Needle Exchange Programs: The Best Solution? The United States of America has
been contending with adverse social and economic effects of the drug abuse,
namely of heroin, since the foundation of this country. Our initial attempt to
outlaw heroin with the Harrison Narcotic Act of 1914 resulted in the U.S. having
the worst heroin problem in the world (Tooley 540). Although the legislative
actions regarding heroin hitherto produced ominous results that rarely affected
any individuals other than the addict and his or her family, the late twentieth
century brings rise to the ever-infringing AIDS epidemic in conjunction with
heroin abuse. The distribution of clean needles to intravenous (IV) drug users
is being encouraged in an attempt to prevent the transmission of human
immunodeficiency virus (HIV) from sharing "contaminated needles" (Glantz
1077). It is the contention of this paper to advocate the establishment and
support of needle exchange programs for intravenous drug users because such
programs reduce the spread of HIV and do not cause an increase of drug use. This
can be justified simply by examining the towering evidence that undoubtedly
supports needle exchange programs and the effectiveness of their main objective
to prevent the spread of the HIV. Countries around the world have come to
realize that prohibiting the availability of clean needles will not prevent IV
drug use; it will only prevent safe IV drug use (Glantz 1078). Understanding
that IV drug use is an inescapable aspect of almost every modern society,
Europeans have been taking advantage of needle exchange programs in Amsterdam
since the early 1980's (Fuller 9). Established in 1988, Spain's first needle
exchange program has since been joined by 59 additional programs to advocate the
use of clean injection equipment (Menoyo 410) in an attempt to slow the spread
of HIV. Several needle exchange programs sponsored by religious organizations in
Australia have "reported no new HIV infections resulting from needle
sharing over the past three years" (Fuller 9). Public safety groups in the
United States are rapidly beginning to accept the effectiveness of needle
exchange programs. The 113 needle exchange programs that are currently operating
throughout the United States (Bowdy 26) are a result of this acceptance. These
programs for the most part are established to support "needle
exchange" more so than "needle distribution" (Fuller 10). Many
needle exchange programs have been initiated by recovering addicts who
understand "the realities of addiction and the potential harm of needle
sharing" (Fuller 9). Perhaps addicts feel more comfortable taking advice
from some one whom has been there and knows what they are going through. Social
interaction between the addict and program is quite simple. Program clients are
asked to donate their old injection equipment in exchange for new materials and
identification cards issued by some programs, allowing the users to carry their
injection equipment anywhere (Loconte 20), reducing the need to share needles.
Volunteers keep track of old needles collected and sterile ones given out with
"a coding system that allows participants to remain anonymous" (Green
15). Unlike some of their European counterparts, needle exchange programs in the
U.S. do not advocate the use of vending machines to dispense hypodermic needles
(Fuller 10). American programs understand the grave importance of regular
contact between the addict and caring members of society who inform addicts
about various avenues of health care and recovery during each visit (Fuller 10).
The assistant director of the Adult Clinical AIDS Program at Boston Medical
Center, Jon Fuller, feels that this intimate approach by American programs
conveys "a powerful message to addicts that their lives and well-being are
still valued by the community" despite their inability to "break the
cycle of addictive behavior" (10). Addicts who can not stay clean or get
admitted into a drug treatment program should be encouraged to take the
necessary precautions to perform safe injections and not put others at risk as a
result of their habit (Glantz 1078). From 1981 to 1997, drug related HIV cases
in the United States rose from 1 to 31 percent not including infants and sexual
partners infected by the user (Fuller 9). With contaminated needles infecting 33
Americans with HIV daily (Fuller 11), it was only a matter of time before an
in-depth analysis of the drug related AIDS epidemic was made. More comprehensive
research in regards to the effectiveness of needle exchange programs is
necessary to provide the basis for making proper legislative decisions. The ban
currently preventing federal funds from being allocated to support needle
exchange programs in the U.S. greatly curtails the means necessary to establish
and operate an effective needle exchange program. President Clinton initially
planned to lift the ban (Bowdy 28) but, against the advise of his health advisor
and compelling scientific support for needle exchange programs, he extended the
ban forcing needle exchange programs to operate within their already thin
budgets (Schoofs 34). A bit of hypocrisy is sensed by Joe Fuller because the
Clinton Administration "refused to lift the ban but encouraged local
governments to use their own resources to fund exchange programs" (8). The
Administration claims that by supporting something other than "zero
tolerance" may give the "wrong message" (Drucker 15). Political
careers were obviously placed ahead of the general safety of the American people
(Green 15) possibly due to public opinion surveys. The Family Research Council
performed a public opinion survey in 1997 (Bowdy 28). Sixty-two percent of the
1,000 registered voters who where asked to voice their opinion about needle
exchange programs did not approve of them (Bowdy 28). Some critics claim that
needle exchange programs may increase drug use and encourage promiscuity (Bowdy
27) while others fear contaminated needles will not be disposed of properly
creating a "public health hazard" (Bowdy 28). These concerns are
understandable but they must be properly weighed against the benefits to society
as a whole. An effective needle exchange program in Windham Connecticut was shut
down after a needle that was improperly disposed of pricked a two-year-old girl
(Connecticut 5). Researchers interviewed a number of clients before and after
the program was terminated to determine the number of participants that secured
their injection equipment from the street or acquaintances (Connecticut 5). The
number of participants using unreliable equipment drastically increased from 14
percent while the program was still operating, to 36 percent immediately after
closing, to 51 percent in an interview three months after closing (Connecticut
5). The status quo remained in regards to the amount of debris after Windham's
program had been terminated (Connecticut 6). Advocates feel that taking the
remote chance of dealing with an improperly disposed needle is worth saving
countless lives for sure. The frustration of dealing with federal and public
resistance is compounded by state laws forbidding individuals from possessing or
distributing hypodermic needles and syringes that are enforced by all but four
states in the U.S. (Glantz 1078). As a result, needle exchange programs across
the country must evade prosecution regularly. The Chai project is a group of
public safety advocates based in New Brunswick, New Jersey that distributes
sterile needles and syringes, condoms, and valuable information about diseases
such as HIV despite interference from local authorities who are required to
enforce laws with which they may or may not agree (Green 15). Diana McCague,
founder of the Chai project, was arrested after giving an undercover detective a
sterile pack of hypodermic needles (Green 15). The judge hearing the case,
Terrill Brenner, praised McCague's undeniably effective contribution to public
safety but was forced by law to convict her of illegally distributing drug
paraphernalia (Green 15). McCague wonders "What kind of society …we live
in that people are arrested for saving lives?" (Green 15). Recently
conducted studies of various needle exchange programs returned rather
encouraging results. The number of HIV infections among drug users decreased of
5.8 percent annually in 29 cities throughout the world where needle exchange
programs where implemented as opposed to a 5.9 percent increase in 51 cities
where they were not (Bowdy 27). The National Institute of Health claims that
needle exchange programs reduce their clients' rate of performing dangerous
injections as much as 80 percent (Fuller 11). From 1991 to 1996 New York City's
rate of drug related HIV cases dropped from 44 to 28 percent (Schoofs 36).
Organizations nationwide such as the American Medical Association, the American
Bar Association, and the American Public Health Association have begun to openly
support needle exchange programs (Fuller 11). Donna E. Shalala, secretary of the
Department of Health and Human Services, was asked to investigate the validity
of needle exchange programs as a whole. She concluded, "needle exchange
programs can be an effective part of a comprehensive strategy to reduce the
incidence of HIV transmission and do not and do not encourage the use of illegal
drugs" (Bowdy 28). Needle exchange programs encourage the participation of
addicts in their program usually by giving out more equipment than is received (Loconte
20). We can not ignore the possibility that addicts are really motivated to
participate in the programs because the extra equipment received from the
program could easily be sold to attain their next bag of dope (Loconte 20). This
will not do the addict any good but it could possibly keep someone from being
victimized to support such a habit. It should be understood that needle exchange
programs are not really concerned with the IV drug users' reasons behind taking
advantage of the services regularly, so long as they do just that, take
advantage of the services regularly. America can no longer ignore the ominous
consequences of its drug abusers and their addiction. HIV has infringed our
society in conjunction with the relentless forces of addiction for which there
is no cure. The perilous habits of a drug addict, especially an IV drug user,
are geared toward getting high (Loconte 15), not personal health and public
safety. However, habitual behavior is not inalterable. It can be swayed by a
little incitement from the brighter, more intelligent members of society;
incitement to support and make regular use of local needle exchange programs.
Although American society may not understand the driving force behind heroin
addiction, we all must understand that it"will always be with us …[so] we
had better learn how to live with [its] …in a way that minimizes [its]
…adverse health and social consequences" (Drucker 15)