FREE ESSAY ON A. NEEDLE EXCHANGE CONTROVERSY

A. NEEDLE EXCHANGE CONTROVERSY

Needle Exchange Programs: The Best Solution?
robert_hamilton37@email.com
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 itwill
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)
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