Needle Swaps Skirt the Law Advocates Push Clean Syringes

by JOHN POPE Staff writer

Several times a week, at an apartment deep in Central City, someone taps at
the door. The man inside may not know every visitor's name, but according
to a state health official familiar with the man's work, he knows what each
person wants: clean hypodermic needles for shooting up intravenous drugs.

The man, who refused to let his name or address be published, goes to a box
to fish out one syringe in exchange for each used needle brought to his
doorstep, the state health officer said. He puts the dirty needles into a
proper container for disposal the kind doctors have, to keep anyone from
getting stuck accidentally.

The syringes are donated by advocates of needle exchanges. No money changes
hands. No questions are asked. The swap, one of more than 200 a month by a
clientele of about 80 addicts who frequent the Central City exchange, is
concluded in minutes.

The man, while not an addict himself, agreed to let his home be used for
the needle exchange after becoming concerned by the health hazard posed by
discarded dirty needles in his neighborhood, the state health officer said.

Everything is hushhush because Louisiana law bans needle exchanges, even
though many publichealth officials have long contended they keep down the
spread of infectious diseases, such as hepatitis and AIDS, which can be
transmitted by sharing contaminated needles.

Critics worry that making needles available at no cost increases illegal
drug use.

Gary Bauer, president of the Family Research Council, a national
conservative interest organization, has condemned needle exchanges as "a
dopey idea," one that condones or even encourages drug use.

But health experts say there is no evidence to justify such fears.

"Although the data available are limited, they provide no evidence that
needleexchange programs increase the amount of drug use by needleexchange
clients or change overall community levels of injection and noninjection
drug use," according to a 1993 study prepared for the federal Centers for
Disease Control and Prevention.

Despite the fact that most needle exchanges are illegal and forced to
operate clandestinely, their number is growing. There are 115 in 29 states,
including the District of Columbia, Puerto Rico and Guam, said Dave
Purchase of Tacoma, Wash., chairman of the North American Syringe Exchange
Network.

"Are we enablers?" he said. "Yes. We enable people to stay alive."

Purchase, who also runs Tacoma's legal exchange, spoke in New Orleans last
week during a meeting of the Drug Policy Foundation, a liberal nonprofit
advocacy organization. Its members, many of whom work in drugrelated
programs, have a common bond: They disagree with much of the federal
antidrug policy, including its opposition to needle exchanges.

The federal government refuses to pay for such programs, despite an
exhaustive 1993 report that recommended lifting the ban. Even though
President Clinton promised in 1992 to let federal money underwrite needle
exchanges, his AIDS strategy, which he announced after reelection last
year, retains the prohibition on giving clean needles to people who shoot
up drugs like heroin and cocaine.

"It's primarily politics," said Dr. Peter Lurie, a specialist in family and
community medicine at the University of California, San Francisco, who led
the team that compiled the report for the CDC.

"It's fear by the Clinton administration that people would depict them as
soft on drugs," he said. "I don't think it has anything to do with science.
I think if the people affected by these programs were anybody but
significantly minority drug users, this would be handled differently."

In addressing this issue at the Drug Policy Foundation's meeting, Imani
Woods, a drugtreatment specialist from Seattle, said, to sustained
applause: "While we're fighting, people are dying. As long as you're not
providing clean needles, you're participating in genocide."

The foundation members are not alone. They have been joined in their
advocacy of needle exchanges by the American Bar Association and the
American Medical Association.

The legal picture on needle exchanges can be confusing. For instance, some
states, like Louisiana, ban the practice outright, but others, such as
Maryland, have made exceptions for areas within the state.

In Louisiana, exchanging needles is a felony after the third conviction.
The maximum punishment is a $5,000 fine and five years in prison.

"The laws are much more effective at barring needles than they are at
barring heroin and cocaine," said Ben Junge, a participant in the New
Orleans drug conference who runs the evaluation of Baltimore's legal
6,500client needle exchange.

If the bans on needle exchanges continue until 2000, the American Medical
Association estimated that as many as 11,000 AIDS cases will result and
that the medical bill will be as high as $630 million.

In Louisiana, about two thirds of all intravenousdrug users share needles
regularly, chiefly because they cannot get clean needles, according to a
report by the state Office of Public Health. Moreover, the report said, one
third of all the state's AIDS cases in men and two thirds of the AIDS cases
in women result from drug use, either from sharing needles or having sex
with an infected narcotics addict.

"All logic indicates needle exchanges decrease the level of infection,"
said Dr. Tom Farley, medical director of the HIV/AIDS program in the state
Office of Public Health.

But, he and Junge said, there is no conclusive proof that readily available
syringes would actually achieve this goal, and, they said, there probably
never will be a way to find out.

The reason: ethical standards. The people conducting such an investigation
would have to give clean needles to one group and withhold them from another.

In the absence of such a project, "the nextbest thing is to learn about
people's behavior," Junge said. "What we've seen is that when people have
increased access to needles, highrisk activity, such as sharing needles,
declines."