2011 - April

Most of us concerned with helping people on the road to recovery try to avoid attaching shame or stigma to those struggling with addiction. Still, we need to face an uncomfortable fact that persistently hobbles the establishment and support of syringe-exchange programs. Drinking and pill-popping can be every bit as deadly and hard to conquer as shooting up, but as images they don't pack the repellent power of the needle—the needle in the shaky hand of a junkie searching the tracks on her 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. It should not surprise us, then, that a prominent and persistent goal of U.S. drug policy, from the federal to the local level, has been to deny drug users easy access to needles and to punish them whenever they are found with one. And even when syringe exchange is legal, many caring people who work in recovery programs cannot bring themselves to approve of providing addicts with an instrument of their addiction.

While understandable, this attitude rests on a false premise. Addicts deprived of clean needles do not give up their drugs; they inject them with contaminated needles, and they contract deadly blood- borne diseases, most notably HIV/AIDS and hepatitis C. According to the Centers for Disease Control and Prevention, nearly 30 percent of new cases of HIV/AIDS and 60 percent of hepatitis C can be traced to injecting drug use. The lifetime cost of treating either of these diseases can easily exceed $300,000, much of which is paid by Medicaid, Medicare, local hospital districts, Veterans Affairs, and other public funds.

Recognizing that HIV and hepatitis were both spreading at alarming rates among injecting drug users (IDUs), public health officials in both the Netherlands and Australia began experimenting in the mid- 1980s with programs to supply addicts with clean needles in exchange for their used ones. The immediate and obvious success of these programs in reducing the incidence of both diseases—the rates quickly dropped as much as one third— led authorities in Canada and numerous European, Asian, Middle Eastern, and Latin American countries to follow suit. In some locales, sterile syringes can be exchanged at pharmacies, police stations, and even from specially designed vending machines. At St. Vincent's Hospital, in Sydney, nuns operate the exchange. Even the hyper-conservative mullahs in Iran have approved of syringe exchange as an acceptable way to fight an HIV/AIDS epidemic spread mainly by drug users.

Repeated major scientific studies have unanimously concluded that access to clean needles reduces the incidence of blood-borne diseases and neither encourages people to start injecting drugs nor increases drug use by those who are already users. Moreover, they take millions of potentially contaminated needles out of circulation instead of leaving them to be passed around or left in parks or public restrooms, where they could injure or infect children and others, including health workers and police who might receive needle-stick injuries in their contact with addicts.

Furthermore, as IDUs come to trust exchange programs, their effectiveness tends to increase, sometimes quite dramatically. After the Baltimore City Needle Exchange had been in operation for six years, the incidence of of HIV in that city dropped by 35 percent overall and 70 percent among the approximately 10,000 participants in the program. Even more striking, at the November 2010 Harm Reduction Conference in Austin, Texas, Dr. Don Des Jarlais, Professor of Epidemiology at New York's Albert Einstein College of Medicine, reported that the incidence of new HIV infections among IDUs in in New York City has dropped to under one percent per year. "We appear," he said, "to be very close to eliminatinginjecting-relatedtransmissions in a city with over 100,000 injecting drug users."

No one seriously any longer seriously disputes the health and financial benefits of SEPs. In 2009, Congress finally removed its long-standing ban on using federal funds to support such programs. State laws vary, but 36 states have syringe- exchange programs and 13 others make other provisions for IDUs to obtain sterile needles. Only Texas still flatly prohibits the purchase or possession of syringes for the purpose of injecting illegal drugs, and that prohibition may not survive the state's 2011 session of its legislature.

In the face of the overwhelming empirical support for syringe exchange, the major opposing argument continues to be, "It sends the wrong message." Before accepting that rationale, opponents of SEPs need to think about the message we currently send: "We know a way to dramaticallycutyourchancesofcontracting a deadly disease, then spreading it to others, including your unborn children. It would also dramatically cut the amount of money society is going to 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. You are social lepers and, as upright, moral, sincerely religious people, we prefer that you and others in your social orbit die."

Less than a decade ago, this was the attitude most churches manifested toward people afflicted with HIV/AIDS. If people were determined to engage in sinful behavior, they should expect to reap the full terrible harvest of their actions. God might be merciful toward sinners, but we were not. And then, in 2002, Franklin Graham hosted Prescription for Hope, a global conference attended by more than 800 Christians from many countries and denominations. PBS Frontline pointed to that gathering as the moment at which Christians got involved in confronting HIV/AIDS. Soon afterward, Rick (author of The Purpose Driven Life) and Kay Warren launched a major HIV/AIDS initiative. Today, many other churches, large and small, minister to people stricken with this disease. These ministries do not screen the people they serve to make sure they were infected through no fault of their own. They meet them at the point of their need and offer what help they can.

Suppose we worked in such a ministry and were confronted by a person who had contracted the virus from a contaminated needle. While we may rightly decry drug addiction and find injecting drug use abhorrent, what defense could we offer if that person said, "You knew that, by using a sterile syringe, I could lessen my chance of getting this disease, and yet you refused to support programs that would make those available to me. What kind of neighbor are you?" How can we justify saying it is permissible, even laudable, to help people after they have contracted HIV/AIDS, but wrong to approve of measures that significantly reduce their chances of contracting that disease? Jesus had nothing to say about needles, but we do know how he treated social outcasts and sinners, and he had a great deal to say about people who let prim concern with their own righteousness interfere with offering needed assistance to those in peril.

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. These are admirable criteria for public policy and private practice that thoughtful people, whether secular or deeply religious, can support with a clear conscience.

About the Author

William Martin is the Senior Fellow for Religion and Public Policy at the James A. Baker III Institute for Public Policy at Rice University.


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Comments (3)
3 Monday, 09 May 2011 08:22
Joe
Boy, talk about a issue that could be (has been) debated for yrs. Advocates for needle exchange make good arguments, which I agree with. On the other hand, people opposed (some) feel that needle exchange encourages (enables) more use, and certainly drives up costs, money that could be used elsewhere! Mind anyone reading this, I’m not saying I agreeing for or against, just stating opinion! That said,
"To Exchange or Not Too?” that is the question! Not to be a fence sitter, I lean towards an exchange with very strict guidelines. Although, as a LCDC, and as someone (like others have) who has worked in centers which struggle w/ funding, sometimes it’s hard to see money spent somewhere that appears to be an endless pit. Only one observation.
Again, just voicing opinion.

To be continued…
2 Monday, 18 April 2011 15:16
Zachary Christian
Thank you Dr./Mr. Martin for a well written article on a subject which has long been of interest to me. The hypocritical "values" of the religion-oriented individuals that have stood in the way of exchange programs in my home state have been an object of my frustration since before entering the field. I'm sure that I'm speaking on behalf of many of those with whom I associated during active addiction years ago in offering my gratitude for your public voice on this sensitive subject. As a recent gradute and individual only recently entering this field on a professional level, I encourage others, who have been distanced from "the streets" for a period longer than the handful of years I have, to spread this message and advocate for those who have not yet, and perhaps will not ever, have the chance to become a client/patient due to having contracted a deadly illness during these prohibitive years in regard to public policy surrounding syringe-exchange programs. Perhaps if more individuals with an audible voice speak up, many of those who are destined to enter the dark realm of injection drug use will avoid the feeling one has upon receiving the news that they have tested positive for a terminal illness. I may have been several years too early, but the present is certainly not too late to create change.
--Zachary L. Christian, LCDCI
1 Thursday, 07 April 2011 11:34
Alan Daggett, BSW, LCDC
Wonderful article Mr. Martin. I was amazed a few years ago when I said something about this to my then supervisor and she adamantly refused to listen to reasons why these programs are a good idea. She is an LCDC and overall a great person to work for, but was absolutely closed minded on this topic. I hope to see more articles like this one in the future. I worked at a Methadone Clinic a few years ago and there were several people I counseled that were waiting for liver transplants. I agree that clean needles would be much more cost effective.

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