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Harm Reduction Policies Slow Spread Of Diseases
As previously reported by Common Sense for Drug Policy, the U.S. House of Representatives recently passed an appropriations bill that, for the first time in over 20 years, does not include the notorious ban on federal funding of needle exchange programs. However, a July 31, 2009 Washington Independent article exposes flaws in the House amendment and warns of possible trouble ahead ("Congress Looks to Lift Two-Decade Ban on Federal Needle Exchange Funds"). As the article states, "ban critics cheered [the legislation's passage] as a long step toward curbing the spread of blood-borne diseases like HIV. Yet the proposal moving through Congress, according to many health and human rights advocates, has been diluted to the point that it won't help the same urban areas most afflicted by those illnesses." Additionally, the version of the bill circulating in the Senate "retains the needle-funding ban."
Despite his best intentions, House Appropriations Committee Chairman and bill sponsor David Obey (D-Wis.) felt obligated to include a restriction in the funding ban repeal that "prohibits [needle exchange programs] from operating within 1,000 feet of schools, daycare centers and other areas where children are likely to congregate," including "pools, parks, video arcades 'or any event sponsored by any such entity,'" and universities - a particularly puzzling inclusion, as most people who attend those institutions are legal adults. According to the Independent, Obey "included the restriction, not because he supports it, but to appease conservative critics who might have killed the entire provision otherwise." However, "needle exchange supporters argue" that the provision renders the bill near-entirely unworkable in urban areas because "the geographic restraints are so expansive that they'll neuter most benefits that would come with allowing funding of clean needle programs."
Allan Clear, who serves as the Harm Reduction Coalition's executive director, summarized needle exchange advocates' concerns most succinctly: "'It's too restrictive,' [he] said [...]. 'You couldn't open a program in Washington, D.C. - or most any urban area - with these restrictions." According to William McColl, political director for advocacy group AIDS Action, "If the bill is enacted as it stands, [...] 'it would preclude the use of needle exchange in the areas that need it most." Human Rights Watch's Rebecca Schleifer elaborated, stating that "As a practical matter, you won't be able to have needle exchange in the city [where] there are schools and daycare centers everywhere." She concluded by telling the Independent that the restrictions "make the bill 'meaningless as a practical matter, even if it's important as a symbolic matter."
However, the Independent provides harm reduction advocates with a glimmer of hope. After briefly discussing the Senate's decision to leave the funding ban intact, the article notes that "Needle exchange supporters on and off Capitol Hill are hoping to remove the geographic restrictions when the two chambers meet to hash out the differences between the two bills." Hopefully, the Senate will concur with the House's decision, and perhaps the two chambers could design a proposal that protects both public safety and needle exchange programs' ability to effectively operate in areas that need their services most direly. But, according to the article that "process [...] won't arrive until September, at the earliest." While harm reduction proponents would like to see the ban repealed more quickly, the delay does provide citizens, health and human rights groups, and other interested parties ample time to contact their representatives, organize events and demonstrations, and generally push their perspectives into public view.
Despite his best efforts to continue the ban on federal funding for syringe exchange programs, Rep. Mark Souder (R-IN) failed to convince the majority of his colleagues to remove an amendment that sought, as AP reported on July 25, 2009 ("House Permits Needle Exchange Programs"), to allow communities to use federal funding for needle exchange programs. The vote was close - 218 to 211 - but harm reduction advocates ultimately prevailed on the controversial measure, even after sitting through a "brief but passionate debate on [the] amendment [added] by [Souder] to keep the ban in place."
Souder argued that "HIV is spread chiefly through sexual activities and that needle exchange programs don't have a proven record of success." He added that "providing needles acts as a way for drug users to sustain their intravenous drug use and does not address the primary illness of the drug addiction." However, fellow Representatives like Lucille Roybal-Allard (D-CA) rebutted, saying "the scientific evidence is indisputable and that needle exchange programs put addicts into contact with social service agencies, opening the door for them to seek treatment." As mentioned above, Roybal-Allard's argument proved more convincing, and for the first time since 1988, the federal government will monetarily support syringe exchange programs in regions that wish to establish them.
Syringe exchange programs moved one step closer to having access to federal funding following the House Appropriations Subcommittee on Labor, Health, and Human Services' removal of the long-standing ban. Chairman of the House Committee on Appropriations David Obey wrote in a July 10 press release that "Scientific studies have documented that needle exchange programs, when implemented as part of a comprehensive prevention strategy, are an effective public health intervention for reducing AIDS/HIV infections and do not promote drug use." Obey also stated that the Subcommittee felt the time had come to "lift this ban and let State and local jurisdictions determine if they want to pursue this approach."
However, as Philadelphia City Paper blogger Isaiah Thompson ("House Subcommittee Removed Ban on Needle Exchange Programs") reminds readers, "This isn't the end, [and] the measure still has to be approved by the Senate" and the full House itself. But, if recent protests in both Philadelphia and Washington, D.C. are any indication, concerned citizens are looking to Congress to, as Philadelphia activist Jose De Marco put it in a press release ("AIDS Activists Take Over Capitol Rotunda to Demand Action on AIDS from Obama and Congress") issued by Health GAP, "show real courage where the President has not."
For more on this historic deletion, stop by David Borden's blog post on the issue here.
The first legal syringe exchanges in the state of New Jersey began operation recently.
The Philadelphia Inquirer reported on Jan. 30, 2008 (Getting Out the Word on Needle Exchange") that "In the two weeks since it launched, only seven people have signed up for the Camden Area Health and Education Center syringe-exchange program, in a city with more than its share of intravenous drug users. Camden County ranks among the top in the state for drug abusers, with 1,516 heroin and opiate users alone seeking help in 2006, according to the New Jersey Substance Abuse Monitoring System. The state had more than 22,053 people who sought treatment for heroin abuse that year. The city of Camden ranks ninth among New Jersey municipalities for residents infected with HIV/AIDS, which is commonly transmitted among intravenous drug users by sharing needles. As of June 30, 2005, there were 1,384 cases in the city, according to the New Jersey Division of HIV/AIDS Services. Newark leads the state with 12,720. Camden's is the second syringe-exchange program to open in New Jersey since passage of legislation last year aimed at reducing the spread of blood-borne diseases among intravenous drug users. The state was the last in the country to legalize needle exchanges. Philadelphia already offers the service."
According to the Inquirer, "In Atlantic City, a needle exchange opened in a drop-in HIV counseling center in November and has already registered 170 people in a state-mandated database. Exchanges are also set to open in Paterson and Newark. Part of the Atlantic City program's allure is that it is run by an established treatment facility. That exchanges are made indoors and there are free coffee and doughnuts doesn't hurt, either. In Camden, the service is run out of a van and offers only the warm hearts of workers and fresh needles."
The Inquirer noted that "In Camden, the program has drawn much less scrutiny than a proposal to move a methadone clinic from near Cooper University Hospital to a site just a few hundred yards from the needle-exchange van. On Monday, members of Camden's Sacred Heart Church gathered to oppose the relocation of the Parkside Recovery Methadone Clinic. But they had little to say about the exchange. 'The exchange is run very well and can save lives,' said Msgr. Michael Doyle of Sacred Heart, who has been in Camden for 40 years. 'This is where the drug people are,' he said, explaining that the exchange saves lives, but that he believed methadone clinics perpetuate addiction. He said he thought that moving the methadone clinic would concentrate the problems of all of Camden County in an area of the city that has struggled for years to remake itself."
The Texas state legislature authorized creation of the state's first legal needle exchange, as a pilot project, in San Antonio. Local officials are blocking the plan and now harm reduction workers involved in a needle exchange there have been arrested.
The Los Angeles Times reported on Jan. 28, 2008 ("His Needle Plan Has Touched A Nerve") that "Bill Day doesn't fancy himself an outlaw -- and with his Mr. Rogers demeanor, he definitely doesn't look the part. But soon the 73-year-old lay chaplain could spend up to a year in jail for breaking a law that he considers immoral. Day hands out clean needles to drug addicts on some of the seediest streets in this south Texas city. He does it because he's convinced that it reduces human suffering by curtailing the spread of HIV, a view that has been supported by medical research for more than a decade. However, Day's actions are illegal in Texas -- the only state that has not started a needle-exchange program of some kind. So when a San Antonio police officer spotted him swapping syringes with prostitutes and junkies this month, he was arrested on drug paraphernalia charges."
According to the Times, "Neel Lane, a high-powered San Antonio lawyer who agreed to defend Day for free after learning about his case through their church, St. Mark's Episcopal, said it was time for the Lone Star State to admit it was behind the times. 'When you're the only state that doesn't have [a needle-exchange program], you're either the 2% smartest or 2% dumbest in the country,' Lane said. Though Texas is the only state that has not begun at least a pilot needle-exchange program in any city, lawmakers last year authorized one -- for San Antonio. Bexar County public health officials are studying whether to launch it, but Dist. Atty. Susan Reed has warned that she could prosecute anyone who distributes needles because she considers the act illegal. 'I'm telling [local officials], and I'm telling the police chief, I don't think they have any kind of criminal immunity,' Reed said in August, according to the San Antonio Express-News. Reed has not explained why she opposes the program, and her office did not return requests for comment. But at the request of a state lawmaker, Texas' attorney general is reviewing the dispute. Day and two associates, cited with him on Jan. 5, initially faced Class C misdemeanors, which are punishable by a fine of up to $500. But Reed's office and police plan to increase the charges to distributing drug paraphernalia, a Class A misdemeanor, which carries a possible one-year jail sentence."
The Times noted that "Day's supporters say they are outraged that police and prosecutors are treating the activists as criminals. 'How silly to arrest senior citizens who are trying to stop the spread of HIV in their community,' said Jill Rips, deputy executive director of the San Antonio AIDS Foundation, which provides HIV testing and runs a hospice. 'Don't police have something better to do?' Day said he accepted the arrest as part of a process that his community must go through before it could begin a healthy debate about reducing the spread of AIDS by addicts."
Legislation recently signed by the President contained a provision lifting the ban on local funding for syringe exchanges in the District of Columbia. The New York Times reported on Dec. 27, 2007 ("New law Allows Needle Exchanges in Washington") that "Since 1999, the nation's capital, which reports having the highest rate of AIDS infection of any major city in the country, has been the only city barred by federal law from using municipal money for needle exchanges. A recent report by the city showed that intravenous drug users' sharing of needles was second only to unprotected sex as a leading cause of H.I.V. transmission. Congress controls local government here, and for nine years members of the House, expressing concerns about worsening drug abuse, had inserted into the bill approving the city's budget a provision to prohibit financing needle exchange programs. But with Republicans' loss of Congressional control to Democrats, this year's bill, signed by Mr. Bush on Wednesday, reversed the ban."
According to the Times, "Officials of the District of Columbia Health Department said that with the ban lifted, they would allocate $1 million for such programs in 2008."
The Times noted that "'For too long, Congress has unfairly imposed on the citizens of D.C. by trying out their social experiments there,' said Representative Jose E. Serrano, the New York Democrat who heads the House Appropriations subcommittee that handles the city's budget. 'The ban on needle exchanges was one of the most egregious of these impositions, especially because the consensus is clear that these programs save lives.'"
San Francisco Considers Establishing Safe Injection Site
The Tenderloin, a notorious San Francisco dwelling of injection drug users, is an obvious choice for a city-funded, legal center where intraveneous drug users can receive free needles and consume drugs in a safe environment according to an October 19, 2007 San Francisco Chronicle article ("S.F. Injection Center Idea Draws Support and Doubt"). The Chronicle reported that 'Momentum for such a center seems to be gaining strength among drug reform advocates and some public health workers, who say it will help stop the spread of HIV and hepatitis C, prevent deaths from drug overdoses and keep dirty needles off city streets.Supporters include the San Francisco AIDS Foundation, the Mission Neighborhood Resource Center, the Harm Reduction Coalition and San Francisco General Hospital's Opiate Treatment Outpatient Program. But so far, no San Francisco politician appears ready to champion the cause."
According to the Chronicle, "It took 10 years of community organizing for the Vancouver center to go from idea to reality, said Sarah Evans, the center's program coordinator, who spoke Thursday at the San Francisco symposium. Insite, which opened four years ago, is North America's only injection drug center, though many exist in Europe. Insite is a rather bland, sterile place used by 800 intravenous drug users every day. They bring their own drugs - most often heroin, crack, cocaine and crystal methamphetamine - but are given free needles by the center's staff. The center hands out and collects 2 million needles a year. Despite a lot of initial skepticism, the Vancouver center now has the backing of the majority of the public, the mayor, the police chief and local merchants, Evans said."
The Chronicle noted that "The center has proven it can help stop the spread of disease and prevent deaths from overdoses, said Dr. Thomas Kerr, an HIV/AIDS researcher at the University of British Columbia. He has studied Vancouver's injection facility since its inception, and spoke at Thursday's event. Kerr said 800 overdoses have happened at the facility, but they have resulted in no deaths because trained professionals are right there. Without the center, overdoses would happen in back alleys or single-room-occupancy hotel rooms where there would be no help, he and other supporters of the facility said.' It's really been studied to death - it's time to move on,' Kerr said. 'It's obvious this is something that works."
The federal ban on funding of syringe exchange services in the District of Columbia is edging closer to an end. The full US House of Representatives agreed to drop the ban from the DC budget bill. According to the Library of Congress's THOMAS system, the amendment to prohibit the use of funds to be used for the Prevention Works! or Whitman-Walker Clinic needle exchange programs (House Amendment 466, sponsored by Rep. Mark Souder (R-IN) amending HR2829) was defeated by a roll call vote of 208-216 on June 28, 2007.
The Washington Post wrote in an editorial on July 2, 2007
Groups in DC involved in syringe exchanges are preparing for the lifting of the funding restriction. The Washington Post reported on July 1, 2007 ("Big Break For Small Crusade") that "Now that the House has lifted the ban, over White House objections, such organizations as PreventionWorks! could begin tapping into local tax money as early as October, said D.C. Health Director Gregg A. Pane. The bill must still go through the Senate, which is not expected to reverse the decision. The Health Department would commit $1 million to support needle-exchange programs, HIV testing and intravenous-drug counseling services next year, Pane said. The city would allocate $250,000 to PreventionWorks!, he said, but would also encourage other programs in the city, including several run by the Health Department, to begin offering needle-exchange and drug counseling services. 'This isn't just giving away needles,' Pane said. 'It's a chance to interact with people. To do HIV and hepatitis testing and make the appropriate referrals to detox. It's a chance to interact with folks and do a number of good things.'"
The Post noted that "The Whitman-Walker Clinic helped set up PreventionWorks! after the clinic's government funding was jeopardized by the ban. In 1998, as the newly named executive director of PreventionWorks!, [Paola] Barahona delved into books at District libraries, teaching herself how to apply for private grants that would subsidize the program. With an operating budget of about $666,000 this year, almost all of the funding comes from private donations. It was only last year that PreventionWorks! got its first District contract. The $15,000 grant was not for a needle exchange but to provide HIV testing to Ward 7 residents as part of a three-month health initiative. By the end of the program, 433 people were tested; 5 percent tested positive. PreventionWorks! has two full-time employees: Barahona and Ron Daniels, who oversees its street outreach program. There are also three part-time workers. PreventionWorks! relies heavily on the 137 volunteers who help pass out needles and offer counseling at its offices, on 14th Street behind the Whitman-Walker food bank, or twice a week from its Winnebago at sites across the city. With the funds, she says, the program would expand such services as HIV testing and counseling and increase the number of support workers. From Oct. 1, 2005, to Sept. 30, PreventionWorks! counselors saw more than 10,000 addicts. During that time, they passed out more than 236,000 needles. The District has one of the highest HIV infection rates in the nation, with as many as one of 50 D.C. residents testing positive for the virus, according to Health Department estimates. About one-third of new AIDS cases annually are caused by syringes passed among drug users."
The ban on funding for syringe exchanges in Washington, DC, imposed by the US Congress years ago, may soon be lifted. The Associated Press reported on June 6, 2007 ("Needle Exchange Ban Lifted From DC Budget") that "A congressional subcommittee has voted to lift a ban on the use of local tax money for a needle exchange program in the District. Members of the House Subcommittee on Financial Services and General Government voted Tuesday to remove the prohibition from an appropriations bill governing the D.C. budget. The measure has been included as a rider each year since 1998."
According to AP, "The District has one of the worst rates of HIV/AIDS infection in the country. Officials said intravenous drug users account for a third of new AIDS cases, reported each year. A nonprofit group has operated a limited needle exchange program in the city for several years."
The AP noted that "The District budget is still subject to a series of votes in the House and Senate before it is sent to the White House for President George W. Bush's signature. D.C. Mayor Adrian Fenty has said he would provide local funding for a needle exchange program if the ban is removed."
A survey of Canadian citizens in several major cities showed strong support for use of sanitary consumption facilities similar to the Insite project in Vancouver, British Columbia. The Edmonton Sun reported on May 30, 2007 ("Safe Injection Site Supported") that "A recent Canada West Foundation survey found 47% of Edmontonians think safe injection sites are a good or very good idea. The survey polled Canadians in seven major cities -- six in the west, plus Toronto. It found support for safe injection sites ranged from a low of 42% in Winnipeg to a high of nearly 55% in Vancouver."
According to the Sun, "Darren Grove, supervisor of Edmonton's park ranger unit, said while he doesn't have any hard numbers, he figures workers are picking up 1,000 to 1,500 discarded needles in the river valley each year. The last time the city had hard numbers was in 2005, when officials collected 497 needles from park areas, most of them around homeless camps. 'Absolutely there is a concern,' Grove said. 'We don't want to have someone stumble across them and accidentally get struck with a needle.' Marliss Taylor, who speaks for Streetworks, said while the group isn't pushing for a safe injection site, it would welcome one. 'We're not hopeful it will happen here at this time,' she conceded, noting the federal government appears opposed to the concept."
The Sun noted that "However, when respondents were asked to rank potential responses to illegal drug activity, safe injection sites ranked well below increased law enforcement and increased programs for addicts."
Research published in the journal Addiction shows that use of a sanitary consumption facility by drug users in Vancouver, BC, is leading some drug users to enter detox and eventually drug treatment. The Vancouver Sun reported on May 25, 2007 ("Insite Raises Use Of Detox, Report Says") that "The report, published in a London-based medical journal, says Insite has resulted in a 30-per-cent increase in the use of detoxification programs such as methadone replacement therapy, addiction counselling, or participation in Narcotics Anonymous. That higher use of detox since Insite opened in 2003 suggests, based on previous research, that the facility 'has probably helped to reduce rates of injection drug use among users of the facility,' concluded the five scientists at the B.C. Centre for Excellence in HIV/AIDS in their report, published in the June issue of the peer-reviewed medical journal Addiction."
According to the Sun, "Health Minister Tony Clement questioned whether research supported Insite last September when he refused to grant a 31/ -year extension in the facility's federal permit. Clement, noting that Prime Minister Stephen Harper's government is about to introduce a tough national drug strategy that puts more focus on enforcement and less on so-called 'harm reduction' measures like injection sites and needle exchanges, suspended Ottawa's decision on Insite's future until the end of this year. 'The government seems intent on ignoring scientific evidence to pursue an ideological agenda at the expense of lives in the Downtown Eastside,' co-author Dr. Julio Montaner said in a statement. He said the new conclusions answer Clement's questions about whether Insite is contributing to lower drug use and fighting addiction."
The Sun noted that "The new report in Addictions, summarizing results of a study funded by the federal government, said the average number of users entering detox programs increased to 31.3 from 21.6 in the year after Insite opened. While that increase represents an increase of roughly 50 per cent, the researchers adjusted the results to take into consideration other factors in coming up with the 30-per-cent figure. 'There have been many benefits of Insite in terms of public order and reduced HIV risk,' said co-author Dr. Evan Wood. 'However, the fact that it appears to be pulling people out of the cycle of addiction by leading them into programs that reduce drug use is remarkable.'"
A copy of the Addiction article, "Rate of detoxification service use and its impact among a cohort of supervised injecting facility users," is available by clicking here.
The Texas State House of Representatives passed legislation creating the state's first legal needle exchange as a pilot project. The Ft. Worth Star-Telegram reported on May 22, 2007 ("House Votes For State's First Needle-Exchange Program, But Only In Bexar County") that "The Texas House voted to allow the state to create the first ever needle-exchange program for intravenous drug users -- but only as a pilot project around San Antonio. The provision was added to a broad Medicaid bill, Senate Bill 10, which was sponsored in the House by Rep. Dianne White Delisi, R-Temple. Rep. Ruth McClendon, D-San Antonio, at first tried to add an amendment to the bill that would create a statewide needle-exchange program. But she limited her amendment to Bexar County, where San Antonio is, when it appeared that she did not have support in the House for the broader program."
According to the Star-Telegram, "McClendon said Texas is the only state without a needle-exchange program. 'The purpose of the clean-needle program is to keep them from spreading the disease,' she said, referring to hepatitis C and HIV, which are commonly spread by intravenous drug use. Delisi did not dispute the public health benefits but said that constituent concerns about appearing to support illegal drug use outweighed those benefits. 'Our constituents [are concerned] about [whether] promoting the free exchange of needles for the illegal use of intravenous drugs is something the state should be doing,' she said.
The Star-Telegram noted that "Under the program, IV drug users could anonymously exchange their used syringes for clean ones. The details of the program remain to be worked out. The amendment was adopted in the House 71-60."
Now that the state has finally authorized it, several cities in New Jersey have begun the process of applying to the state to begin legally operating syringe exchange programs. The Cherry Hill Courier-Post reported on May 13, 2007 ("Cities Apply To Start Needle Program") that "Five of the 12 eligible cities have applied to the state Department of Health and Senior Services to begin pilot needle exchange programs. Up to six municipalities could receive permission to start needle exchange programs -- hoped to curb the spread of HIV/AIDS and other diseases among intravenous drug users -- provided they exceed certain statistics: 350 residents with HIV/AIDS and a prevalence rate attributable to drug use of more than 300 per 100,000 residents. Of the 12 cities that meet the criteria, Camden and Atlantic City, which have long sought exchange programs, applied, along with Newark, Paterson and Trenton. Asbury Park, New Brunswick, Plainfield, East Orange, Elizabeth, Irvington and Jersey City did not. 'It's been a battle, so we're glad to see it,' said Ron Cash, director of Atlantic City's Health Department, which plans to provide needle exchanges through vans and fixed sites."
According to the Courier-Post, "By the end of the summer there could be up to five programs in New Jersey -- the last state to have any sort of needle exchange program. Camden's program will begin once the state approves its program, which is expected to occur by the end of June. 'It's going to be crucial to saving lives of injection drug users,' said Jose Quann, program coordinator of the Camden Area Health Education Center. 'It's going to affect the community at large where contaminated needles wouldn't be discarded all over the city. Injection drug users will have access to sterile syringes that they might not get infected or infect their loved ones.'"
The Courier-Post noted that "Roseanne Scotti, director of the Drug Policy Alliance, said the programs will work in New Jersey without the rise in crime that critics predict. Some cities that didn't apply are waiting to see how the programs do before starting ones, Scotti said. 'It's a process that takes time,' Scotti said. 'Atlantic City and Camden spent a couple years -- while they were advocating for this -- educating their city officials and educating the staff at the organizations that would do this. . . . I certainly think there are other cities that are interested and that they will just apply late and the state will hopefully grant them some leeway there. We're talking about saving lives here.' If New Jersey's pilot programs work, the Health Commissioner will report to the Legislature in five years whether the program should become permanent and possibly expanded."
The Texas Senate approved legislation allowing operation of syringe exchanges in the state. The San Antonio Express-News reported on April 27, 2007 ("Needle Exchange Approved") that "Texans could save a lot of money if illegal drug users were allowed to exchange clean needles, Sen. Bob Deuell said Thursday before the Senate approved such a program. Texas is the only state in the country that does not allow a needle exchange program for drug users. The Senate voted 22-7 for the measure, which has not cleared the House."
According to the Express-News, "'It brings people in to get rehabilitated. It lessens the contaminated needles in the drug-using community. It cuts down on diseases such as HIV and hepatitis B and C,' said Deuell, a physician and Republican from Greenville. 'And, in the long run, it will save the state money.' The bill did not trigger debate. Treating one person with HIV costs taxpayers an estimated $385,000 over a lifetime, Deuell said. Contaminated needles are responsible for half of all HIV cases and 40 percent of hepatitis C cases in Texas, he said. 'There is no good reason to continue to refuse what we know clearly works,' Deuell said. A clean needle exchange program has resulted in many drug users 'getting off drugs because they went someplace where people cared and got into a rehabilitation program before they caught a disease that might kill them,' he said."
The Express-News noted that "Chances of the bill passing the House are unclear. Many people believe a needle-exchange program encourages drug addicts, said Deuell, who once shared that attitude."
A bill in the Maine Legislature would ease some of the restrictions under which the state's syringe exchanges operate. The Portland Press Herald reported on May 11, 2007 ("Needle Swap Bill Gets Good Reception") that "A state panel is backing legislation that would relax limits on needle-exchange programs for drug users as a way to reduce the transmission of blood-borne infections such as human immunodeficiency virus and viral hepatitis. A bill before the Legislature would allow participants to exchange an unlimited number of used syringes for sterile ones, eliminating the current limit of 10 per visit. The measure also would protect participants from criminal charges that could stem from the possession of residual amounts of drugs in the used syringes."
According to the Press Herald, ""Clearly, if you're in a rural area, this bill will help you, because you can drive fewer times and exchange more needles," said the bill's sponsor, Rep. Lisa Miller, D-Somerville. Miller introduced the bill at the request of the state HIV Advisory Committee. The proposal will go before the Health and Human Services Committee today for a public hearing. A total of 555 people are enrolled in four state-certified needle-exchange programs in Maine. The programs are in Portland, Augusta, Bangor and Ellsworth. On average, 10 syringes are the equivalent of a three-day supply, said Martin Sabol, the advisory committee chairman and manager of Portland's infectious-disease program."
The Press Herald noted that "Maine would not be alone in having no cap on exchange programs. Oregon, Hawaii, San Francisco and Baltimore already allow an unlimited number, she said. Proponents acknowledged that some uneasiness remains around needle-exchange programs because of a sense that they condone drug use. Maine passed a law allowing them 10 years ago."
After a tense legislative session New Jersey became the final state in the US to approve access to sterile syringes. The Newark Star-Ledger reported on Dec. 12, 2006 ("Lawmakers OK Clean-Needle Bill") that "After more than a dozen years and countless hours of impassioned debate, the Legislature yesterday passed a bill to prevent the spread of HIV and AIDS among drug addicts by allowing needle exchange programs in six cities. Gov. Jon Corzine said he would sign the bill into law quickly. 'The science is clear: Needle exchange programs reduce sharing of contaminated needles, reduce transmission of HIV and hepatitis C and serve as gateways to treatment,' Corzine said. For 13 years, lawmakers have wrestled with the legal and moral paradox of giving addicts syringes to use illicit drugs. Opponents questioned scores of scientific studies, the vast majority of which have found that needle exchanges reduce drug users' exposure to AIDS and do not entice more people to use drugs."
According to the Star-Ledger, "'The bottom line is that this program will save lives,' Corzine said. 'I applaud the Legislature for getting it to my desk, and I look forward to signing the bill and seeing the program implemented rapidly.' Health and Senior Services Commissioner Fred Jacobs called the vote a 'great day for public health in New Jersey' and praised the inclusion of $10 million for drug treatment services. 'Hopefully we will put this behind us and get on with the issue of saving lives,' Jacobs said. Atlantic City health officer Ron Cash, who came to witness the vote in Trenton, said the city already has passed an ordinance permitting the pilot exchange program -- a requirement of the bill -- and could have a syringe access program operating in three to six months. 'We've tried education, counseling,' Cash said. 'We just want this as a tool to fight the disease.'"
The Star-Ledger noted that "After more than two hours of emotional discussion, the Senate approved the bill ( S494 ) 23-16. Minutes later, the Assembly passed the bill 49-27 with four abstentions. 'The action we are taking today will save lives,' said Assembly Speaker Joseph Roberts ( D-Camden )."
The United States once again has blocked a UN resolution on AIDS because of objections to needle exchange programs. The Associated Press reported on Sept. 21, 2006 ("AIDS Treatment Resolution Withdrawn At WHO Meeting Because Of US Opposition") that "A resolution calling for universal access to HIV/AIDS treatment has been withdrawn from the World Health Organization's Asia-Pacific conference because the United States insisted on changing it, senior officials said Friday. American officials submitted a series of last-minute amendments to remove expressions of support in the resolution for items such as needle exchange programs for drug addicts, said officials at the meeting in Auckland, New Zealand's largest city. New Zealand Health Minister Pete Hodgson, who chaired WHO's annual weeklong conference of officials from the Western Pacific region, said the U.S. amendments would have watered down the resolution. Negotiations failed to resolve differences over the wording. 'So, having ascertained that no resolution would do no damage ... I put it to the meeting that we would be better off to have no resolution than one that was perceived to be weakened,' Hodgson told The Associated Press."
According to AP, "Hodgson said one of the issues U.S. delegates had sought to change was references to needle exchange programs for intravenous drug users — which advocates say help stop the spread of HIV through the sharing of syringes. The U.S. 'position is that if they have needle exchanges then people will use needles more and use intravenous drugs more,' Hodgson said. 'I think it is demonstrably wrong. New Zealand has had needle swaps for 20 years — it has been an amazing success.' WHO's acting regional director, Richard Nesbit, confirmed the resolution had been withdrawn on the last day of the conference after U.S. officials sought changes. He said the U.S. delegation also had issues with spelling out specific high-risk groups such as sex workers, intravenous drug users and men who have sex with men. 'They had been advised by Washington to make a number of changes to the language,' Nesbit said, adding that WHO estimates injecting drug users make up more than a third of the region's new HIV cases."
AP noted that "UNAIDS estimated that 8.3 million people were living with HIV, the virus that causes AIDS, last year in the Asia-Pacific region — including South Asia, Indonesia and Thailand, which are not part of the Western Pacific region. Nearly 85 percent of those infected had no access to anti-retroviral drug treatment, it said."
The state of New Jersey is moving nearer to finally allowing access to sterile syringes. The Newark Star-Ledger reported on Sept. 19, 2006 ("Senate Panel Advances Needle Exchange Bill") that "After a full day of public hearings and backroom bargaining, the state Senate Health Committee reached a compromise last night on legislation aimed at combating the spread of AIDS by allowing addicts to exchange dirty needles for clean ones. The bill (S-494) was approved 5-2, with one abstention, after being amended to limit needle exchange programs to six municipalities and subject them to re-evaluation at the end of five years. It was alsochanged to include $10 million for drug treatment programs, which some senators insisted should be the state's priority. The committee deadlocked and took no action on companion legislation that would have allowed pharmacies to sell up to 10 syringes without a prescription. Sen. Joseph Vitale (D-Middlesex), the sponsor of that bill (S-823) and the committee chairman, said, 'We all want to have further discussion and a little more research.'"
According to the Star-Ledger, "Yesterday, Health and Senior Services Commissioner Fred Jacobs told lawmakers the state "should not delay another minute" in providing access to clean needles. He said New Jersey is "the only state in the nation that has failed to give communities the tools they need" to combat the spread of AIDS. In July, Delaware established a pilot needle exchange program, leaving New Jersey as the only state that has no such program and also forbids the sale of syringes without a prescription.
The Star-Ledger reported that "The bill must also be approved by the Budget and Appropriations Committee because of the $10 million for treatment programs, and then go to the full Senate and Assembly. The legislation would allow up to six cities or towns to apply to the state Health Department to begin demonstration programs. Camden and Atlantic City have already expressed interest. Atlantic City attempted to set up its own program but last year a state appeals court ruled it was illegal. Sen. Nia Gill (D-Essex), who sponsored the needle-exchange legislation, said the compromise version is 'not perfect, but I'm not here to be the enemy of the good.' Her original version would have allowed any municipality to establish such a program. Roseanne Scotti, director of the Drug Policy Alliance of New Jersey, said the bill's approval was 'a huge step' and 'really historic.' She said it was the first time in her 13 years of lobbying that such a bill won approval in the Senate Health Committee, which last year killed a needle-exchange program passed by the Assembly.
The Star-Ledger noted that "Jacobs, the state health commissioner, said replacing HIV-infected needles with clean ones is a basic public health measure on a par with killing mosquitoes that spread the West Nile virus or pulling 'bad spinach' from grocery shelves. Addicts will 'be on drugs with or without these free syringes,' Jacobs said. 'If you don't have infected syringes, you don't pass the infection.'
The Massachusetts State Legislature in July overrode the governor's veto of legislation to allow sale of sterile syringes without prescription. The Worcester Telegram & Gazette reported on July 24, 2006 ("Lawmakers Override Needle Veto") that "State lawmakers last week overrode a Gov. Mitt Romney veto of the long-debated bill, which opponents criticized for putting the state in the position of condoning intravenous drug use. 'This particular bill, now that it's the law, will, in fact, slow down the spread of HIV,' said Edla L. Bloom, executive director of AIDS Project Worcester. 'There will be tangible numbers. People that are getting infected from injection drug use, or relationships with people who are injection drug users, those numbers will go down as they have in other states.' Buying hypodermic needles in Massachusetts has long required a prescription."
According to the Telegram & Gazette, "The fight over the needle bill was an offshoot of a contentious debate over clean needle exchange that in recent years has visited many cities in Massachusetts. Supporters of needle-exchange programs point to Boston and Cambridge -- both have been distributing needles to addicts for more than a decade -- which boast of the lowest rates of injection-related HIV transmissions in the state. The HIV service community was virtually united in support of distributing needles to addicts who otherwise would be prone to sharing needles and spreading the disease. But in many cases it came up against unwavering political opposition. District 4 City Councilor Barbara G. Haller has been one of Worcester's loudest voices against providing addicts with easy access to clean syringes, arguing that advocates of such policy do more harm than good. Ms. Haller said government should be aggressively reaching out to addicts with information about the dangers of drug use, information that also should be made available to the public at-large and children. Drug use, she said, ought to be taboo."
The Telegram & Gazette noted that "In the wake of the more than two-thirds override vote by both the Senate and House, AIDS Action Committee of Massachusetts Executive Director Rebecca Haag said the result would be lives that are saved, a reduction in new infections and millions in savings for the state in health care costs. State data show 39 percent of people with HIV/AIDS in Massachusetts infected directly or indirectly by a dirty needle."
The governor of Massachusetts, Milt Romney Jr., in June 2006 vetoed a piece of legislation which would have reduced the incidence of HIV/AIDS in Massachusetts. The Lowell Sun reported on July 1, 2006 ("Romney Vetoes Needle-Sale Measure") that "Gov. Mitt Romney yesterday vetoed a bill that would allow for the sale of hypodermic needles without prescription, saying it could help promote heroin use and send the wrong message to young people. Romney said the bill, which proponents hope will stem the spread of blood-borne diseases such as HIV and hepatitis C, would have had 'unintended consequences' such as encouraging more widespread heroin use."
According to the Sun, "The veto was disappointing news, if not surprising, for Lowell Health Director Frank Singleton. 'All the evidence shows this bill would do good,' he said, reached by phone yesterday. In addition to preventing the spread of disease, decriminalizing the possession of needles helps protect police and other public safety officers, because IV drug users don't hide their needles in their pockets and clothing, Singleton added. 'There would not be more dirty needles in the street,' he said. '( The decision to veto is ) basically a political decision made by some people on an ideological basis.'"
The Sun noted that "Proponents of the bill cited a 2001 study by the American Journal of Public Health that studied drug use in 90 metropolitan areas and found there was no evidence that allowing needles to be sold over the counter would lead to increased drug use. Most states in the U.S. allow sales of hypodermic needles without a prescription for that reason, Singleton said. 'If ( all these problems ) are going on, why are all the other states allowing over-the-counter sales?' he said. 'We're not exactly in the majority here.'"
The American Civil Liberties Union's Drug Law Reform Project succeeded in winning heightened protection for a Connecticut needle exchange in June 2006. According to the Drug War Chronicle ("ACLU Wins Victory In Connecticut Needle Exchange Case," June 2, 2006), "In a case brought by the American Civil Liberties Union Drug Law Reform Project, a federal judge has ruled that protections she previously granted to people possessing needles should be expanded to include other injecting equipment as well."
The Chronicle reported that "In 2001, acting on complaints of harassment and persecution by drug users and needle exchange workers in Bridgeport and citing the Fourth Amendment's protections against unreasonable search and seizure, the ACLU won an order blocking the Bridgeport Police Department 'from searching, stopping, arresting, punishing or penalizing... any person based solely upon that person's possession of up to thirty sets of injection equipment.' But as she prepared to hand down her latest ruling Thursday, US District Court Judge Janet Hall complained that 'my order may well have been written in invisible ink.' On Thursday, she chastised the Bridgeport police for failing to diligently follow her earlier order, but rejected an ACLU motion to find the department in contempt. She did, however, expand the protection in the earlier order to include injection equipment such as cotton balls and items used to cook drugs."
The Chronicle noted that "The Bridgeport Syringe Exchange, in operation for more than a dozen years now, is one of around 200 such programs in the country. Every scientific study of needle exchanges has found that they are an effective way of reducing the spread of infectious diseases such as HIV/AIDS and Hepatitis C. 'The police can contribute to public health and safety by supporting efforts that engage injection drug users in disease prevention programs that simultaneously serve as conduits to treatment for addiction,' said Robert Heimer, PhD, a professor at Yale School of Public Health and a nationally renowned expert on the emergence and prevention of infectious diseases. 'In the long run, this is the only reliable means to decrease addiction at the community level.'"
AIDS experts and advocates are concerned that US pressure may hinder the worldwide fight against AIDS. The Washington Post reported on June 1, 2006 ("Weaker UN Declaration On AIDS Is Feared") that "Negotiations over an updated version of the United Nations' 'declaration of commitment' on AIDS are bogging down in battles over the language sensitivities of Islamic countries and the reluctance of the United States to have specific, very expensive global targets spelled out in detail. According to numerous people in close contact with the negotiating teams, the declaration that will be presented to the General Assembly tomorrow may be far weaker than the one adopted in 2001. Though that declaration was not a binding document the way a treaty is, it is widely believed to have been a key factor in marshaling the world's energy and resources to address the needs of AIDS patients in the developing world. Some participants said it will be ironic if the new declaration turns out to be vague in its goals and sanitized in its language, as an unprecedented number of activist groups and civil society organizations -- about 800 in all -- were invited to take part in preparing it and have been pressing for greater explicitness and accountability. 'We are seeing the U.N. system poised to take an enormous step backward,' said Kim Nichols of the New York-based African Services Committee. 'If we can't arrive at a unified set of global targets, then we're in deep, deep trouble.'"
According to the Post, " UNAIDS, the United Nations' AIDS program, estimates that $20 billion to $23 billion a year will be needed by 2010. The United States now spends more on AIDS in the developing world than any other country and is considered likely to continue supporting the large number of people now getting antiretroviral therapy through the $15 billion President's Emergency Plan for AIDS Relief (PEPFAR) even after its five-year term expires. People familiar with the negotiations here said the U.S. delegation fears that the United States will be held more accountable than other donors for funding shortfalls that may occur in the future if the targets are spelled out explicitly. Civil society groups want a target of providing drugs by 2010 to 80 percent of people whose infection is advanced enough to require antiretroviral treatment and to 80 percent of infected pregnant women, as well as to all people who have both tuberculosis and AIDS. None of those goals is mentioned in a draft of the declaration dated May 30. The United States is seeking to have the document 'take note' of a goal of providing UNAIDS $20 billion to $23 billion by 2010, rather than having that need 'recognized.'"
UN officials and AIDS experts are expressing concern that anti-AIDS efforts are faltering internationally. Reuters reported on May 30, 2006 ("Anti-AIDS Drive Still Falling Short After 25 Years") that "Twenty-five years after AIDS was first recognized, the world is still falling short in its battle against the disease with severe gaps in prevention and treatment, the United Nations said on Tuesday. 'Despite some notable achievements, the response to the AIDS epidemic to date has been nowhere near adequate,' said UNAIDS, the U.N. agency that coordinates the global campaign against the pandemic."
According to Reuters, "The global AIDS incidence rate is believed to have peaked in the late 1990s. About 1.3 million people in the developing world are now on life-extending antiretroviral medicines, which saved about 300,000 lives last year alone. Still, some 4.1 million people were newly infected and 2.8 million died in 2005. There were 4.9 million new infections and 3.1 million deaths in 2004. Fewer than half of young people were knowledgeable about AIDS. Among those injecting illegal drugs or having homosexual sex, few received preventive services last year. The global supply of condoms was less than 50 percent of what was needed, and antiretroviral drugs, while more widely available, remained costly and hard to get. Ignored in many countries are prostitutes, said Thoraya Obeid, the Saudi Arabian executive director of the U.N. Population Fund. She said they also had the right to prevention and treatment, especially since many were poor women or girls, sold into prostitution and victims of violence. However, a final statement by governments at the conference this week is not expected to refer to prostitutes, drug users or homosexuals, due to objections from Islamic nations, some Catholic countries and the United States which fear that merely mentioning these groups would endorse their behavior. Infected individuals still suffer from ostracism and discrimination, while the vast majority of the world's 40 million infected people have never been tested for HIV and are unaware of their status, the report said."
Reuters noted that "While $8.9 billion is expected to be available in 2006 to combat AIDS in developing countries, $14.9 billion will be needed, UNAIDS said. By 2008, it predicted, $22.1 billion would be needed, including $11.4 billion for prevention plans alone."
In England in May 2006, an independent panel funded by the Joseph Rowntree Foundation issued a report endorsing use of safe consumption rooms. The Guardian reported on May 23, 2006 ("Heroin Addicts Could Inject Themselves At Supervised Centres In Police-Backed Plans") that "Police chiefs have backed proposals which could see heroin addicts injecting themselves in officially sanctioned centres. An independent working group, tasked by the Joseph Rowntree Foundation, will today recommend the introduction of supervised drug consumption rooms to the UK, so that users could take illegal drugs in safe, hygienic surroundings. Members of the group included Andy Hayman, a Scotland Yard assistant commissioner who also chairs the Association of Chief Police Officers' drugs portfolio, and his Acpo colleague, Met police detective superintendent Kevin Green."
According to the Guardian, "There are 65 drug consumption rooms ( DCRs ) in eight countries worldwide, including Switzerland, Germany, Spain, Australia and Canada, and the working group, which visited some of these during its 20-month research period, believe they reduce the risk of harm to the individual as well as the costs to society. Unlike so-called 'shooting galleries', which are largely unsupervised and where drugs are often purchased, or premises where prescribed heroin is available, users would bring their own drugs to DCRs, and although supervisors would not be able to intervene, they could advise and give immediate assistance if a user collapsed. The initial pilot proposal is for injection facilities, but European countries are increasingly adding smoking rooms, where heroin and crack cocaine can be smoked."
The Guardian noted that "Four years ago, the Home Office rejected similar recommendations from the home affairs select committee. But Dame Ruth Runciman, the chairwoman of the independent working group, hoped the government would now reconsider. 'The Home Office rightly said in 2002 that there was not enough evaluated evidence from drug consumption rooms abroad,' said Dame Ruth. 'There has been a lot more evidence since. There have been millions of injections in drug rooms abroad and only one death, which was not due to an overdose.' She suggested the consumption rooms could be run by local authorities, the NHS and voluntary bodies, but added: 'Most importantly and without question, they must involve the police.' She said the two police officers on the working group supported the group's findings as individuals, but she was aware there would be a range of reactions among the police."
Unfortunately the UK's Home Office may not be as willing to examine the evidence as Dame Ruth hoped. The opposition Tories may on the other hand be more flexible. The Daily Telegraph reported on May 24, 2006 ( "Tories Back Injection Centres For Drug Addicts") that "The Tories tentatively supported calls yesterday for the Government to set up special centres where heroin addicts could legally inject themselves. In a surprise move, Edward Garnier, the shadow home affairs minister, said: 'We do not rule out [these] recommendations. If this is to take place in a controlled environment and is to be used as a stepping stone to actually getting people off drugs, we will look at this carefully.'"
The ruling Labour Party on the other hand was less receptive. According to the Telegraph, "Vernon Coaker, the Home Office minister, said the Government's position was unchanged. 'The reasons for rejecting it in 2002 are as valid today - the risk of an increase in localised dealing, anti-social behaviour and acquisitive crime,' he said. But the DrugScope charity, which campaigns to shape drugs policy, welcomed the Joseph Rowntree Foundation report and said it hoped for a rational debate. 'A policy which can save lives deserves serious consideration, however controversial it may seem at first,' said Martin Barnes, the charity's chief executive."
The American Academy of Pediatrics issued a new policy statement in early February 2006 strongly endorsing use of needle exchanges and other risk reduction methods for preventing HIV infection. The Associated Press reported on Feb. 6, 2006 ( "Pediatricians Group Backs Needle Exchanges") that "Pediatricians should speak out in support of needle exchange programs to reduce the spread of HIV among injection drug users, the American Academy of Pediatrics says in a toughened policy statement. Doctors also should discuss HIV risk with their teenage patients "with a nonjudgmental approach" and offer confidential help if local laws allow, the group says in the statement appearing Monday in the journal Pediatrics. "If we can help young people avoid a chronic illness that we have no cure for, I would hope people would embrace that idea," said the lead author, Dr. Lisa Henry-Reid of Chicago's John H. Stroger Jr. Hospital."
According to AP, "The new policy statement says of needle exchange programs, which let addicts trade dirty syringes for clean ones: "Pediatricians should advocate for unencumbered access to sterile syringes and improved knowledge about decontamination of injection equipment." The beefed-up wording is based on research showing the programs reduce HIV infection, said Dr. Peter Havens of the Medical College of Wisconsin, a member of the committee that wrote the policy. Needle exchange programs can include counseling to further reduce risky behavior, but opponents say they work against efforts to fight drug abuse. Congress has banned federal funding of needle exchange programs, but the Centers for Disease Control and Prevention says they can reduce the spread of disease without increasing drug use."
The policy statement, "Reducing the Risk of HIV Infection Associated With Illicit Drug Use, was published in the Feb. 2006 issue of Pediatrics. The abstract is below. A complete copy of the statement can be downloaded from the CSDP research archive or directly from the AAP.
Following is the report abstract:
An executive order authorizing needle exchanges in New Jersey expired at the end of 2005, which prompted the withdrawal of the lawsuit filed by a handful of state legislators blocking the order. The Associated Press reported Jan. 19, 2006 ( "Legislators Pull Suit As Time Runs Out On Needle Exchange Order") that "Four Republican lawmakers on Thursday said they were withdrawing their lawsuit to prevent needle exchanges from starting in three cities because the order authorizing the program had expired. Declaring a public health emergency, former Gov. James E. McGreevey used his executive power just before leaving office in 2004 to authorize syringe access programs for drug users in Atlantic City, Camden and a third, unnamed city. The order was challenged almost immediately, however, and lapsed on Dec. 31, before the lawsuits were resolved or any programs were running. New Jersey and Delaware are the only states that do not provide access to free needles. Proponents say such programs stem the spread of AIDS and HIV by providing clean, sterile needles to intravenous drug users. Opponents contend that giving needles to drug abusers fuels addiction and its accompanying ills, and fails to address social problems like poverty and unemployment that lead to drug addiction. The litigation filed by Sens. Ronald Rice, D-Essex, and Tom Kean, R-Union, and Assemblymen Joe Pennacchio, R-Morris, and Eric Munoz, R-Union, claimed that there was no emergency and McGreevey did not have the right to bypass the Legislature on the issue."
According to AP, "Bills authorizing needle exchange programs in the state have been introduced in both houses of the Legislature, which convened Jan. 10. Similar legislation was approved by the Assembly in the prior session but stalled in the Senate. Gov. Jon S. Corzine indicated during the campaign that would support a needle exchange initiative. 'This issue transcends party lines,' Corzine spokesman Anthony Coley said Thursday. 'Legislators of all political stripes agree that we must curb the spread of HIV and AIDS, which has skyrocketed in our communities. The governor is considering how best to achieve this goal and welcomes input from these legislators.'"
In its story, AP noted that "Recent court decisions have gone opponents' way. The Appellate Division stayed the executive order in June, siding with the four lawmakers. A three-judge Appellate Division panel shot down Atlantic City's syringe-exchange program July, saying it violated state drug laws. Advocates have filed a petition with the state Supreme Court to hear the case. 'We would hope the state Supreme Court would hear this case,' said Roseanne Scotti, director of the pro-needle exchange Drug Policy Alliance. 'We think it's a very important one about the power of municipalities to guard their local citizens.'"
The sponsor of needle exchange legislation in New Jersey is using a senatorial privilege in order to force a vote on the exchange bill in the state's senate. The Newark Star-Ledger reported on Jan. 6, 2006 ( "'Senatorial Courtesy' Blocks Bid For Reform") that " State Sen. Nia Gill (D-Essex) is blocking acting Gov. Richard Codey's appointment of two reformers to the UMDNJ board of trustees until the governor uses his power as Senate president to revive an unrelated proposal to provide clean needles to drug addicts. Gill acknowledged she is using the long-standing tradition of 'senatorial courtesy' to block dozens of appointments, including law professor Paula Franzese's nomination to the UMDNJ board. She said she will relent only if Codey forces the stalled needle exchange bill before the full Senate for a vote. 'We have a public health epidemic,' Gill said. 'Senatorial courtesy is not being used to advance a (real estate) development or please a party boss, but for women and children who may even not be in a position to vote for me.'"
The Star-Ledger reported that " Gill said she has nothing against reforming UMDNJ. She just wants to force a vote on needle exchange legislation that she believes is critical to the health of many of the state's most vulnerable residents. Codey failed to convince Gill to drop her objections during a private meeting Wednesday. He said he had nothing but respect for Gill 'as a lady and as a state senator,' but declined to comment further. The governor pointed out the irony of the standoff: Not only is he a long-time ally of Gill, but he supports needle exchange. 'I voted for needle exchange, so I'm not necessarily disagreeing with her. That's life,' Codey said. Still, the governor has refused to use his power as Senate president to give special consideration to the needle exchange bill, even if it means delaying plans to reform UMDNJ. The needle exchange measure passed the Assembly but is stalled in the Senate Health Committee due to lack of support."
The Star-Ledger noted that "Gill and other needle exchange proponents argue that the programs are needed in New Jersey, which has the highest AIDS and HIV rate among women in the nation and the third-highest pediatric AIDS and HIV rate."
The Massachusetts House voted to allow over-the-counter sales of clean syringes in mid-November 2005. The Boston Globe reported on Nov. 15, 2005 ( "House Votes To Allow Sale Of Syringes") that "The Massachusetts House voted yesterday to legalize over-the-counter sale of hypodermic needles to curb the spread of HIV and other blood-borne infections, potentially setting up a political showdown with Governor Mitt Romney over whether the bill will save lives or promote drug use. The controversial measure, which would bring Massachusetts in line with 47 other states that allow syringes to be sold without a prescription, has long been championed by public health advocates, infectious disease doctors, and substance abuse specialists, who argue that it would vastly reduce incidence of AIDS, hepatitis C, and other diseases spread through the sharing of needles. 'This legislation is long overdue in this Commonwealth,' Representative Peter J. Koutoujian, a Waltham Democrat and lead sponsor of the bill, said on the House floor. 'As soon as this legislation passes, it will save lives.'"
According to the Globe, "The House passed the measure, 115-37, after almost three hours of passionate debate. It now goes to the Senate. Representatives of Senate President Robert E. Travaglini's office could not be reached for comment last night. But Senator Susan C. Fargo, a Lincoln Democrat and cochairwoman of the Joint Committee on Public Health, said she's optimistic her colleagues in the Senate will approve the bill. 'I don't think people should be afraid of it,' she said. 'I am delighted it's moving forward.'"
The Globe noted that "The bill would allow anyone 18 or older to purchase a syringe from a pharmacy without a prescription. It also would decriminalize possession of a hypodermic needle, which is a misdemeanor, and require pharmacists to hand out information about treatment programs and about proper use and disposal of syringes to needle-buyers."
Legislation to ease the ability of cities and counties to allow needle exchanges was signed by California's governor in early Oct. 2005. The Lake County Record-Bee reported on Oct. 8, 2005 ( "Governor Signs Berg's Clean-Needle Bill") that "Gov. Arnold Schwarzenegger on Friday signed a bill by Assemblywoman Patty Berg that makes it easier for cities and counties to maintain needle-exchange programs that fight the spread of AIDS and Hepatitis-C. "This bill very simply saves lives," said Berg, D-Eureka. "I'm very happy that it has been signed into law." Assembly Bill 547 will reduce red tape by eliminating a section of state law that requires cities and counties to declare a health emergency every two weeks in order to continue operating a needle-exchange program."
According to the Record-Bee, ""This is a great moment for public health," said Dr. Ann Lindsay, public health officer for Humboldt County. "This bill will allow at least six more counties to conduct needle-exchange programs and protect not only injection drug users, but their families from infectious disease." Last year, the governor vetoed a similar bill by Berg. But this year, Berg and her supporters managed to garner the support of key law enforcement groups. In addition to sponsorship by California's public health officers, the bill had backing from the California Peace Officers' Association and the California Narcotic Officers' Association. In California, more than 1,800 people die of AIDS every year, and 1,500 new infections occur through syringe sharing among intravenous drug users. Another 5,000 people become infected with Hepatitis C in the same manner."
The Record-Bee noted that "The following 14 cities and counties operate needle-exchange programs: the counties of Alameda, Contra Costa, Humboldt, Marin, Mendocino, Monterey, San Francisco, San Mateo, Santa Clara, Santa Cruz, Sonoma and Ventura, and the cities of Berkeley and Los Angeles. Health officers from Butte, Inyo, Riverside, Sacramento, Siskiyou, Solano and Yolo counties have expressed interest in operating exchange programs if Berg's bill becomes law."
In a blow to anti-HIV/AIDS and other harm reduction efforts, an appeals court in New Jersey has upheld the ban on needle exchanges in that state. The Washington Times reported on Aug. 16, 2005 ( "NJ Court Bars Needle Exchanges") that "The court agreed with a judge's ruling that a state law banning the possession and distribution of drug paraphernalia applies to municipalities as well as non-profit groups."
According to the Times, "The appeals panel acknowledged the arguments in favor of the programs. But the judges said that only the Legislature has the power to change the law. 'Atlantic City is not exempt from the Code provisions ... simply because they adopted a needle exchange for beneficent reasons,' the opinion said. When it adopted the needle exchange program, the Atlantic City Council said that the city faced a public health crisis because of AIDS and that 60 percent of AIDS infections came from the sharing of needles by drug users."
Police stations in Scotland are to become syringe distribution sites in an effort to bring transmission of HIV/AIDS via injection drug use under control. The Glasgow Herald reported on Aug. 14, 2005 ( "Needle Exchange At Police Stations") that "Officers are planning to offer free needle exchanges in police stations to try to reduce drug related deaths in Scotland. Figures show that last year there was a significant increase in drug related deaths in the Strathclyde police area, despite ministerial pledges to tackle the issue."
According to the Herald, "Though the number of deaths appears to be dropping this year, police and drug action teams believe offering clean needles to addicts who have been held in police custody could help to further reduce the problem. Currently those arrested by Strathclyde police have their dirty needles confiscated, raising concerns that this is likely to increase the spread of HIV and hepatitis. The police policy of confiscating needles was blamed for rising levels of HIV cases in Scotland in the 1980s. Since then a number of forces have reviewed their approach."
The Herald noted that "Drug related deaths in Strathclyde make up the majority of those in the country. The national figures, which increased last year, will be released by the Scottish Executive at the end of this month. They are expected to show there were approximately 300 drugs deaths in 2004. Superintendent Alistair McKie of Strathclyde police said joint working between the police and drug action teams has since helped to reduce the problem. 'We are not condoning the taking of drugs, but in terms of harm reduction we have to be aware of the health implications,' he said. 'We are considering needles exchanges in police stations. Reducing the number of drug related deaths is a constant battle and although the figures are down this year we can not be complacent . . . 63 drugs deaths is still 63 too many.' At a conference last week on drug related deaths Hugh Henry, the deputy justice minister, said he would consider the issue of the Naloxone pill, an antidote to help users recover from overdoses. Experts also called for safer injecting rooms for homeless people and for heroin prescribing as ways of reducing fatalities, but ministers have not agreed to this."
The US Centers for Disease Control released the results of a survey of syringe exchange programs (SEPs) in mid-July 2005, updating a survey which had been done two years earlier. The survey was conducted by staff from the Beth Israel Medical Center in New York City and the North American Syringe Exchange Network. According to the CDC ( "Update: Syringe Exchange Programs United States, 2002," Morbidity and Mortality Weekly Report, Vol. 54, No. 27, July 15, 2005), "In 2002, for the first time in 8 years, the number of SEPs, the number of localities with SEPs, and the amount of public funding for SEPs in the United States decreased; however, the total number of syringes exchanged and total budgets for all SEPs surveyed continued to increase. During 2000–2002, the number of SEPs known to NASEN decreased 3.8% (from 154 to 148), the number of states/territories with SEPs decreased 8.6% (from 35 to 32), and public funding of SEPs decreased 18% (from $8.9 million to $7.3 million). During the same period, the number of syringes exchanged increased 10.2% (from 22.6 million to 24.9 million) and total SEP budgets from public and private funds increased 7.4% (from $12.1 to $13.0 million). In addition, compared with data from 1998 (5), the proportion of SEPs in 2002 considered mediumsized (10,000–55,000 syringes exchanged) or large (55,001–499,000 syringes exchanged) increased 19%, whereas the proportion of small SEPs (<10,000 syringes exchanged) decreased 33%."
The report noted that "119 SEPs reported exchanging a total of 24,878,033 syringes; seven SEPs did not track the number of syringes exchanged. The 11 largest programs exchanged 49% of all syringes."
Syringe exchanges and similar programs do more than merely hand out syringes. The survey found for example that "SEPs provided other services in addition to syringe exchange. One hundred ten (87%) SEPs provided male condoms, 96 (76%) female condoms, 111 (88%) alcohol pads, and 86 (68%) bleach; 97 (77%) provided referrals for substance-abuse treatment; 91 (72%) offered voluntary on-site counseling and testing for HIV, 54 (43%) for hepatitis C, and 37 (29%) for hepatitis B; 42 (33%) provided vaccination for hepatitis A and 45 (36%) for hepatitis B; 39 (31%) offered sexually transmitted disease (STD) screening; 29 (23%) provided on-site medical care; and 28 (22%) provided tuberculosis screening. Most programs provided risk-reduction and risk-elimination education to IDUs. One hundred fifteen (91%) programs provided education on hepatitis A, B, and C; 114 (90%) on HIV/AIDS prevention; 111 (88%) on safer injection practices; 104 (83%) on abscess prevention and care; 100 (79%) on vein care; 110 (87%) on STD prevention; 110 (87%) on male condom use; and 94 (75%) on female condom use."
What is probably most astounding is that these services are provided
with limited, and in some cases diminishing, support from public agencies.
The CDC's report noted that:
The table below is reproduced from the report and presents some of the basic data.
*Previously unpublished data from survey on year 2000 activities, Beth Israel Medical Center, New York City.
In a surprising move, Chinese government officials are aggressively working to slow down the progress of HIV/AIDS by supporting condom distribution and needle exchanges. The San Jose Mercury News reported on June 7, 2005 ( "China Urges Needle Exchanges To Fight AIDS") that " In an aggressive new anti-AIDS push, China's Health Ministry is urging the promotion of free condoms and needle exchanges - strategies previously considered taboo by the conservative communist government. The proposed guidelines urge local governments to tailor those measures to high-risk groups in one of the boldest nationwide campaigns yet against the disease. The most striking proposal calls for combining methadone treatment with needle exchanges to promote safe behavior among drug users - a group almost completely ignored in the past."
According to the Mercury News, "China says it has 840,000 people infected with HIV, the virus that causes AIDS, and 80,000 have the full-blown disease. But health experts say the true figures are much higher and warn that China could have 10 million infected by 2010 unless stronger measures are taken. The government only recently became open about its AIDS epidemic after years of denying it was a problem, although independent activists are still frequently detained and harassed."
The Mercury News noted that "China launched a new national anti-drug campaign last month. Its aggressive new approach on AIDS was praised Tuesday by Randall Tobias, the U.S. global AIDS coordinator. 'I'm very encouraged by the commitment that the senior leadership of the government has made,' Tobias said at a news conference in Beijing. He warned, however, of massive challenges in the countryside, where AIDS has often spread through unsanitary blood-buying schemes. 'It will be a very long journey,' Tobias said. Washington is providing China with $35 million for AIDS from 2004-08."
China's new anti-drug campaign was launched after an unusual admission of failure in its previous efforts. The Taipei Times reported on May 27, 2005 ( "China Admits Drug War Is Failing") that "Chinese officials issued an unusual appeal to the public yesterday for help fighting drug trafficking, acknowledging in a nationally televised news conference that they have failed to stop surging narcotics abuse despite repeated crackdowns. Drug smuggling and the difficulty of fighting it are rising as a result of globalization and freer trade, the officials said, citing the seizure this month of 400kg of the party drug ketamine brought in from India via the Middle East. 'Although we've made a lot of achievements, the spread of drug problems remains serious,' said Yang Fengrui, secretary-general of the National Narcotics Control Commission. 'Heroin use is down in some areas, but the use of new drugs such as ecstasy, marijuana and others is increasing.' Communist Party leaders declared a 'People's War on Drugs' last month, Feng said. He appealed to the public to inform on traffickers and to help addicts reform -- a rare step by a government that usually says it can handle crime and social problems on its own."
According to the Times, "Communist leaders have been increasingly open in recent years about the spreading use of heroin and other drugs. But even by those standards, Feng and other officials at the news conference were strikingly candid about the failure of official efforts to stamp out narcotics abuse. 'Since the beginning of the 1980s, the problem of drugs has been dealt with by the government and the party, but it has never been resolved,' Feng said. Earlier this year, Chinese police announced that two informers split a reward of 200,000 yuan ( US$24,000 ) - a huge sum by Chinese standards - - for a tip that led to the capture of a gang leader accused of making 14 tons of methamphetamine. Last year, Chinese police arrested 67,000 people on drug charges, seized 10.8 tons of heroin and 2.7 tons of methamphetamines, according to a report distributed at Feng's news conference. Some 273,000 people were sent to compulsory drug treatment centers last year, the report said. They said the number of known addicts rose 6.8 percent last year to 791,000, including 679,000 heroin users. Experts say the true figures are much higher. In addition, the report said, 'addicts of new types of drugs such as ecstasy and ketamine, [used] in entertainment places, are increasing rapidly.'"
The Times noted that "In the case this month, police in the southern province of Guangdong, which borders Hong Kong, seized ketamine, methamphetamines, and more than 1.36 tonnes of drug-making chemicals, said Ji Mengyuan, deputy director of the province's Anti-Narcotics Bureau. Ji said 22 members of a drug gang led by a Hong Kong resident were arrested and police seized a drug-making laboratory. Drug smuggling and manufacturing by gangs with ties to Japan, South Korea, Indonesia and the Philippines also is growing, Feng said."
On June 29th, the Joint United Nations Program on HIV/AIDS released a progress report on international anti-AIDS efforts. As the Guardian reported on June 28, 2005 ( "Britain Rebuffs Call To Block Anti-AIDS Needle Exchanges"), "The US is pressing the UN to block the use of needle exchange programmes in countries where drug use is driving the spread of Aids, arguing that the schemes encourage users to continue their habit. But critics, including Britain, believe that the fight against Aids in eastern Europe, central Asia and other parts of the world could be jeopardised if the US manages to water down the UN's policy. The board of UNAids, the UN agency which coordinates the fight against the pandemic, is formulating a global prevention strategy in Geneva."
According to the Guardian, "Britain opposed the US position yesterday, when Gareth Thomas, the international development minister, told the meeting in his opening statement that the UK wants to see 'efforts to intensify harm reduction strategies, including needle and syringe exchange programmes'. He said: 'We support effective harm reduction programmes, especially needle and syringe exchange and methadone substitution therapy because they have been proven to reduce HIV infection among infecting drug users and their sexual partners in many countries.' The UK, he said, had 'a different approach' from the US."
The Guardian noted that "The row is critical, because needle sharing by injecting drug users is the main cause of the soaring figures for HIV/Aids infection in many countries, and provides a gateway for the spread of infection into the heterosexual community through the partners of drug users. Drug injecting is responsible for 80% of the cases in eastern Europe and central Asia, and is also driving the epidemic in a wide range of countries in the Middle East, north Africa, south and south-east Asia and Latin America. HIV prevalence within certain populations of drug injectors exceeds 80%. Europe accepts evidence from studies which have shown needle exchanges to curb the spread of infection, but the US, which will not fund such studies domestically, does not."
This issue, of HIV/AIDS and support for needle exchanges, dramatically illustrates the gap between the UN's drug control agency and the public health & medicine sector. As the Guardian noted, "The issue has already become fraught. At a meeting in Vienna earlier this year the UN agency responsible for the policing of narcotics, the United Nations office on drugs and crime, was forced to accept the US line and oppose needle exchanges. USAid, the American development agency, is not permitted to fund or be involved with programmes that include needle exchange. Democrats are lobbying against the government's position."
(For background on the US pressure on UNODC, see UN Office On Drugs And Crime Buckles Under US Pressure.)
In expressing its support for needle exchanges, the UNAIDS report decried the lack of political will and intestinal fortitude on the part of some governments, primarily the US. According to the report, "Increased testing presents new opportunities to link people to prevention and treatment services, to supply commodities such as condoms and clean injection equipment, and to provide appropriate prevention support for people living with HIV/AIDS as part of the continuum of care."
The report continues: "Injecting drug users have specific prevention and treatment needs, including testing and counselling, needle and syringe programmes [emphasis added], drug substitution therapy and ART. While the need to implement and integrate these services for this population is becoming increasingly clear in the era of ART, political commitment is still lacking in many of the countries where these services are needed most. (p. 21)
World Drug Report 2005 (also issued June 29, 2005),
the UN Office on Drugs and Crime avoided reference
to needle exchanges. Instead, they chose
to focus on the strategies of convincing injectors to quit injecting
and on getting other users to quit using. As UNODC wrote:
Safe disposal of used syringes is a serious concern. To address this issue, several organizations -- including the American Association of Diabetes Educators, the American Diabetes Association, the American Medical Association, the American Pharmacists Association, the Association of State and Territorial Health Officials, and the National Alliance of State and Territorial AIDS Directors -- created the Coalition for Safe Community Needle Disposal. In a 2002 letter to colleagues soliciting support, the group notes: "At least 3 billion injections occur yearly outside of health care settings. About 2 billion of these injections are administered by people with diabetes and patients receiving home health care. Approximately 1 billion are attributed to injection drug users (IDUs) using illicit drugs like heroin and cocaine. Most of the needles used for these injections end up discarded in household trash and community solid waste, putting workers and the public at risk of needle stick injuries and potentially fatal infections."
The Coalition has identified a number of disposal options, including:
Drop Box Collection Points (Community drop-off sites, located in pharmacies, police and fire departments, and public drop boxes). Unfortunately, the Coalition notes that "Most states don’t offer these types of programs, but they are the most cost effective for the end user. States where these programs are readily available include Wisconsin, Rhode Island, and Florida."
Household hazardous waste collection sites. According to the Coalition, "Self-injectors can place their used sharps in a special sharps container or, in some cases, an approved household container, take them to municipal household hazardous waste collection sites, and place them in the sharps collection bins. These sites also commonly accept hazardous materials such as cleaners, paints, and motor oil. Many communities already have hazardous waste drop-off sites available for the collection of oil, batteries, computers, etc."
Supervised Container Collection Sites. In this approach, "Sharps users can take their own sharps containers filled with used needles to appropriate collection sites. These may include, doctor’s offices, pharmacies, hospitals, health departments, fire stations, medical waste facilities, and household hazardous waste drop-off sites."
Mail-back Programs. With this solution, "Used sharps are placed in special containers, which are mailed (in accordance with U.S. Postal Service) to a collection site for proper disposal. Mail-back programs are available for individual use by sharps users, and may also serve as a disposal method for community collection sites. These programs work especially well for rural communities, communities that don’t already have a medical waste pick-up service (e.g., school systems, retail outlets, sporting arenas, casinos), and individuals who wish to protect their privacy. Mailbacks are virtually accepted by any state as a safe option for needle disposal."
Syringe Exchange Programs. The Coalition also suggests SEPs as an option, observing that "These enable injection drug users to exchange used syringes for new ones. Some state and local governments, as well as many non-profit organizations, fund these programs for users of illicit drugs as a means of inhibiting the spread of infectious diseases through needle sharing. . . . If you wish to find out more about the availability of syringe exchange programs in your community, contact the North American Syringe Exchange Network at 253 272-4857 or online at www.nasen.org."
Residential Special Waste Pick-up Service. The Coalition suggests that where the service is available, "Self-injectors can place their used sharps in a special container, similar to a recycling container, and place it outside their home for curbside collection by trained special waste handlers. Some programs require customers to call for a pickup, while others offer regular pickup schedules."
In-Home Individual Disposal Products. According to the Coalition, "A variety of products are available that destroy used needles and make them safe for disposal. These devices can, through various methods including snipping or breaking the needle or melting the sharp into a non-hazardous pellet, reduce or eliminate the danger of sharps entering the waste stream."
The United Nation's Office on Drugs and Crime plans a major shift in drug policy. The London Observer reported on Feb. 6, 2005 ( "US Cash Threat To AIDS War") that "The Bush administration opposes any programme that appears to condone the continued use of drugs, and wants the UN to seek abstention by users, combined with an end to narcotics production. Drug experts believe that if the UN shelved its so-called 'harm reduction' strategy in favour of an outright war on drugs, it could contribute to a rise in the rate of infection with HIV/Aids through shared needles and unsafe sex, as well as increasing the number of addicts."
According to the Observer, "Correspondence seen by The Observer shows that on 10 November 2004, Antonio Maria Costa, Executive Director of the United Nations Office on Drugs and Crime ( UNODC ) held a meeting with US Assistant Secretary of State Robert Charles to discuss the Bush administration's concerns about the direction the UN was taking. A leaked letter sent by Costa the next day shows him agreeing to demands to expunge references about harm reduction from UNODC literature and statements. 'On the the general issue of 'harm reduction', I share your concern. Under the guise of 'harm reduction', there are people working disingenuously to alter the world's opposition to drugs. These people can misuse our well-intentioned statements for their own agenda, and this we cannot allow. Accordingly, as we discussed in our meeting, we are reviewing all our statements, both printed and electronic, and will be even more vigilant in the future.' Costa goes on to clarify the UN agency's position on needle exchanges, where addicts are given clean injecting equipment to minimise the risk of infection from HIV and and hepatitis. In words that have caused alarm among drug treatment experts, Costa wrote: 'We neither endorse needle exchanges as a solution for drug abuse, nor support public statements advocating such practices.'"
The Netherlands-based Transnational Institute points out that this shift completely contradicts other UN policy positions as well as the scientific literature. In the TNI webpage on the UN and harm reduction, they point out that "This position taken by Mr Costa under US pressure is in direct conflict with many statements made by other UN agencies on this issue as well with statements made by UNODC representatives or in UNODC documents in the recent past. More than ever, inconsistency reigns within the UN around an issue all 191 UN Member States have pledged to achieve in the Millennium Development Goals: Halt and begin to reverse the spread of HIV/AIDS."
Indeed, as TNI points out, Mr. Costa until recently was a supporter
of syringe exchange and other pragmatic harm reduction approaches:
California has finally enacted a law allowing sale of clean syringes through drug stores. The San Jose Mercury News reported on Sept. 21, 2004 ( "Governor Signs Clean-Needle Legislation") that "California adults could be allowed to buy clean needles from pharmacies without a prescription for the first time under a pilot program approved Monday by Gov. Arnold Schwarzenegger." According to the Mercury-News, "Schwarzenegger's action on the needle bill means that starting in January pharmacists and physicians will be allowed to sell up to 10 needles or syringes to adults without a prescription. Pharmacy participation is conditional on city and county approval. In his veto message last year, Davis rejected a similar bill because he said it 'weakens county oversight and accountability' and required the state to reimburse local health officials. But the legislation Schwarzenegger signed Monday, SB 1159, requires local approval and pharmacies to provide information about drug treatment, disease testing and safe disposal. California has been one of only five states that required the prescription. Research from states without such restrictions has shown that access to clean needles reduces infection rates without increasing drug use or crime. The California pilot program expires in 2010, when the Legislature will decide whether to make it permanent."
Unfortunately, according to the Mercury-News, "Schwarzenegger vetoed another disease-prevention bill Monday, AB 2871, that would have made it easier for cities and counties to participate in needle exchange programs by eliminating some of the red tape. To maintain such programs, local governments must now renew declarations of public health emergencies every two to three weeks. In his veto message for the bill by Assemblywoman Patty Berg, D-Santa Rosa, Schwarzenegger said he was willing to 'reconsider the concept of this bill in the future if there are appropriate local control measures in place.'"
The state of New Jersey may turn around its backward policies against needle exchanges. According to an AP report in the Jersey Journal on Sept. 1, 2004 ( "Gov, Pols Vow Needle Exchange Program"), "Gov. James E. McGreevey has asked legislators and state health officials to design a program that offers drug users clean needles to slow the spread of AIDS and hepatitis C. Health Commissioner Clifton Lacy said yesterday he met with legislators earlier in the afternoon to work out details of the program. A specific proposal was expected in upcoming weeks, he said. "It's our intent to have this legislation crafted, moved through the Legislature and to Gov. McGreevey by the end of his tenure," said Lacy. McGreevey, who has been a supporter of needle exchange programs, will leave office on Nov. 15 in the wake of a sex scandal."
The Journal reported that "New Jersey is one of two states with neither a legal needle exchange program nor a law allowing nonprescription sales of needles and syringes. Under the working proposal, municipalities will be able to decide if they want to have a needle exchange in their town, said Sen. Nia Gill, D-Essex. The program will also provide addicts with referrals to health care providers and counseling. New Jersey had 62,752 reported cases of HIV - the fifth highest in the United States - and a third of those cases were transmitted through shared needles, according to state officials. The state is also the third highest in the nation for pediatric AIDS cases, and one of every three HIV victims is a woman. 'We have rates ( of HIV/AIDS ) in proportion to a Third World country, and the people who are most affected are women and children,' Gill said."
In spite of overwhelming evidence supporting the wisdom of syringe exchange programs, some in New Jersey law enforcement and state government remain opposed. The Philadelphia Inquirer noted on May 28, 2004 ( "Needle Exchange In NJ"), "Of all the issues to choose from to draw a line in the sand, Gov. McGreevey is blocking Atlantic City's effort to start a needle exchange program. Camden, too, has been warned that if it starts exchanging needles, addicts who participate may be arrested. Only New Jersey, Delaware, Illinois, California and Massachusetts still require a prescription for a person to have a syringe. But only New Jersey and Delaware won't amend their rules to allow needle exchange. McGreevey apparently would rather risk increased AIDS cases than risk being seen as soft on drug abuse. His position is political. Given his popularity ratings, it is understandable. But it's also wrong."
As the Inquirer observed, "McGreevey is following the lead of the Clinton and Bush administrations, neither of which managed to push beyond politics and support needle exchange. They have ignored the endorsement of needle exchange by both the American Medical Association and the American Pharmacists' Association as a key ingredient in combating the spread of AIDS. Needle exchange has been around long enough to give political pantywaists the ammunition they need to support it. The first comprehensive needle exchange program in this country began in 1988 in Tacoma Wash. Today, there are more than 150 programs nationwide, including Prevention Point Philadelphia, which provides new syringes in exchange for used ones to more than 8,500 registered participants at six weekly exchange sites. The nation's largest city-regulated program is in Baltimore, which began needle exchange in 1994. Baltimore now gives clean needles to about 14,500 drug users. Public health officials say that has helped decrease the rate of new HIV cases among intravenous drug users by 70 percent in the past eight years. There has also been a 20 percent drop in drug use among needle exchange participants, and a reduction in dirty needles found near needle exchange sites. McGreevey says he would support hospital based needle exchange programs, but no such programs exist and none have been proposed. Two social-service agencies in Camden are ready to use grants to start such a program if the state gives its approval. More than half of the 62,752 HIV cases reported in New Jersey through last year were transmitted through shared needles. McGreevey is foolish to ignore that."
The governor is not alone. In Atlantic City, the local prosecutor is suing the city to prevent a syringe exchange program from being implemented. The Morning Call reported on June 24, 2004 ( "Prosecutor Sues Over Needle Exchange Law") that "Atlantic County Prosecutor Jeffrey Blitz filed suit Wednesday to stop the city from establishing a needle exchange program. Saying it would violate state law, Blitz filed a four-page civil suit in Superior Court asking that the city be barred from forging ahead with plans to give hypodermic syringes to drug addicts who turn in dirty ones. The Comprehensive Drug Reform Act of 1986 bans the distribution of syringes to people who don't have a valid prescription for a legitimate medical purpose, Blitz said. 'If the activity is allowed to commence, there will be irreparable harm, in that the prosecutor will be forced to arrest persons for unlawfully receiving that which another component of government has given to them,' according to the suit, which also asked that a city ordinance establishing the needle exchange be invalidated. Supporters say a 1989 amendment to that law exempts municipalities from the restriction, but Blitz contends that the while the city itself is exempt, those who would receive needles are not."
The Morning Call noted that "Citing high rates of HIV infection in this casino capital, City Council last week approved the ordinance. It was signed into law Monday by Mayor Lorenzo Langford and takes effect July 8. Critics say needle exchanges can encourage drug use by putting government in the position of supplying the means by which users of heroin and other illegal drugs can inject them. Supporters say addicts will shoot up anyway, and that allowing them to do so with dirty needles leads to more infections. As of 2003, New Jersey had 62,752 reported cases of HIV -- the fifth-highest in the United States -- and more than half were transmitted through shared needles, according to state officials. The suit was served on city solicitor Beverly Graham-Foy, City Council solicitor Daniel Gallagher and the city clerk. Graham-Foy, who had advised the city against adopting the ordinance, said she will vigorously defend the city nonetheless. 'We would argue that the exception still holds and that the city still has the power to implement the program,' Graham-Foy said. Superior Court Judge Valerie Armstrong has set a July 7 hearing on the complaint."
Research published in the respected medical journal The Annals of Internal Medicine, shows that marijuana use does not impair the immune systems of individuals with HIV, and may even lead to improvements. The Reuters news service reported on Aug. 18, 2003 ( "Marijuana Use Does Not Accelerate HIV Infection"), that "Dr. Donald I. Abrams, from the University of California at San Francisco, and colleagues assessed the outcomes of 67 HIV-infected patients who were randomly assigned to use marijuana cigarettes, cannabinoid capsules, or sugar pills ( placebo ) three times daily for 21 days. All of the patients had been receiving the same antiretroviral regimen, which included indinavir or nelfinavir, for at least 8 weeks before the study began. More than half of the subjects in each group had undetectable viral loads throughout the study, the researchers note. Although not statistically significant, marijuana and cannabinoid use were actually associated with a slight drop in viral load compared with placebo use. Marijuana and cannabinoid use did not produce a drop in CD4+ or CD8+ cell counts. In fact, compared with placebo use, treatment with these agents was actually associated with a slight increase in cell counts. The results suggest that short-term cannabinoid use is not unsafe for patients with HIV infection, the authors note. "Further studies investigating the therapeutic potential of marijuana and other cannabinoids in patients with HIV infection and other populations are ongoing and should provide additional safety information over longer exposure periods," they write."
A copy of the study, "Short Term Effects of Cannabinoids in Patients with HIV-1 Infection," is available online.
The organization Human Rights Watch in May, 2003, issued a report criticizing the Vancouver, BC police for their treatment of drug users. According to an Associated Press story in the Wilmington, NC Morning Star on May 8, 2003 ( "Report Assails Vancouver Police"), "A police crackdown on drug dealers in downtown Vancouver is causing more harm than good for the neighborhood's AIDS and hepatitis epidemic, a Human Rights Watch report says, asserting addicts are being driven away from needle-exchange programs and other services. Called Operation Torpedo, the crackdown has gotten some pushers off the streets, 'but at a high cost,' said the report issued Wednesday by the New York-based rights group. Its findings were echoed by health care workers, activists and addicts in the city, known for its progressive drug policies."
According to Human Rights Watch's news release of May 7, 2003
"Vancouver Police Persecuting Drug Users"):
A copy of the report, "Abusing The User: Police Misconduct, Harm Reduction and HIV/AIDS In Vancouver," can be downloaded from the HRW website or directly as a PDF by clicking here.
The city of Vancouver, British Columbia, Canada, is preparing to establish safe injection facilities as part of a national harm reduction project sponsored by Health Canada. As the Vancouver Courier reported on May 8, 2002 ( "Owen Says Safe Injection Sites 'A Done Deal'"), "City council may have reiterated its support last Thursday for supervised drug injection sites, but the plan still has a few bureaucratic hoops to jump through before it becomes reality. Mayor Philip Owen, however, says he's not worried about the need for approval from the provincial government, the Vancouver Coastal Health Authority and the police, not to mention a Health Canada review of the national pilot project. The province, health authority and police board are on record as approving the mayor's four-pillar approach to drug problems in the city, including setting up supervised injection sites, he said, adding Liberal MPs Alan Rock and Anne McLellan also support the idea. 'It's a done deal.'"
According to the Courier, "Last Thursday, city council agreed to participate in a national harm reduction pilot project. At a recent Federation of Canadian Municipalities' meeting in Ottawa, Owen called for three or four cities to participate with Health Canada in scientific trials of supervised injection sites. Owen said Quebec City and Montreal have already agreed to participate. Now it's just a matter of Vancouver city staff soliciting renewed support from the province, police and health authority before sending a report to Health Canada. A legal framework will also have to be developed by the federal government, with possible changes to the Controlled Drugs and Substances Act. Provisions exist in the Act to accommodate supervised injection sites, said Dr. Perry Kendall, the province's chief medical health officer, who accompanied Owen to Ottawa in February for the municipalities' meeting."
Meanwhile in the US, city officials and the local paper in Peoria, IL, are taking a less progressive view of syringe exchange. The Peoria Journal Star reported on May 8, 2002 ( "Needle Exchange Program Outlawed") that "The City Council sided with neighborhoods Tuesday, unanimously approving an ordinance that makes it illegal for needle exchange programs to operate on the city's streets and alleyways, despite pleas by public health officials. The ordinance allows such programs - designed to stop the spread of HIV, hepatitis and other diseases through use of dirty hypodermic needles - to continue inside buildings in nonresidential areas."
Unfortunately, such an alternative arrangement won't work. As the Journal Star reported on May 10, 2002 "Needle Swap Program Seeks Office") "Larry Rogers, who represents the AIDS program at the University of Illinois College of Medicine at Peoria, said public health programs operate most effectively when they go directly to the source - schools, nursing homes and the like. He says needle exchanges also are most effective when outreach workers are in the environment where drugs are being used - on the streets. 'It's really about ( building ) a human relationship. That is what moves people to accept and deal with the problem,' he said. 'Can that be done under a roof? It can. There are people you're not going to be able to reach that way.' Finding a building at a location neighbors will accept also could be difficult for Lifeguard, he said."
The discussion in Peoria has been marred by misinformation. For example, the Journal Star's May 10, 2002 article notes that "Dr. John Gilligan, CEO of Fayette Companies in Peoria, which runs a state-licensed drug treatment program, said the needle exchange program is not effective. 'If it's just a giveaway program it's like sowing grass seeds and I think there's just a lot of evidence that it ( needle exchange programs ) causes more harm than it prevents the spread of blood-borne diseases,' said the clinical psychologist. Gilligan says a structured needle exchange program carried out in a controlled environment in conjunction with counseling could be effective in encouraging drug abusers to give up their lifestyles."
Gilligan is unfortunately misinformed. Studies and real-world experience show that syringe exchanges are quite effective in helping prevent the spread of HIV/AIDS, Hepatitis C, and other bloodborne diseases; and further, syringe exchanges do not encourage drug use or criminal activity, as some opponents try to claim. For more information, see the Syringe Exchange section of Drug War Facts.
Sadly, the local paper, Peoria's Journal Star, has led the charge to get rid of the syringe exchange program, including this editorial, "Get The Point: 'Needle Lady' Should Be Sent Packing," and this column, "Needle Lady Enabling Drug Users," both published on May 7, 2002.
For more information about the events in Peoria, check out the website of Lifeguard Harm Reduction Services. Also, this excellent article, "Needle Exchange Not Playing Well In Peoria" from DRCNet's Week Online includes an interview with Beth Wehrman of Lifeguard HRS. The situation in Peoria is also the subject of this MAPinc Focus Alert, "Disease Plays Better Than Needle Exchange In Peoria."
Declaring that " Canada is in the midst of a public health crisis concerning HIV/AIDS, hepatitis C, and injection drug use," The Canadian HIV/AIDS Legal Network is calling for establishment of safe injection facilities on a trial basis. Their new report, "Establishing Safe Injection Facilities In Canada: Legal And Ethical Issues," concludes that "Federal, provincial, and municipal governments cannot continue to ignore the health risks associated with injection drug use and with the prevailing criminal law approach to combating drug use. Switzerland, the Netherlands, and Germany have demonstrated that the provision of safe injection facilities is possible and effective. Australia has recognized the need and is experimenting." The report is also available as a PDF by clicking here. d
In the Network's April 11, 2002 news release ( "New Report Calls For Trials Of Safe Injection Sites") Ralf Jürgens, Executive Director of the Canadian HIV/AIDS Legal Network, said "We cannot continue to close our eyes to the staggering amount of avoidable disease and death resulting not just from injection drug use but also from governments' failure to put a comprehensive prevention and treatment strategy in place."
According to the Network, "in 1999, 34 percent of the estimated 4,190 new HIV infections were among injection drug users. Over 60 percent of the approximately 4,000 yearly new hepatitis C infections are related to injection drug use. The number of deaths from drug overdose is equally alarming. In British Columbia alone, more than 2,000 illicit drug overdose deaths have occurred since 1992, and overdoses have been the leading cause of death among people aged 30 to 49 in the province for five years in a row. 'Safe injection facilities offer drug users a place to inject their drugs using clean equipment and with considerably less stress with the available care of medically trained personnel, helping to prevent the transmission of blood-borne diseases such as HIV/AIDS and hepatitis C, and offering referrals to social, health and addiction treatment services,' explains Benedikt Fischer, Assistant Professor at the Department of Public Health Sciences and Centre of Criminology at the University of Toronto. 'Such facilities are successfully in operation in several countries in Europe and in Australia. The available evidence suggests that including safe injection facilities as one component of a broader public health-oriented policy response to injection drug use has the potential of producing significant benefits for both drug users and the general community,' Fischer adds.
The Network's release continues:
Health Canada Report Endorses Harm Reduction To Deal With Injection Drug Use; Critics Express Some Disappointment But Praise Progress
As reported by Canada's National Post on September 1, 2001 ( "HIV Spreads While Ottawa Ponders Drug Policy") that "A federally funded research organization has criticized Health Canada for its 'vague' response to a report that recommends radical changes to Canada's drug policies in order to reduce HIV and AIDS. In 1999, the Canadian HIV/AIDS Legal Network released a report commissioned by Health Canada that said HIV and AIDS is a crisis among injection drug users. It said Canada's drug policies make the problem worse by criminalizing drug use and forcing users to hide their addiction, share needles and avoid medical help. The report recommended sweeping changes to Canadian drug policies, such as the establishment of safe injection sites, medical prescriptions for heroin and cocaine, and the decriminalization of small amounts of illegal drugs for personal use. Yesterday, after almost two years, Health Canada released a response to the report."
Regarding the report, the
Toronto Globe and Mail on September 1, 2001 (
"Ease Up On Heroin Addicts, Federal Study Says")
said of Health Minister Allan Rock that
"By publishing the report, Mr. Rock, sometimes mentioned as a
possible future prime minister, stepped deeper into a war zone
between those who favour strict drug enforcement and those who call
the current law outdated. It calls for sentences of up to seven
years for possession of heroin and life for possession for
purposes of trafficking." The Globe and Mail continued:
In its response to Health Canada's response, the Canadian HIV/AIDS Legal Network called the Health Canada report and another report, the Federal/Provincial/Territorial Committee on Injection Drug Use's "Reducing The Harm Associated With Injection Drug Use In Canada," "an important and significant step in the right direction. The federal and provincial/territorial governments have made important acknowledgements and commitments. It remains to be hoped that action will follow the words."
New Federal Report Cites Increasing Heroin Use And Injection Drug Use Among Youth In New Jersey
The US Centers for Disease Control published a study May 18, 2001 ( "Trends In Injection Drug Use Among Persons Entering Addiction Treatment -- New Jersey, 1992-1999), which "summarizes an analysis of trends in injection drug use among persons admitted to New Jersey addiction treatment programs during 1992--1999; the findings suggest substantial increases in injection use among young adult heroin users throughout the state and an increase in heroin use among young adults who reside in suburban and rural New Jersey."
Some of this change reflects a decrease in use in urban areas as well as an increase in use in suburban and rural areas. The CDC report notes that "Decreases in heroin use in urban areas may reflect risk reduction resulting from intensive efforts to reduce the transmission of HIV and acquired immunodeficiency syndrome in these communities(2). Another possible explanation for these changes is a substantial decrease in heroin purity. Decreased injecting among heroin users in the northeastern United States during the 1980s and early 1990s has been attributed, in part, to increases in heroin purity, from <10% to >50%(3). Purer heroin allows users to maintain their addiction by inhaling (snorting), which has a lower risk for transmission of HIV and other bloodborne infections than injecting. However, during the period of increases in the proportion of young heroin users in New Jersey who reported injecting, the purity of heroin continued to be >60%*. Another explanation may be population shifts from the cities to suburban and rural areas that may have contributed to the regional changes in heroin use and injection. However, U.S. census data for 1990 through 1998 indicate that suburban growth in New Jersey resulted from increases in the number of residents aged >35 years while the number of young adults in these regions declined."
"* Among 23 US cities surveyed in 1999, Newark and Philadelphia (the two largest heroin distribution centers for the area) had the highest mean purity levels (72% in Philadelphia and 67.5% in Newark) (Drug Enforcement Administration, Department of Justice, unpublished data, 1999)."
Syringe Exchange Update
The US Centers for Disease Control published a study titled "Update: Syringe Exchange Programs -- United States, 1998" in the May 18, 2001 edition of its Morbidity and Mortality Weekly Report. The study, performed by staff from New York's Beth Israel Medical Center and the North American Syringe Exchange Network (NASEN) is based on survey responses and telephone interviews from 110 syringe exchange programs (SEPs) around the country. According to the report, "SEPs operated in 81 cities and 31 states, the District of Columbia, and Puerto Rico. The largest number of SEPs were in four states: 21 in California, 14 in New York, 12 in Washington, and nine in New Mexico. SEPs were classified by the number of syringes exchanged during 1998 (Table 1); 107 reported exchanging 19,397,527 syringes. The 12 largest programs exchanged 62% of all syringes. In addition to the basic syringe exchange service, SEPs also frequently provide other health and harm reduction services:
Some organizations working on AIDS, needle exchange and methadone issues include:
Check out this excellent article, "Myths vs Realities In Needle Exchange Program" by Dr. Peter Beilenson, Commissioner of Health for the Baltimore City Health Department, published in the San Diego Union Tribune April 13, 2001.