whitman-Walker, a non-profit, community-based health organization specializing in HIV/AIDS, organized the first needle exchange program in D.C. The group split from the program after Congress enacted the first of several bans that prohibit the use of federal funding to support exchange programs. “Needle exchange programs are simply giving them [IDUs] a chance to take care of themselves,” explains Hawkins of Walker-Whitman. “Substance abuse is the same since 1996. They aren’t changing their behavior; they are just using clean needles.” In addition to HIV, people who share syringes are at high risk for Hepatitis C because infected blood from dirty needles can be injected directly into the blood stream. Various legal barriers prevent many from getting sterile syringes. The Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act of 1992 requires: “None of the funds provided under [the Public Health Service Act] shall be used to provide individuals with hypodermic needles or syringes so that such individuals may use illegal drugs, unless the Surgeon General of the Public Health Service determines that a demonstration project would be effective in reducing drug abuse and the risk that the public will become infected [with HIV].” Inasmuch as needles are distributed to known drug users that don’t have legal medical prescriptions, these programs cannot be funded by the federal government. “They [the government] prohibit federal funding, but let local jurisdictions do what they want to do,” Hawkins says. “Actually, D.C. is the only place prohibited from using their own money to contribute to exchange programs.” According to Hawkins, D.C. needs the needle exchange programs the most. The CDC reports that the District has the highest number of new AIDS cases. The rate of HIV/AIDS is 12 times higher than the national average and it is estimated that one in 20 adults in D.C. are infected. AIDS is the third-leading cause of death in the district. Approximately 94 percent of people infected with AIDS because of injection drug use in the area are Black, reports the local department of health. All 50 states and D.C. have drug paraphernalia laws that impacts any needle distribution programs. Most of the statutes are based on the Model Drug Paraphernalia Act drafted by the U.S. Department of Justice in the 80s. The act makes it “unlawful to use, or to possess with intent to use, drug paraphernalia to introduce into the human body a controlled substance in violation of controlled substance laws.” In general, drug paraphernalia laws don’t prohibit the sell of syringes if the seller has no reason to believe that the equipment will be used for illegal activity. Pharmacists are not required to question buyers’ intent, but may decline a purchase if there are obvious signs of drug use. In order to be considered legal, most needle exchange programs “must be designed to prevent transmission of HIV and Hepatitis C, provide maximum security for sites and equipment, provide a one-for-one exchange, screen out non-IDUs, provide drug treatment, counseling and education to all participants,” according to data distributed by the state of Hawaii, which had the first state-endorsed NEP. At present, there are more than 125 known programs in 102 cities including, New York, Philadelphia, Chicago, Los Angeles, Seattle, Atlanta, Cleveland and Minneapolis. Needle Exchange Programs (NEPs) began in Europe in 1983. Amsterdam introduced the NEP to reduce the transmission of Hepatitis B and HIV among injection drug users and their sexual partners and children. Of the more than 100 NEPs operating nationwide, Hawkins says that there is no scientific evidence that they increase drug use. A study prepared for the Centers for Disease Control and Prevention (CDC) confirms her assertion. The report is titled, The Public Health Impact of Needle Exchange Programs in the U.S. and Abroad and was prepared by the School of Public Health, University of California, Berkley and the Institute for Health Policy Studies, University of California, San Francisco. “Although quantitative data are difficult to obtain, those available provide no evidence that NEPs increase the amount of drug use by NEP clients or change overall community levels of non-injection and injection drug use…,” the report states. “NEPs in the U.S. have not been shown to increase the total number of discarded syringes and can be expected to result in fewer discarded syringes.” Other studies, such as Health Report 2003, prepared by the Harm Reduction Coalition, and research by the American Foundation for AIDS Research (amfAR) reached similar conclusions. “Every scientific study has shown that exchange programs don’t increase drug use,” Hawkins notes. “This is not about science, it’s about politics-all politics.”In 1999, the U.S. government took a stance on NEPs. The Clinton Administration endorsed the practice of exchanging used needles for clean ones, but still upheld the ban forbidding the federal government to offer financial support. “The senior scientists of the Department and I [the Surgeon General] have unanimously agreed that there is conclusive scientific evidence that syringe exchange programs, as part of a comprehensive HIV prevention strategy, are an effective public health intervention that reduces transmission of HIV and does not encourage the illegal use of drugs. When properly structured, syringe exchange programs provide a unique opportunity for communities to reach out to the active drug injection population and provide for the referral and retention of individuals in local substance abuse treatment and counseling programs and other important health services,” David Satcher, former U.S. Surgeon General wrote. Bill Hall of the Department of Health and Human Services (DHHS) states: “Congress says we can’t fund needle exchange programs, so we don’t. We think its best to have local communities handle the situation because every community is different.” The CDC also has limitations. “We can not support needle exchange programs financially because of Congress, but we know at the CDC that most studies show that access to sterile injection equipment among active injection drug users decreases the transmission of HIV without increasing the frequency of drug use,” Kathy Harben of the CDC says. Million of Americans inject illegal drugs every year. Since the AIDS epidemic began, this population accounted for almost one-third (36 percent) of reported AIDS cases in the U.S., reports the CDC. Of all AIDS cases in 2000, 193,527 (25 percent) were related to intravenous drug use (IDU). Among those, 42 percent were White women, 41 percent were Black women and 40 percent were Hispanic women compared to 9 percent of White men, 34 percent of Black men and 35 percent of Hispanic men. Hawkins, the new director of Whitman-Walker, says that until we change our attitudes we won’t make any progress treating the million of IDUs across the Nation. “If we started to look at drug addiction as an illness and not a sin, we might have a whole different look on needle exchange programs. Nobody wakes up and says I want to be an addict and since we don’t have perfect treatment programs NEPs are necessary,” she says. “Local jurisdictions are very supportive and they are doing a lot with their local dollars, but we could reach so many more people with federal dollars.”