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THE EDUCATOR - Summer 2003

Needle Exchange: A Bad Fix

By James McDonough, office of the Governor, Florida Drug Control Policy

Two recent articles in the Police Executive Research Forum made the case for needle exchange programs [NEPs]. To its credit, PERF has offered the opportunity for a dissenting opinion. Let me make the case against needle exchange.

For starters, needle exchange programs (NEPs) contribute to drug abuse.

In Baltimore, the oft-cited example of needle exchange "success," fatal overdoses from drug abuse have tripled in the past decade. In 1999, Baltimore's heroin death rate surpassed its homicide rate. One-tenth of the city's population are illicit drug users-- almost double the national rate--and 7.5 percent are heroin addicts, a rate 10 times the national average. In Vancouver, British Columbia, which has the largest needle exchange program in North America, the mortality rate for drugs jumped from 18 in 1988 (before implementation of the NEP) to 200 in 1993 and approached 600 province-wide by 1998 (most of the deaths occurring in the city). The data repeat, NEP locale by NEP locale. Clearly NEPs foster drug abuse.

Secondly the purported "proof" that needle exchange lowers HIV rate is not there. In Vancouver, HIV prevalence rates among injection drug users went from 2 percent pre-NEP to 23 percent post-NEP. In Montreal, 33 percent of NEP users became infected with HIV, compared to 13 percent for non-users. Even studies that endorse NEPs admit the scientific support for these programs is not there. In 1995, the National Academy of Sciences declared that its own pro-NEP conclusions were not based on well-designed trials. Don Des Jarlais, a leading researcher and advocate of NEPs, has conceded "there has been no direct evidence that participation is associated with a lower risk of incident HIV infection for the individual IDU [intravenous drug user]." At the same time, there is strong indication that needle exchange participants have a higher incidence than non-NEP drug users of Hepatitis B virus and Hepatitis C virus infection. Medical professionals are concerned. Dr. Glenn Dewberry, in 1999, faulted an entire body of published literature relating HIV reduction to NEP for "inaccurate assumptions." He closed his critique by reminding fellow doctors of their oath to "First, do no harm." Dr. James Curtis of Harlem Hospital describes NEPs as "bad medicine, bad public health.unethical and immoral." Dr. Mitch Rosenthal of Phoenix House calls NEPs "more a cause than a cure [of HIV infection]."

If NEPs lead to increased drug abuse and if there is grave doubt that they lower HIV rates, how can there be such widespread discrepancy between claims and findings? The answer lies both in ill-conceived policy and forced science. First, needle exchange programs are bad policy. Treatment is given short shrift or ignored entirely. They became a magnet for social ills: They draw in addicts who are pursued by drug sellers. The resulting mixture brings in prostitution, theft, property crime, economic blight, lawlessness, and human degradation. Not surprisingly, disenfranchised neighborhoods inherit the NEPs while affluent communities reject them, a case of flawed social experiments being perpetrated on those powerless to defend against them.

Second, NEP advocates too often use science to explain away the problematic outcomes to "intervening variables." The argument, glorified as regression analyses, goes as follows: If only the addicts and the drug sellers didn't arrive in droves. If only the crack-addicted prostitutes didn't attempt to make the cost of their fix. If only the mind-altered heroin users didn't use the nearest available needle. If all these bad things did not happen, then needle exchange would be a good thing.

But the bad things do happen. As a result, NEPs tend to fail on all counts: Addiction goes up, drug use spreads, people die, and so do neighborhoods. This is the reality of needle exchange. It fails as a compassionate response to the HIV epidemic. It exacerbates the drug problem and is an unmitigated disaster as social policy. Surely there are better ways to address HIV and drug addiction. Treatment, uncorrupted by dispensing needles for drug injection, is one of them.