Syringe laws more likely than controversial needle-exchange programs
Syringe laws more likely than controversial needle-exchange programs
Needle programs could be politically dangerous
States increasingly are changing laws that make it illegal to purchase, sell, or possess syringes without prescriptions in efforts to slow the spread of HIV through injection drug user populations. New York is one of the latest states to change its syringe law with a bill that decriminalizes needle possession and allows pharmacists to sell syringes without prescription.
Other states that have considered similar measures this legislative session include Rhode Island, Illinois, and New Hampshire. Some states, including New Hampshire, are renewing their pilot needle-exchange programs. Also, Massachusetts is considering an amendment that would sanction needle exchanges, which have already been available in some cities in the state, including Boston.
These changes follow recent studies indicating that needle-exchange programs are helping to stop the spread of HIV and show no evidence of causing increases in drug use or crime.
Still, a prevalent conservative political attitude toward HIV and injection drug users is preventing both the federal government and many states and localities from providing money for needle-exchange programs.
Decriminalizing syringe possession or allowing syringe sales in pharmacies would be easier politically than providing state funding for needle-exchange programs, notes Lisa Speissegger, public health analyst for the HIV/STD Project for the National Conference of State Legislatures (NCSL) in Denver.
When states fund needle-exchange programs, legislators are vulnerable to criticism that they are using state money to support drug use.
"We know people are using needles, and they’re passing bloodborne pathogens to each other, and that’s costing us money," Speissegger says. "So we’re just going to ignore that part of the paraphernalia law, and it’s really an easier fix."
Rhode Island State Sen. John Roney (D - Providence) says that while needle exchange programs have obviously helped, the state’s AIDS population continues to increase, and therefore needle exchanges are not necessarily the best solution. Roney introduced a bill that would permit pharmacies to sell syringes without prescription and would remove syringes and needles from the definition of drug paraphernalia.
"We feel that needle exchanges are not the effective answer," Roney says. "I do believe that decriminalization [of syringe possession] is the answer, but that’s more what logic tells me."
AMA, CDC, NIH all agree: Exchanges work
Still, needle-exchange researchers and AIDS advocates say states and the federal government should stop shying away from funding needle-exchange programs because the number of studies showing such programs to be beneficial has reached a critical mass.
"It’s very discouraging. It shows that many policy-makers in this country are really being irrational about the problem of drugs and HIV and AIDS," says Don C. Des Jarlais, PhD, director of research for the Chemical Dependency Institute of Beth Israel Medical Center in New York City. Des Jarlais was a chief investigator in a study that shows a recent reduction in HIV seroincidence among New York City injection drug users (IDUs). (See story on needle exchange and IDU research, p. 76.)
The National Institutes of Health (NIH) in Washington, DC, the Centers for Disease Control and Prevention (CDC) in Atlanta, the American Medical Association in Chicago, and the American Public Health Association in Washington, DC, all have acknowledged the overwhelming body of evidence that needle-exchange programs work at stopping HIV infection, says Julio Abreu, deputy director of government affairs for AIDS Action in Washington, DC.
"Science ought to drive this discussion," Abreu maintains. "There has been a plethora of scientific evidence demonstrating that needle-exchange programs work and ought to be implemented. That’s where we ought to be, but the reality is that politics have taken this issue hostage and have not allowed needle-exchange programs to be implemented using federal dollars."
Speissegger says the states probably should concentrate first on decriminalizing possession of needles, because that measure could reach far more people who are at risk for HIV than needle-exchange programs could.
All but a few states have laws prohibiting the sale and possession of drug paraphernalia. Until recently, these laws included syringes used to inject illegal drugs, Speissegger says. Then, in the mid-1990s, Connecticut changed its paraphernalia law to exclude needles. By 1999, Hawaii, Maine, Maryland, Massachusetts, New York, Rhode Island, Vermont, Washington, and Washington, DC, passed bills to exclude syringes or to at least provide an exception for needle-exchange programs. Some states, such as Wisconsin, have rejected such a change in syringe laws.
Rising heroin use breeds skepticism
As national reports show heroin use rising among teen-agers — particularly among middle-class youths — local politicians, law enforcers, and others have been skeptical of any law or program that permits easy access to syringes.
"Heroin is a big concern in our area, and there were 39 deaths last year from heroin overdoses," says Orange County Commissioner Ted Edwards of Orlando, FL. "We’re a very family-oriented, law-abiding community, and to have heroin become the drug of choice for whatever reason and to have it cause a considerable number of deaths is something we need to address as an epidemic."
An Orange County citizens group approached Edwards earlier this year and asked him to look into a proposed ordinance from Dade County that would put restrictions on the sale of syringes, which are legal without a prescription in Florida. The county has never authorized needle-exchange programs.
Edwards and other local officials thought a syringe restriction measure was worth investigating as a possible solution to increased injection drug use. They met with pharmacists, law enforcement officials, citizens’ groups, and people involved in drug rehabilitation.
The committee convinced Edwards and other local officials that there might be some unintended consequences of such an ordinance, such as an increase in the sharing of needles and the spread of HIV and hepatitis C, he says.
Those working in drug treatment see a large number of addicts who have contracted HIV or hepatitis C, Edwards adds. "About half of the addicts they treat are HIV-positive," he notes.
Given this information, Orange County officials have decided to suspend plans to pursue a syringe-restriction ordinance but will pass some sort of ordinance addressing the safe disposal of hypodermic needles. They also might seek more state money for drug treatment and have police try to clean up areas that attract crime and illicit drug use.
Momentum lost for needle-exchange bills
In 1998 and 1999, nearly half of the states considered needle-exchange legislation, but only a handful passed such measures. According to a new legislation search on the Web site of the Health Policy Tracking Service (www.stateserv. hpts.org), no new needle-exchange legislation has been introduced this year. However, the state of New Hampshire signed a bill in May extending its needle-exchange pilot program for four years.
Fewer than 15 states sanction needle-exchange programs through state statutes, regulations, or local ordinances. However, the programs exist in more than 30 states. Some states and local governments simply choose to ignore illegal programs. For instance, the Chicago city attorney decided that needle-exchange programs may be permitted under the research exception to the state’s syringe prescription law. At the other end of the spectrum, New Jersey Gov. Christine Whitman has sanctioned the arrest of needle-exchange volunteers. (For more information on needle-exchange programs and New Jersey’s alternative approach to HIV prevention among IDUs, see AIDS Alert, June 1999, pp. 61-67.)
The uneasy alliance most municipalities and states have with private needle-exchange programs hinders the programs’ efforts to stop the spread of HIV, says Steffanie Strathdee, PhD, associate professor of epidemiology at Johns Hopkins School of Public Health in Baltimore. Strathdee has studied the effects of needle-exchange programs in North America since 1988.
Needle-exchange programs should be a cornerstone of HIV prevention among injection drug users, Strathdee says. She maintains that the use of needle-exchange programs is actually a moral issue because IDUs with HIV wind up spreading the virus to many people, including some who are not addicts — even to children, she adds.
"The tragedy is that in many U.S. states, because of a congressional ban that prevents federal funds from being used to support needle-exchange programs, there are paraphernalia laws that make needle exchanges illegal," Strathdee says.
While some private groups persevere and continue to provide illicit needle exchanges, they are poorly funded and cannot offer the ancillary services that are critical to HIV prevention, such as screening for sexually transmitted diseases, helping people connect with drug treatment programs, and providing HIV testing and counseling, she adds.
States vary widely in how they handle needle exchange and syringe laws, which causes confusion. Some states may permit the possession of syringes, but not the sale. Others have made possession a misdemeanor instead of a felony, and still others have piled restrictions and requirements on needle-exchange programs, Speissegger says. (See story on various state laws on syringes, p. 77.)
"From what we have seen in terms of looking at legalization of the purchase, sales, or possession of syringes, there are only a handful of states that actually have decriminalized purchase, possession, or sales," Speissegger says.
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