What message are we sending by implementing needle exchange programs in this country? This has been a highly volatile subject taking heat from both sides. On the one hand, of course we want to lower the risk of HIV/AIDS contraction through infected shared needles of drug users and by all other means. I’m all for public health and less cases of diseases with and without a cure.
On the other hand, is this giving a free pass to IV drug users to continue their abuse, walking around with an “immunity card”, preventing them from being arrested for carrying drug paraphanelia? This attitude is almost like giving up on these people and saying, “if they want to use drugs, let them - just as long as they don’t increase our health care costs with more HIV/AIDS cases.”
I tend to lean more to the side of the latter opinion. What are we saying to these people? The needle exchange program comes complete with clean needles and an “acceptance” of IV drug use. Addiction is not something that becomes okay because clean needles are being used. Addiction is a horrible disease that costs our society billions of dollars in addiction treatment, hospitalization, and incarceration costs. Just because we may be able to decrease a small number of HIV/AIDS cases from infected needle sharing doesn’t mean we’ll avoid HIV/AIDS cases brought on by prostituting for drugs or engaging in reckless sexual behavior while under the influence of drugs. What about crimes committed for money to buy drugs, violence as a result of drug use and black market drug dealing? What about the millions of families and close relationships destroyed on a daily basis because of drug abuse? What are we going to do about these things?
We shouldn’t encourage programs that give addicts exemption from the illegality of carrying around drug paraphanelia, this just perpetuates their addiction. Perhaps this serves the interest of public heath in one area while undermining it in other, arguably more harmful areas. This is supposed to save the lives of drug addicts? They’re killing themselves, HIV or not. If it is the will of our society to save the lives of the millions of Americans struggling with addiction, we need to put more money and effort into drug rehab programs and drug addiction education. Sobriety is the only life-line an addict has, not the availability to get clean needles which they can then turn around and sell for more drug money, or use to overdose. This is ludicrous to me. What real difference is it going to make in the lives of those who struggle with drug addiction to have clean needles to use to get high and continue to kill themselves?
I’m dying to hear an opinion which will make this program somehow make sense to me.
3 Comments
I’d like to help you try to understand needle exchange programs (NEPs) a little better.
Infected needles contribute between 25-50% of all HIV cases in the US, depending on locality. That’s not a small number, it’s quite large as a matter of fact. A injection drug user not only spreads to those she shares needles with, but those she shares intamcy with, those she gives birth to, and those who have accidents assisting her in medical emergencies (nurses, EMS workers, police officers etc). The US has become a leader of HIV infections in the Western world, and a huge controllable portion of those infections happen among IDU’s and their associates. To curb this simply and inexpensively, NEPs work very well. It is a public health priority for the entire population that we get a handle on this horrible epidemic.
Hepatitis C- 70-90% of all IDUs are now infected with hep c- which you can catch by sharing a toothbrush, a razor or other items exposed to blood. This is a much greater risk than HIV for the population at large, and it’s irresponsible to not try to get on top of this epidemic as well.
By collecting sterile syringes, we are giving a junkie a choice to start taking responsibility for their own behavior, something many don’t do as they live outside of societal norms, entrenched in criminal lifestyles, and often completely cut off from family, loved ones and social services. When users access NEP services, they come into contact with health care workers, ex addicts, drug counselor, all who smile and ask how they are doing, how’s that abscess, how you feeling. Users get education about safer shooting, safer sex, shelter, and yes, drug treatment opportunities and options, and when a user is ready for treatment, NEP staff are there to help.
And I agree, we badly need more treatment centers and honest realistic drug addicition education that works. But until then, and for the sake of those who are not able to get those services, why not, at the very least, keep them uninfected and offer not only a reason to live, but the reality of living?
I’ve worked in NEPs- I’ve seen clients come and go for years who will never quit. They often are prostitutes (both sexes), indigent. Some are functioning, hiding their addiction from their wives and children. And some come to us to find help, and they get it. We’ve had clients come back years later, sharing stories about their lives today, their jobs, their families, and they thank us for the fact that they aren’t sick or dead.
Needle exchange programs aren’t the kind of thing that makes immediate sense to us. They seem counter-intuitive, but I’ve seen them save and change peoples lives. And for those who use the service to stay clean as they continue their addiction, well, you and I both know you can’t quit until you are ready. Let’s keep them clean so they don’t infect the others who might come clean one day.
One thing NEPs don’t do is affect the drug supply. Herion, cocaine and meth use don’t increase when a needle exchange comes to town. They stay the same or decrease, because NEPs hook people up with treatment.
What do you do if you have a city with, let’s say, 10,000 heroin addicts and funding for only 70 treatment beds? I agree that we should increase treatment for sure. but that money isn’t available at all, NEPs can save lives and help people survive for the price of a few needles and a couple of staff. Maybe once our over burdened health care system is no longer strapped with so many people sick and dying from HIV and hep c, maybe then our government will think about serious drug addiction treatment and effective prevention. Till then, we’ve got a real world out there with real people dying.
Thank you for your comment Tracy. This post was written by my wife and partner in helping people with addictions. I was a heroin addict in my past, an IV drug user myself, and my brother died from heroin addiction. When she wrote this post, she asked me how I felt about her point of view, and I told her I had conflicting feelings about it, but I encouraged her to post it as I felt it would be a source of quality debate -
Your comment is quite informative and I agree with it in many ways, and I believe my wife probably would as well in some sense (I look forward to her reply). I agree that we need much more funding for treatment in this country, and I’d far prefer that over needle exchange programs. Needle excange is a harm reduction model for handling a problem, and I believe it is worthwhile. HOWEVER - it would follow that based on the laws of this country, it does do what Karima suggested - it mitigates illegality of possession of drug paraphenalia for heroin, meth, cocaine and other drugs of addiction wich are abused intravenously, and makes access to obtaining this paraphenalia quite simple and low-cost (to everyone but the taxpayer whose interests might be better served by their tax money going to treatment beds for these addicts, or drug education and prevention). Should we give out free crack pipes as well? Agreed, crack pipes don’t transmit AIDS in general, but playing the devil’s advocate, why shouldn’t crack addicts have the same “advantages” in obtaining their drug paraphernalia as heroin addicts?
Needle exchange is a catch-22 in my eyes. It helps with one problem, while creating others. Overall, I’m for it, and the public health is served by the program, however as a heroin addict in recovery, I know first hand to what degree needle exchange programs perpetuate the initial problem of the addiction in the first place.
I agree that giving out clean needles is just fighting fire with fire… it’s increasing one problem to decrease another. There must be better ways to deal with this.