Opponents of needle-exchange programs should think about their message to drug users

03/23/05

Researcher at Rice University's Baker Institute recommends good public policy

Many opponents of needle-exchange programs argue that supplying drug users with clean needles sends the wrong message. But a researcher at Rice University's Baker Institute for Public Policy advises that they should be concerned about the message they're actually sending. Despite the overwhelming evidence that needle-exchange programs (NEPs) can help reduce the spread of HIV/AIDS and hepatitis, many legislators refuse to support such efforts and instead write off death and illness as "just deserts" for illegal behavior, said William Martin, senior fellow in religion and public policy at the Baker Institute.

In a research paper posted this month on the Baker Institute Web site, Martin paraphrases the message these opponents are really conveying to injecting drug users (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 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."

Martin cites a number of alarming statistics to show the size of the drug problem. The number of IDUs is estimated to be between 1 million and 1.4 million. By mid-2000, 36 percent (270,721) of AIDS cases in the United States had occurred among IDUs, their sexual partners and their children, and these three categories of people accounted for half of all new HIV infections in the nation. In fact, 57 percent of children born with AIDS in the United States are the offspring of IDUs or their sexual partners. IDUs also risk exposure to various forms of hepatitis. Between 50 and 80 percent of IDUs contract hepatitis C the most dangerous strain -- within their first year of needle use.

Martin also translates the problem into dollars. A 2005 report from the Centers for Disease Control and Prevention (CDC) estimates that the lifetime treatment cost for a person with HIV is $155,000. With 40,000 people being infected with HIV each year, lifetime treatment for those infected in just the past five years is projected to cost $31 billion. "The CDC estimates that only 1,300 cases would need to be averted annually to make a full-scale program of syringe exchange and disposal for IDUs economically effective," Martin said.

Other countries, particularly the Netherlands and Australia, have demonstrated that supplying drug addicts with clean needles in exchange for their used ones is an effective means of reducing the incidence of blood-borne diseases. Addicts receive a clean needle for every used one they turn in; this limits careless and dangerous disposal of contaminated needles. A 2002 report from Australia estimates that over the decade of the 1990s, Australia's NEP helped avoid 25,000 cases of HIV and 21,000 cases of hepatitis C. In U.S. dollars, Australia's investment of more than $71.8 million for the NEP resulted in a savings of between $1.3 billion and $4.1 billion.

Martin noted that the contrast between Australia and the United States is "particularly striking," as evidenced by a presentation that physician Alex Wodak made during a 2002 Baker Institute conference on "Moving Beyond the War on Drugs." Wodak, who helped persuade the Australian government to support NEPs, reported that in 2000, the rate of 14.7 new AIDS cases for every 100,000 Americans was dramatically higher than the rate of 1.1 new AIDS case for every 100,000 Australians.

During the 1990s, a small number of U.S. cities experimented with NEPs. The most carefully studied program was in New Haven, Conn., where researchers estimated that the HIV and hepatitis B transmission rates dropped by approximately one-third during the first two years of the program.

Government-funded studies of NEPs and reports from such respectable organizations as the National Academy of Science, the American Medical Association, the National Institutes of Health and the CDC have endorsed access to clean needles as an effective measure for reducing the incidence of blood-borne diseases and increasing access to treatment for drug users, Martin said. "In addition, they have persuasively documented that access to sterile needles neither encourages people to start injecting drugs nor increases drug use by those who are already users."

Yet policy makers at the federal, state and local levels have resisted providing IDUs with easier access to clean needles from physicians, pharmacies, the police or other readily available sources. In 1997 Congress enacted Public Law 105-78, which prohibits federal funding of any program that distributes sterile needles for the injection of illegal drugs.

Consequently, only 120 NEPs current operate in the United States, with funding from state or city governments, private foundations and/or individuals. Martin noted in his research paper that Houston the fourth largest city in the nation has nearly 20,000 known cases of AIDS but no NEP. Dallas has a program run by four volunteers who reportedly distribute 250,000 needles a year from a pickup truck mainly in African-American neighborhoods. "Limited as it is, this effort surely plays some role in an AIDS rate 57 percent lower than that of Houston's," Martin said.

Although NEPS are consistently rejected by politicians and platforms of both major political parties, Martin said some lawmakers are starting to consider changes in policy as they learn more about studies confirming that NEPs can save lives and money without increasing drug abuse. Last year, for example, California became another state that allows pharmacy sales of up to 10 sterile syringes without a prescription, and the Texas legislature is currently considering a bill that will permit the operation of NEPs.

"No responsible person wants to encourage drug abuse," Martin said. "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 IDUs with access to sterile syringes allows us to be responsible, prudent and compassionate admirable criteria for good public policy."

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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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