Free needle exchanges for intravenous drug users would (presumably) help reduce the spread of AIDS – a horrible disease. On the other hand, having a legal, free needle exchange program might (conceivably) encourage the use of intravenous drugs and interfere with drug enforcement. This could lead to more drug-related deaths and other sorts of harm from drug-addiction.
What do you think?
Also, are there alternatives to needle exchange programs that could reduce the spread of AIDS amoung drug users without (possibly) increasing the prevalence of intravenous drug usage?
Australia introduced needle exchange programmes in the mid-1980s as part of its strategy to combat the spread of HIV. I’m not sure how much of the early data will be available online, but I’ll see what references I can pull up relating to the success of the programme in terms of its original objectives and the impact it’s had in relation to law enforcement and drug education issues over the last 15 years (the impact has been considerable, but I want to find the specific cites).
My impression (and I admit I have not personally investigated this) is that there is no serious debate on this subject in the public health community. The only debate is in the political community. I.e., from a public health point of view, it is clear that needle-exchange programs are beneficial. But, the politics of “being tough on drug users” (particularly if you are a former drug user, as our current and past Presidents have been) means these programs don’t get implemented…at least on a national level.
is because in Australia there have been a lot of issues arising out of the needle exchange programme. While needle exchange has been quoted as being spectacularly successful in containing the spread of HIV among injecting drug users in the 1980s (the incidence of HIV seropositivity among injecting drug users in Australia has remained low), the current astonishlingly high number of injecting drug users with Hepatitis C brings into question the extent to which it was needle exchange programmes which were responsibly for the low incidence of HIV.
In order for needle exchange programmes to be accepted as part of Australian public health policy, our government’s strategy in relation to drug use shifted from the goal of a drug-free society to that of harm-minimisation. The impact of that shift has been dramatic (we are about to have our first legal, government funded, supervised injecting room opened here).
I’m busy during most of today, but I’ll be on-line tonight and will pull reports on the various evaluations which have been made of our needle exchange programmes. The issue is a complex one, and it involves many trade-offs in other areas.
I don’t see any logic in not giving needles to junkies. Here I’m assuming that “junky” means that the person is addicted. When someone is addicted, they need crack cocaine, heroine, or whatever they’re using. That means that they will inject themselves, regardless of whether a clean needle is available.
No shit, I’ve seen intelligent people trying to file an old jagged needle on whatever rough surface they handy to get it usable for shooting more coke (back when I was snorting it one of my connects was a shooter). Even people who had the sense to know to use clean needles and want to do so will use a dirty one if that’s all that’s available - that’s how strong the addiction is.
I don’t think providing clean needles is going to increase drug use. IV drug users are a special breed, usually already severely addicted to at least one drug when they start, they aren’t the type who are going to decide not to use IV drugs because there are no clean needles available. Most can obtain free needles, but when they run out they will reuse old ones as long as possible instead of ‘wasting’ drug money on new ones.
Thank you J for raising this point. A couple of years ago, I got a copy of a major study of needle exchange done by some official American public health agency. (I forget who.) The study was printed as a book. The study group had taken testimony from witnesses on all sides of the question. Several witnesses from the law enforcement community testified that legalized needle exchnge would hamper law enforcement, for various constitutional, practical and psychological reasons.
The authors of the study went on to consider the problem that people holding these views would need to be convinced to support needle exchange. However, they did not address the possibility that these people might be right.
Based on discussions with my spouse, who is a professor in a medical school public health department, a common attitude in the public health community is that they can measure the good that needle exchange would do. They can’t measure the harm, so they simply ignore that aspect.
I would think that a needle exchange program would be beneficial to everyone involved. The users exchange their dirty needles for clean ones and the dirty ones are disposed of properly instead of being discarded on the street or somewhere else where someone can accidently get pricked with them and possibly get infected with something.
So someone explain to me what the disadvantage would be in doing this. I’m trying to think of some and can only come up with a couple of things.
From what you are saying here, the public health community has documented evidence of the benefit of needle exchange programs. OTOH, the law enforcement community has concerns that they would hamper law enforcement, but no evidence (see the part I bold-faced above). So we have a documented benefit and an unsupported concern. Which way should we go, hmm?
If the law enforcement comes up with evidence, then re-visit the issue. In the meantime, there is no documented reason not to have exchange programs.
Sua – What you say sounds reasonable, but it’s not that simple. The public health community has epidemiological models showing how much HIV is transferred by used needles, so they can calibrate the benefit of needle exchange. My spouse says it’s just too difficult to set up a model for the harm a needle exchange program would do.
Should public policy decisions ignore consequences that cannot be modeled mathematically? Of course not. E.g., nobody would support the US threatening a nuclear attack on China if they don’t release our aviators, even though there’s no mathemtical model showing the degree of harm.
IMHO it should be possible to set up a model of needle exchange, which would show the degree of interference with law enforcement and the impact on drug addiction. However, the model would be sociological rather than epdiemiological. Maybe part of the problem is that people in the public health community are uncomfortable in looking outside their traditional field.
Or, maybe some people are pre-disposed to favor needle exchange programs because drugs are trendy. Consider an alternative program which provides free condoms for rapists. This would reduce the spread of AIDS by a measurable amount. The harm can’t be measured. Nobody would support this policy, because rape is (rightly) abhored.
Well then, have law enforcement set up the sociological model and present the evidence. BTW, the impact on drug addiction is a epidemiological issue and has already been studied.
Apples and oranges. Needles cannot be obtained on the open market - prescriptions are required. A rapist can get condoms anywhere.
Sua - Not quite apples and oranges. Needle sales were restricted in order ot fight intravenous drug usage. If the proposal were merely to permit needle sales, then I would agree with you.
However, the proposal is that the government should provide free needles to drug users, even though drug usage itself is illegal. This is analogous to the government providing free condoms for rapists, even though rape is illegal.
reprise – your comments are most interesting to me.
My spouse, a medical school professor of bio-statistics, speculates that the dramatic rise in rates of Hep C among drug users may simply mirror the rise in reported rates of Hep C everywhere. My spouse also speculates that the rise in reported rates may be due to better reporting, not to increasing prevalence of the disease.
Hope you are able link us to some real data, which could confirm or refute these speculations.