Would you rather save lives and save money — or make a political point? Sadly, when the question involves the issue of clean needle programs, the choice to “send a message” always seems to win.
The provision of clean needles to drug addicts is one of the most effective known interventions in the entire field of public health. Nonetheless, the budget agreement reached this week in Congress reinstates a federal ban, which had been removed in 2009, on funding for such programs.
There’s still hope that the ban could be lifted at the last minute, but the fact that needle exchange, a cheap, effective lifesaver, still remains a political football is profoundly depressing to me. Not only do opponents of needle-exchange programs misunderstand the data on their effectiveness, but they also fail to understand the invaluable message of empowerment and hope that such programs actually send.
You see, in 1986, learning to use clean needles saved my life. At the time, I was an intravenous drug user, shooting cocaine and heroin up to 40 times a day. New York City had yet to open a syringe-exchange program. I hadn’t even heard of AIDS.
If a San Francisco outreach worker on vacation in New York hadn’t taught me how to protect myself, I probably wouldn’t be here to write this story. The man she was staying with in the city — with whom I frequently took drugs — was HIV-positive.
Indeed, 50% of IV drug users in New York City in the 1980s had HIV. That percentage has dropped to 16% today, falling steeply after the introduction of needle exchange programs. Today, infection is far more common among those without access to needle exchange or legal access to clean syringes. When educated and empowered, people like me will protect themselves and others: that’s one thing needle exchange teaches. I’ve now been in recovery for 23 years.
But back when I was still using, half of all new HIV diagnoses in New York were linked to injection drug use. Secondary transmission by those infected via needles was responsible for most heterosexual and pediatric cases too. Today, just 4.3% of new infections are linked to IV drug use, meaning far fewer chances for heterosexual exposure. (New York no longer sees new HIV infections in babies, in part because mother-to-child transmission can be prevented with medication).
Washington, D.C., by contrast, has long been hampered by the federal ban on funding for needle-exchange programs; a particularly heartless Congressional ban even prevented D.C. from using its own local money for the purpose. In 2008, however, the local ban was lifted (it’s not clear if the new budget agreement will reinstate this ban). The capital’s Department of Health then funded a large expansion of private needle-exchange programs, enrolling 3,000 additional drug users and exchanging nearly a million needles. By 2010, D.C. saw a 60% decrease in new HIV infections [PDF]. The expanded needle-exchange programs also got 900 drug users into treatment.
Despite the concerns of critics, no study has ever found that needle exchange increases drug use or that it prevents users from quitting. On the contrary, these programs encourage many addicted people, who were formerly isolated, to get help and recover.
The effect may seem counterintuitive, but the reality is that addiction isn’t fun and many IV drug users genuinely want to quit. But out of fear of abusive treatment (which, sadly, is not uncommon), they often fail to seek help or don’t even know where to go to find it.
By participating in needle exchanges, addicted people may develop relationships with those who provide the syringes. The outreach workers are often former users themselves, who demonstrate every day that recovery is possible and that it is not as frightening as many users imagine it to be. By being nonjudgmental and providing lifesaving information and equipment, needle-exchange programs send a critical message.
They tell drug users that they are worthy of being saved, that they matter — even if they don’t want to stop using. Paradoxically, that is the message that often spurs recovery: if I’m worth it, maybe I don’t need to destroy myself, maybe I can do something meaningful and important, like the workers here do.
Isn’t this the message that politicians should be encouraging? By banning funding for needle exchange funding, they are not only failing to save money, but they’re also failing at sending a true addiction-fighting message. Instead, the ban tells people with addictions: Keep using, kill yourself and possibly your loved ones, too, because nobody cares.