Comment & Debate
Many illicit drug abusers inject drugs such as heroine directly into the blood stream with syringes or needles. For many users, sterile syringes are not readily available and drug paraphernalia laws in some countries make it an offense to distribute or possess syringes for non-medical purposes. As a result, many drug users share needles, which contributes to the spread of diseases such HIV and Hepatitis C, which have become near pandemics in countries and communities around the world. The spread of these diseases among drug users has become so concerning that, starting in the 80s, some activists and cities began opening needle exchanges. These government funded programs supply clean needles to drug addicts, so that they are at a lower risk of sharing needles and spreading diseases. Opponents argue that needle exchange programs condone illicit and immoral behavior and that governments should focus on punishing drug users, discouraging drug-use, and providing treatment for quitting. Several questions arise surrounding this debate: Do needle exchanges significantly reduce the spread of diseases? Do they save lives? Or, do they decrease or increase drug-use, and possibly put more lives at risk? Should governments be involved in distributing drug paraphernalia? Does this send the wrong message about drug-use? Are needle exchanges a more economic measure than treating those who are already affected with such diseases? Do needle exchanges help tie drug addicts into treatment programs? Is halting the use of drugs the only way to halt the spread of disease among drug users? Do needle exchanges harm communities? Do they deter prospective residents? Do they discourage customers and harm businesses? What is the overall balance of pros and cons? Are needle exchanges good public policy?
“Research has shown needle exchange programs (NEPs) offer a number of public health benefits in the prevention and reduction of IDUs’ exposure to HIV, HBV, HCV and other diseases. For example: ? New Haven, Connecticut found a one-third reduction in HIV prevalence after its NEP had been in operation for only 4 months. ? Researchers found an 18.6% average annual decrease in HIV seroprevalence in cities that had introduced an NEP, compared to an 8.1% annual increase in HIV seroprevalence in cities that had never introduced NEPs. ? HIV prevalence among NEP attenders in a Canadian city was low, even though high-risk behaviors were common. ? IDUs in Seattle who had formerly attended an NEP were found to be more likely than non-exchangers to reduce the frequency of injection, to stop injecting altogether, and to remain in drug treatment, while new users of the NEP were five times more likely to enter drug treatment than never-exchangers.”
“With over a 100 people in the United States becoming infected with HIV, HCV, or HBV every day as a result of injection drug use, it is clear that we must do more. We must continue to educate people about the harms of drug use, particularly injection drug use. We must pay attention to the expertise and knowledge of public health officials and scientists who urge that sterile syringes be made legally available to people who inject drugs.”
“Many intravenous drug users eventually overcome their habit and become productive members of society — but not if they are afflicted with AIDS. Needle exchange programs are an effective and obvious strategy to prevent the spread of this devastating disease.”
“Needle exchange programs have also achieved reductions in the rate of hepatitis infection, which can also be spread through sharing needles. In Tacoma, WA, clients of a needle exchange program were up to eight times less likely to contract Hepatitis B or C than non-client IVDUs.”
“Although promoters claim that needle exchange programs do not encourage drug use, there has been a major increase in heroin use since needle exchange programs have become widespread. Heroin use by American teens has doubled in the past 5 years. Dr. Lucy Sullivan of the Australian Centre for Independent Studies states that hepatitis prevalence among intravenous drug users is 65%, suggesting that free needles are not having their intended effect of preventing exchange of body fluids. Sullivan also states that ‘There is no sign of an impact on the rate of decline (of HIV incidence rates) with the introduction of needle distribution in 1992.’ (Sullivan, 1997).”
There are many ways by which drug-addicts can transfer bodily fluids between one-another. Needles are only one of many pathways. Sharing of mixing water for heroin another significant problem, and needle exchanges do not necessarily address this issue.
“The drug problem is arguably bigger and more threatening to public health and stability than disease problems. And, yet, needle exchanges seem to place the interests of fighting diseases over the interests of fighting drugs, in so far as needle exchanges actually enable drug-use, in order to reduce the spread of disease.”
“Addicts still are prone to death, perhaps not from HIV, but from overdose, collapsed veins, poisoned dope, or the violence and criminality that go along with the illicit drug trade.”
“Disease Epidemics: Both scientific and anecdotal evidence indicates that NEPs have failed to provide a prevention panacea for drug abusers against the dangers of HIV, hepatitis, and other health risks, which continue to increase at alarming rates.”
Dr. David Murray, chief scientist at the Office of National Drug Control Policy: “Needles are not the magic bullet. We are being politically pressured to make this decision (in favor of needle exchange). But it’s time to rethink if there’s a more humane, effective public health response than continuing to support injection drug use.”[1]
“Harm reduction holds that the health and well-being of the individual is of primary concern; if individuals are unwilling or unable to change addictive behaviors at this time, they should not be denied services. Attempts should be made to reduce the harm of their habits as much as possible. This approach to addiction is viewed by some as compassionate and pragmatic; by others as selfish and dangerous.”
“Providing clean syringes and needles to intravenous drug users does not say that we condone their behavior: it says that we still care about them and that we want them and their partners to be healthy as a first step in becoming a productive member of society again.”
While opponents may argue that drug-abusers must live with the consequences of their decisions to use dirty needles, the issue is not just about helping drug-addicts avoid diseases. It is also about protecting the public from the consequences of the spread of these diseases. The consequences include higher risks of infection as well as higher taxpayer costs in providing the health care for more sick people. Also, needle exchanges help protect the families of drug-addicts from the possibility of their loved-one acquiring a potentially fatal disease such as HIV.
There are certain principles that should not be sacrificed to expediency. The individual choice to do drugs should be met sternly with the principle that it is wrong and that an individual that chooses to do drugs should suffer the consequences on their own, without burdening other taxpayers. The idea of needle exchange harm reduction sacrifices these principles to the expediency of reducing harm to the individuals involved. Such infractions on principle fore expediency’s sake are inappropriate.
Atlantic City judges ruled in 2005 against Needle Exchanges on the basis that: “Atlantic City and its employees are not exempt from the (criminal) code provisions prohibiting the possession, use and distribution of drugs and drug paraphernalia simply because they adopted a needle-exchange program for beneficent reasons.”[2]
“Due to their potential to take more risks, young people must receive a clear ‘NO’ on Drugs: Harm reduction campaigns like NEPs send the wrong message to the community and to young people. Rather than supporting the ‘zero tolerance’ message that they are most likely receiving from home and currently in school, NEPs send the message ‘if you do decide to take drugs, we’ll help you with clean needles’.”
While it is true that individuals that do drugs and share unclean needles face a greater risk of HIV/AIDS.
“The opposition to needle exchange programs would have us believe that such programs encourage drug use. Studies of the Amsterdam program, however, demonstrate that drug use does not increase; the programs generally only attract those who have already become intravenous drug users. The implementation of the San Francisco program actually resulted in decreased drug use, as the program established much-needed links with the drug-using community.”
“A preponderance of evidence shows either no change or decreased drug use. The scattered cases showing increased drug use should be investigated to discover the conditions under which negative effects might occur, but these can in no way detract from the importance of needle exchange programs. Additionally, individuals in areas with needle exchange programs have increased likelihood of entering drug treatment programs.On the basis of such measures as hospitalizations for drug overdoses, there is no evidence that community norms change in favor of drug use or that more people begin using drugs. In Amsterdam and New Haven, for example, no increases in new drug users were reported after introduction of a needle exchange program.”
“Giving clean needles to addicts is no way to solve the drug problems that plague our society. So the court decision last week to block such a program is OK with me. Needle programs only help drug addicts stay high.”
“Drug Dealers Blatantly Sell Near NEPs: Commonly, drug dealers operate unimpeded by police when they are in the area of an NEP. For example, in Vancouver Canada’s Downtown Eastside area “The dealers hang around with impunity on the corner of Hastings and Main and the police don’t touch them.”
Some studies have shown that needle exchanges no effect on drug use, or a small deterring effect. These studies however tend to focus on the short term, what isn’t looked at is the mass effect, on a large population scale, as well as over a very long period time. Any sort of needle exchange is a step towards condoning drug use, or at least accepting it. To eradicate drugs you never want to have any sort of acceptance of the substance. Also some studies talk about how needle exchanges give drug users, networks and a chance to get better. It would probably be a lot easier and more beneficial to simply set up networks specifically for helping people who have drug addictions.
“Most needle exchange programs operate on a one-for-one basis, so they also reduce the presence of infected needles in playgrounds, streets, and trash receptacles, thus protecting children, sanitation workers, and others from accidental needle sticks.”[3]
Dawn Day, a Catholic priest and member of the New Jersey Governor’s Advisory Council on AIDS: “I believe we have an obligation to permit people who inject drugs to have access to sterile needles so they can protect their health. Injection drug users are also God’s children. And, like the reckless driver in the example above, people who inject drugs have wives, husbands, and babies. When we abandon the person who injects drugs to HIV/AIDS, we are abandoning their non-drug injecting partners and babies as well. God has given us knowledge with which to slow the spread of HIV/AIDS to all these people. Let us use it.”[4]
“While opposed by some on the grounds that it seemed to be condoning drug use, needle exchange programs (NEPs) quickly proved to be an effective means of reducing the incidence of blood-borne diseases in both countries and have been widely recognized as a valid part of a good public health policy and practice in many other parts of the world. In such programs, addicts receive a clean needle for every used one they turn in, thus limiting careless or dangerous disposal of needles. In some locales, syringes can also be easily obtained from pharmacies or even from vending machines. These are not only more convenient, but encourage the use of clean needles by IDUs who may be reluctant to signal their addiction by going to an NEP.”
“Increased, Open, Injection drug Use in Areas surrounding NEP’s due to influx of users. In Downtown Eastside (Vancouver BC), police estimate there are 7,500 to 8,000 addicts, and users shoot up on the streets because the injection site has waits of up to 45 minutes5. More police had to be assigned to the area to try and minimize the number of users who were shooting up outside the NEP area.”
“Neighborhood Businesses Affected: Dale Deslauriers, the owner of Save on Meats on West Hastings (Downtown Eastside, Vancouver BC), said business is down “at least 20 percent” because customers are afraid of drug users and dealers.”
The mere idea of having a needle exchange in one’s community is off-putting. This is for a variety the many reasons described here, all of which discourage new residence, particularly those with families.
“Discarded Needles: Reports of discarded needles in public places outside of NEP sites abound from cities with NEP’s. Here is just one example. In Cairns Australia, City Place has been revealed as Cairn’s biggest drug shooting gallery with 1000 syringes discarded since January in toilets and streets surrounding the inner city mall. Addicts are also dumping hundreds of used syringes at many of the city’s other popular public places, including the Esplanade near Muddy’s playground, the city library, in gardens and in various other public places. The figures were released by Cairns City Council after a recent audit of its sharps disposal bin program7.”
Needle exchanges bring in drug-addicts, who are generally less clean than other individuals. Aside from discarding needles in the street and in parks, they are generally much more prone to leaving trash around, deficating outside, and spreading illnesses and even diseases in a community.
Drug-addicts are unstable and prone to crime. By bringing more drug-addicts into a community area, needle exchanges can jeopardize the safety of a community.
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