A very important national debate about drug policy is taking place, but the deep significance of the debate is unfamiliar to many people. The question is whether tax dollars should be used to buy clean syringes for drug users who inject heroin, cocaine, and other drugs. Advocates of funding “needle exchange programs” say that providing an unlimited supply of clean needles will decrease the number of AIDS cases among addicts.

At first glance, this seems like a debate between AIDS prevention and drug prevention. The discussion often proceeds along those lines, and has created an unfortunate rift between well meaning people on both sides. But what keeps the argument hot is that it is also a clash of two very conflicting ideologies about drug policy.

On one hand is a small but well funded and vocal group of persons who believe that drug use should be only a matter of individual choice; that the only public policy concern about drugs should be from the perspective of helping keep drug users safe from disease and injury. This point of view is called “harm reduction.” The most extreme form of “harm reduction” claims that drug use is an individual right, and hould be given constitutional protection!

On the other hand are people who believe that drug use is both a health problem and an anti social act; an act that hurts non users in a number of ways. Drugs are therefore a justice issue as well as a health issue.

Harm reductionists say that if there is a chance to decease AIDS infection by buying clean needles, we should do that. They claim that to do otherwise is cruel folly.

Those of us on the other side see at least three major problems with that reasoning:

1. Contrary to the views of some, the effectiveness of needle exchange is still very much in doubt. Positive results have been obtained in programs that combine needle exchange with other preventive efforts such as preventive education. The role of needle exchanges hasn’t been separated from those other efforts. Two studies that did try to measure this more carefully found increased rates of infection among needle
exchange users. Needle exchange proponents, including some of those studies’ authors, have been quick to try to explain away these results.

2. Even if needle exchanges are developed that do lower HIV rates among users, this is an inferior approach to public health than aggressive outreach and substance abuse treatment. People who die from chronic intravenous drug use are just as dead as those who die from AIDS. Drug users’ deaths can be just as awful and much quicker. Getting these people off of drugs is the only answer that addresses both deadly problems at once.

3. Needle exchange programs create health, social, and economic problems for communities as they attempt to handout needles. In areas where these programs operate, unrestricted drug use and carelessly discarded needles have come to be the norm.

The above three points are reasons to oppose any needle exchange program. One further point is made by many in regard to tax funding of needle exchanges. The point is that taxpayers don’t like the idea of supporting needle handouts with their money. It’s not that these taxpayers are cruel: most would be glad to have tax money cover the cost of substance abuse treatment for drug addicts. They see this as more
humane and more sensible than supporting use through needle handouts.

The free needle issue may not be resolved for some time. Meanwhile, the fundamental clash between anti drug beliefs and those who see drug use as a benign pass time will re surface in other debates. # # #

Letter to Editor – U.S. News & World Report, April 19, 2003

CLEAN NEEDLES: When you write that clean needles are “saving” lives, and use the example of street-worn Silky as testimony, I am curious what Silky will do with his second shot at life as he shuffles off into that cold New England morning, following his visit to the needle-exchange van (“How Clean Needles Are Saving Lives,” March 29).

While it “strikes” the head of a Yale research team that the federal government’s reluctance to fund such a program is “very bad public policy,” it strikes me as very bad public policy for governments setting laws criminalizing behavior to then make such behavior easier to perform and, even worse, for journalism to make philosophers out of heroin addicts.