Needle Exchanges

Congress is considering legislation that would permit Washington D.C. to use city money to fund a needle exchange. The Washington Post weighs in today:

HIV-AIDS IS laying waste to Washington. The District has one of the worst infection rates in the country, and intravenous drug use is one of the primary modes of transmission. Yet the District — unlike any other jurisdiction in the country — is prohibited by Congress from using its own money to fund a needle-exchange program. Yesterday, Rep. Jose E. Serrano (D-N.Y.) took the first step toward ending this nuttiness.

The ban has been in place since 1998. That’s when Rep. Todd Tiahrt (R-Kan.) succeeded in getting it attached to a bill governing the District’s budget. With the Republicans in control, the prohibition on the District spending its own funds for needle-exchange programs survived every attempt to excise it from the House appropriations bill. But the Democrats are in charge now. Mr. Serrano, as chairman of the House Appropriations subcommittee on financial services and general government, which doles out federal money to the District, stripped the ban from legislation that passed unanimously yesterday. The action now moves to the full Appropriations Committee and then to the floor of the House, where opponents are expected to try to reinstate the prohibition.

“I do not dispute that drug addiction is a very real problem in this and other cities,” Mr. Tiahrt told us via e-mail yesterday, “but [needle-exchange programs] have been proven in many studies to be ineffective and a threat to the surrounding community, especially to children.” Yes, drug addiction is such a problem that there are now more than 210 syringe-swapping programs in 36 states. They constitute but one weapon in an arsenal of measures to help stem the tide of people converting from HIV-negative to HIV-positive. And they make it easier for outreach workers to talk to users about their addictions and then to get them into treatment.

The District is cautiously optimistic. City Administrator Dan Tangherlini told us that two departments (Human Services and Health) are beginning to work on a series of needle-exchange program options for Mayor Adrian M. Fenty (D) to consider. If all goes well, the District would be able to get something up and running for fiscal 2008. Congress should let it happen.

4 thoughts on “Needle Exchanges

  1. I have worked with a needle exchange program for the past few years. I originally had strong reservations about providing people with needles, to assist in using drugs. What I now understood through studying harm reduction is that not everyone is ready for sobriety and some may never be, no matter how much we would like them to be. If we say no to needle exchange programs, we are ultimately playing judge, jury and executioner. People are not going to stop using because they do not have a clean needle, instead they will use dirty needles and put their own lives and the lives of others in jeopardy. The issues of hepatitis C and HIV are real issues that are not going away. The fact is that an estimated 80% of injection drug users have Hepatitis C after 2 years of using. It is a hard fight for those of us who believe in meeting a client where they are at. I have tried promoting treatment and still readily do at every opportunity but not everyone is ready for that step and even those who are have issues with trying to get funding and real opportunity for treatment, not a 30 day stay in a hospital but real long term treatment. I want to keep my clients alive long enough to give them an opportunity to make positive change and at the same time protect my community. People who are against needle exchange want empirical evidence to support it, the problem is twofold, the first issue being that no one wants to fund a longitudinal study about syringe exchange and the second is that it is still hard for people to accept that sobriety isn’t for everyone. DO we simply say to those people, then you deserve to die or to attain HIV and Hep C? If you are skeptical about syringe exchange good, we should all be. If you are interested in learning more about syringe exchange, I would advise you to search Harm Reduction Strategies on the internet and also look at the Philadelphia syringe exchange program.

  2. “It is a hard fight for those of us who believe in meeting a client where they are at. I have tried promoting treatment and still readily do at every opportunity but not everyone is ready for that step and even those who are have issues with trying to get funding and real opportunity for treatment, not a 30 day stay in a hospital but real long term treatment.”Context matters. I recognize that you want both, so do I, but what’s the message when we’re willing to help them avoid spreading illness but we’re not willing to help get well? How many more people would want help if they could have some faith that there was some meaningful help available? I’ve got no problem with a needle exchange if it is a strategy to engage people into recovery (like Kellogg’s gradualism) and gives serious consideration to the values it communicates and doesn’t communicate. But, how can we engage people into recovery if we can’t get them help of the appropriate dose, intensity and duration?“DO we simply say to those people, then you deserve to die or to attain HIV and Hep C?”Who is this addressed to? I hope no one here. If you’ve spent any time reading this blog you’d know that I try to avoid these kinds of straw man arguments. Locally, injection drug users were 3 times more likely to die of an overdose than contract HIV. These numbers were from the year before Fentanyl caused a spike in overdoses.

  3. My apologies, after reading my statement I realized that is was distorted and not in the right context. I was pondering what our obligation is to others in the community, regarding the transmission of disease and also the individual themselves? I do believe that we need to help bridge the gap in treatment, so that people from lower socioeconomic classes can have better access to good treatment programs. I also believe that we need to work towards a multifaceted approach with treatment and I do believe that Dawn Farm does an excellent job at this aspect.Until we can work together as a society to better our treatment approaches, needle exchanges are one option that I believe is necessary. Should recovery be included in the engagement? Absolutely but its a fine line as far as frequency and intensity. I will look into the model you cited and perhaps that will provide some reference to address these points.

  4. i think the needle exhange program is the dumbest thing ever… my mother has diabetes and she needs to buy needles for her to stay alive… but yet you give free needles to the drug users… THATS JUST WRONG!!!!! we somtimes dont have enough money for us to spent because she needs to buy her syringes!!!!!!!!!!!!!!!!

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