Human Rights
Volume 24 Number 3 Summer 1997
Sterile Syringes and Needle Exchange Programs: On the Frontline in the Battle to Stop the Spread of HIV
by Richard T. Andrias and Robert E. Stein.
Government approved clean needle programs for substance abusers? At first blush the idea seems counterintuitive for many. Won't this lead to increased substance abuse? Won't it entice non-user initiates, especially the young? At the very least, won't the government appear to be sanctioning illegal drug using behavior?
Taking into account our society's efforts to reduce illicit drug use, these reactions are expected. However, scientific and public health evidence on this issue has been accumulating for some time, and the answer that the data gives to each of the above questions is a resounding "no". Moreover, science's verdict also clearly comes down on the side of sanctioning needle exchange programs as an important way of stopping the spread of HIV/AIDS and other blood-borne diseases.
The Data
Needle exchange programs, by increasing the availability of sterile injection equipment, become an important technique in reducing HIV infection among the population of injecting drug users (IDUs) and their often unknowing sexual partners and their children. Extensive studies by the nation's leading public health and scientific agencies, the Centers for Disease Control and Prevention (CDC) and National Research Council (NRC) have shown that needle exchange programs do not increase the frequency of drug use among existing IDUs and do not increase the number of new drug injectors. The conclusions of these studies have recently been confirmed by a Consensus Panel of the National Institutes of Health.Moreover, needle exchange programs involving drug counseling and drug treatment program referrals hold the promise of actually reducing drug abuse.
Many citizens are understandably concerned that needle exchange programs might appear to make government a contributor to drug abuse and such programs might be interpreted as sending a contradictory message about illicit drug usage. However, so long as such programs make available drug counseling and drug treatment referrals, these needle exchange programs should be viewed as a new and different component of government and community efforts to stem the cycle of drug abuse.
Furthermore, because public health policies dictate the use of only sterile syringes, and the evidence is that needle exchange programs result in substantial harm reduction in our communities, on balance they are an important, constructive step. The most rapidly expanding source of new HIV infection is the population of injection drug users, their sexual partners and their children. The only way to protect sexual partners of IDUs and their children from HIV infection (other than abstinence) is by use of sterile syringes.
Other Positive Effects
Drug treatment programs should be a component of any needle exchange program because drug treatment programs provide the most effective means of reducing drug dependency. The trust that is developed in community based needle exchange programs enhances the likelihood of IDUs participating in HIV prevention and counseling, taking advantage of referrals to social and medical services, and actually entering into drug treatment programs.Unfortunately treatment on demand is not always available due to financial and individual limitations, but needle exchange programs can keep IDUs uninfected until they enter a treatment program.
In addition to significant savings of public funds resulting from reduced HIV infection (always important in times of budget constraints), needle exchange programs remove infected needles from playgrounds, streets and trash receptacles, thereby protecting children, sanitation workers and others from needle sticks. Moreover, law enforcement officers, who inevitably come in contact with hypodermic needles while performing narcotic arrests, will benefit from the clean needles distributed through needle exchange programs and the resulting reduction of contaminated needles.
Legal Barriers
There are now almost one hundred needle exchange programs operating successfully across the United States--most in areas in which legal barriers have been removed. There are many other communities that would institute needle exchange programs but for those legal barriers. Removal of these barriers is also supported by public health organizations and the American Medical Association.Among the specific legal changes that have been found to be effective in facilitating the establishment of successful needle exchange programs are: exempting needle exchange programs from criminal and public health laws restricting the sale, distribution and possession of drug paraphernalia; repeal of pharmacy laws and regulations to permit purchase of a limited number of sterile syringes without a prescription; and modification of drug paraphernalia laws to remove syringes from the scope of such laws.
That said, the determination of which legal barriers should be removed to permit the effective operation of needle exchange programs should turn on the laws, policies, customs and attitudes of each jurisdiction.
Clearly, the efforts of substance abuse treatment advocates and HIV/AIDS advocates are directed towards the same goal: saving lives. Substance abuse counseling and treatment saves lives by getting users off drugs; needle exchange programs save lives by keeping users free of HIV/AIDS until they are off drugs.
The Hon. Richard T. Andrias is an associate justice, New York Supreme Court, Appellate Division and is a member of the ABA AIDS Coordinating Committee. Robert E. Stein is vice chair of the ABA AIDS Coordinating Committee.
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