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March 22, 2005 - The Houston Chronicle (TX)

Send The Right Message About Needle Exchanges

Texas Has the Chance to Be Prudent and Compassionate

By William Martin, Senior Fellow at the James A. Baker III Institute for Public Policy at Rice University

Return to Drug War News: Don't Miss Archive

Few images of drug use are more potent than that of the needle in the shaky hand of a junkie searching the tracks on his arm or leg for a vein still able to receive one more injection; the needle hanging from the arm of an addict unconscious or dead from an overdose; the contaminated needle passing its deadly load of HIV or hepatitis to the next user and, through him, to his wife or lover and their unborn child.

Using drugs such as heroin, cocaine and methamphetamines, particularly in the corrupted state in which they typically reach the retail market, is risky business.

That risk is markedly increased when users share needles contaminated by blood-borne diseases such as HIV/AIDS and hepatitis A, B and C. According to the Centers for Disease Control and Prevention, more than a third of AIDS cases in the United States have occurred among injecting drug users (IDUs), their sexual partners and their offspring.

Hepatitis C, the most dangerous variant of that disease, is found in the blood of 70 to 90 percent of all adult IDUs.

One may regard such statistics as a matter of just deserts, regrettable effects of an avoidable cause.

When people use dangerous drugs in the company of dangerous people, bad things happen.

Their sexual partners, though perhaps not users themselves, should confine themselves to more wholesome companions. It is troubling that 57 percent of children born with AIDS in the United States are the offspring of IDUs or their sexual partners, but hardly news when the sins of parents are visited upon their progeny. Those who hold such views, however, should pause in the face of the enormous expense of treating people infected with HIV or already suffering from AIDS. The current estimate of the lifetime cost of treating one person with HIV is approximately $155,000, a high proportion of which is borne by Medicaid or similar taxpayer-funded programs.

Thus, whether driven by compassion, fiscal prudence or self-defense, rational public policy will seek to reduce the incidence of HIV/AIDS, hepatitis and other diseases spread by injecting drug users. Fortunately, the means to such a reduction are well-known and thoroughly proven.

For nearly two decades, public health officials in Europe, Australia and Canada have operated programs that allow addicts to exchange used needles for clean ones. More recently, numerous countries in Asia, Latin America and the developing world have followed suit. This greatly reduces the incidence of blood-borne diseases and limits disposal of needles in places where they can infect children, sanitation or health workers, police and others who might come in contact with them. In some locales, syringes can be easily obtained from pharmacies, at police stations or even from vending machines. A 2002 survey of needle exchange programs in 103 cities found that cities with needle exchange programs experienced an average annual decrease in HIV cases of 18.6 percent over the decade of the 1990s; cities without such programs had an average 8.1 percent increase.

Findings for hepatitis C were similar. In the United States, IDUs, AIDS activists and public health officials operate needle exchange programs in approximately 130 cities, some with full legal protection and funding, some with unofficial encouragement from authorities, and some with legal risk to participants. Researchers familiar with the most carefully studied of these, in New Haven, Conn., conservatively estimate that the HIV and hepatitis transmission rates dropped by a minimum 33 percent in the first two years of the program. Moreover, as a direct result of contact with public health staffers involved in the program, hundreds of users either entered or requested referral to formal treatment programs.

During the 1990s, the federal government and various major professional organizations funded careful scientific studies of needle exchange programs. Without exception, every independent commission to look at this issue has concluded that these programs dramatically reduce the spread of blood-borne diseases without increasing either rates of injection or use of other illegal drugs.

Why, then, have policymakers, from the White House to City Hall, resisted establishment of such proven life-saving programs?

Why have politicians and platforms of both major parties repeatedly vowed, "Not a dime for needle exchange programs"? The real reason may be fear that any sign of being soft on drugs will hurt their standing among people who have not looked at the issue. But the rationale most commonly, often honestly, offered is, "It sends the wrong message."

Before we accept that rationale, we need to think about the message we currently send to IDUs: "We know a way to dramatically cut your chances of contracting a deadly disease, then spreading it to others, including your unborn children.

It would also dramatically cut the amount of money society will have to spend on you and those you infect.

But because we believe what you are doing is illegal, immoral and sinful, we are not going to do what we know works.

As upright, moral, sincerely religious people, we prefer that you and others in your social orbit die."

The Texas Legislature is considering a bill to permit needle exchange programs. No responsible person wants to encourage drug abuse.

No fiscally prudent person wants to waste money simply to satisfy a sense of righteous indignation. No compassionate person wants to consign people unnecessarily to death or a living hell. Fortunately, providing injecting drug users with access to sterile syringes allows us to be responsible, prudent and compassionate -- admirable criteria for good public policy.

A fuller version of this article may be found at (PDF Format)

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