A 1995 government-commissioned study claims that giving clean needles to addicts will slow the spread of the AIDS virus without encouraging drug abuse. While there is reason to question this claim, even if the spread of HIV among intravenous drug users (IDU) were slowed, this action would create some potentially undesirable effects.

The fight to establish federally-funded needle exchange programs (NEP) is being urged as a wedge issue to gain drug legalization. Linking drug addiction with the emotion-charged AIDS epidemic under the pro-drug umbrella called "harm reduction" is good political strategy, but it's a bad idea that is gathering momentum, and it must be countered.

Supporters of federally-funded NEPs are rallying around this issue. Leading NEP researcher Peter Lurie, a professor with the Institute for Health Policy Studies, University of California San Francisco, says the 1995 study is "a vindication for all of the needle exchange workers around the country, as well as the scientists who have been coming to these conclusions for years....[The government] can no longer hide from the weight of scientific evidence...."[1]

In response to the American needle study, the respected British medical journal Lancet said, "It is time for the U.S. to catch up with so much of the world....Needle exchanges do not increase drug use in programme [sic] participants. They do not encourage or increase the number of drug users. They do not increase the number of needles lying about; they do not destroy cities, or towns or neighborhoods."[2]

Dr. Lincoln Moses, chairman of the 15-member panel that led the government's NEP study, said, "We must consider the reality that people do use drugs and that HIV is transmitted in growing numbers by injection drug use."[3]

Not everyone agrees with those who favor needle exchange. Donna Shalala, the Secretary of Health and Human Services (HHS), has doubts. Shalala told CNN that "different experts disagree" as to the efficacy of needle exchange.[4] Philip Lee, Shalala's assistant and a former needle exchange researcher, called NEPs "an extraordinarily complex public policy strategy"[5] and expressed concern that NEPs "may send a mixed message about drug use."[6]

Roman Catholic Cardinal John O'Connor said, "It [needle exchange] drags down the standards of all society.... It is an act born of desperation."[7] Reverend Calvin Butts, pastor of the Abyssinian Baptist Church in Harlem, agrees. "I am not in favor of cooperating with evil," said Butts. "If we give out needles now...the next step will be to legalize crack and heroin."[8] This may be the ultimate goal of proponents of these programs.

LEGAL BACKGROUND

In 1992, Congress ordered HHS to request a study of NEPs by the National Academy of Sciences (NAS), an independent, Congressionally-chartered, non-government research agency. If the Academy found that NEPs were shown to be effective in reducing HIV infection while not encouraging drug use, then the Surgeon General could lift the ban on federal financing for such programs, Congress said.

The Academy concluded its study in 1995 and reported that well-implemented NEPs can be effective in preventing the spread of HIV and do not increase the use of illegal drugs. NAS recommended that "the Surgeon General make the determination called for in Public Law 102-394, section 514, 1993, necessary to rescind the present prohibition against applying any federal funds to support needle exchange programs."[9]

While addicts can legally buy needles in all but nine states without a medical prescription, 45 states have laws making it a crime to carry a needle and syringe.[10] Police in these states argue that the criminalization of drug paraphernalia helps successful drug arrests and prosecutions.

In 1992, Connecticut modified its syringe law to permit the possession and purchase of up to 10 needles without a prescription. But a state-sponsored survey found that IDU needle sharing did not change with the new law.[11]

Community NEPs do not slow illegal needle sales. Numerous studies have found that even where NEPs operate and syringes are available without prescription, IDUs remain dependent upon black market sources for needles.[12]

THE BATTLEGROUND

Needle Exchange Programs are intended to curb the practice of sharing needles among IDUs to reduce the risk of transmitting the AIDS virus. Residual blood retained in a shared syringe can be passed along to the next person using the syringe. This high-risk behavior infects perhaps 20,000 Americans with the AIDS virus every year.[13]

Providing addicts with clean needles may slow the spread of the AIDS virus, but questions remain. Will it lead to more responsible behavior? Will it lead addicts to seek drug treatment? Will this practice encourage more drug abuse?

Researchers discovered that the bite of the infected female anopheles mosquito transmitted malaria. To slow malaria's spread, researchers theorized, the mosquito had to be destroyed. It worked. Dr. Lurie argues that replacing tainted drug needles with clean ones would be analogous to removing the malaria vector.[14]

Nationwide, almost one-third of all AIDS cases are associated with IDUs. This includes almost 60 percent of children under age 13 who contracted the virus from mothers who were abusers or who were sex partners of IDUs.[15] Today, shared needles are blamed for more HIV infections than in the past.

In 1981, only 12 percent of AIDS victims contracted the virus from needles but in 1993 that number had risen to 29 percent.[16] During the same period the proportion of new cases of HIV transmission due to sex between men declined from 74 percent to 47 percent.[17]

Most of the IDUs are found in the 96 largest metropolitan areas. These areas also include 85 percent of all reported AIDS cases, and nearly a quarter (23.5 percent) of all IDUs are located in just six cities: Boston, New York City, Newark, Philadelphia, Baltimore and Washington, D.C.[18]

The total number of IDUs is hard to predict. The U.S. Public Health Service reports that the population exceeds one million.[19] The 1994 National Household Survey on Drug Abuse found that 2,580,000 Americans have used needles to inject illicit drugs in their lives and 257,000 have done so in the past year.[20] A 1994 CHARITABLE DONATIONS COMMITTEE report estimates that in the nation's largest metropolitan areas alone the IDU population exceeds 1.5 million.[21]

WHO ARE THE ADDICTS?

Terri is a 29-year-old Hispanic mother of two and an IDU. She said, "In the beginning, it was fun. I felt like Superman....It was like I had an 'S' on my chest and I had my mask on, and I could conquer the world. The drugs took away the bad feelings."[22]

Terri, like many addicts, started injecting just to get high. Soon she found that the drugs were causing more pain than relief. To support her $200-a-day habit, Terri sold heroin, got caught, and lost custody of her children.[23] There are more than 200,000 addicts like Terri in New York City alone.[24]

According to another addict, "Shooting drugs is not a rational act....I know what it's like to be scared of getting AIDS, but I needed to get high so bad that I didn't think about the risk."[25]

Dr. Steven Koester, an anthropologist at the University of Colorado Health Sciences Center in Denver, explains why addicts share needles in spite of the AIDS scare. "The laws against having syringes made it too risky to carry them on the way to get heroin. It created an artificial scarcity. They were sharing because they had to -- not because of some ritual for bonding." After buying their dope, said Koester, addicts "go to the closest place where they can have privacy and get a syringe." This is typically a "shooting gallery" where, for a small fee, they can get privacy and a needle to use.[26]

It's difficult for an addict to stop injecting drugs because heroin depletes key body chemicals. With these gone, the body experiences intense drug cravings and withdrawal symptoms are unpleasant. That's why a heroin addict may need four to six injections each day, 120 to 180 times per month or 1,500 times per year. Frequent injections with shared needles lead to increased chances of contracting blood-borne diseases like HIV.[27]

HOW NEPS WORK

The typical NEP client is male, has been injecting between seven and 20 years and is between 33 and 41 years old.[28] Racial/ethnic distributions vary considerably depending upon location. One-third to one-half of NEP clients have never been in drug treatment.[29]

The Lower East Side Harm Reduction Center [New York City] provides numerous services. Addicts can get "shooter's supplies" like alcohol pads, cotton balls, cookers, condoms, bottles of bleach and clean water. The exchange hands out about 1,000 needles an hour [30] or between 15,000 and 20,000 each week.[31]

The exchange also helps addicts get into treatment programs, solves housing problems, gives lessons on safer ways of shooting drugs, and keeps tabs on the heroin that has made its clients sick. Warnings about bad heroin are identified by their street names on a chalkboard hung inside the center.[32]

Mark Gerse, the center's director, said, "We've become an information clearinghouse. If we didn't get the word out, it would take a series of deaths to get people's attention."[33]

Terri uses the Lower East Side needle exchange which operates out of a storefront in a residential area populated by working poor. She explains, "This place gives me hope and it makes me feel loved....This place keeps you from hurting yourself until you're able to make a choice to straighten yourself out."[34]

Another addict who has been mainlining for more than a decade, said, "It's good to know that there's someone actually looking after us because the truth is, nobody else cares if we kill ourselves with bad dope."[35]

There are approximately 75 NEPs in 55 U.S. cities.[36] They operate either from fixed sites (stationary van, storefront, street, and health facility) or mobile sites (walk route, deliveries and roving vans) operating a median 10 hours per week. They are staffed with a combination of paid employees and volunteers who may provide a variety of services in addition to exchanging needles, such as HIV testing/counselling, tuberculosis screening, screening for sexually transmitted diseases, primary medical care and substance abuse treatment.[37]

THE SWISS NEEDLE EXPERIMENT

In 1986, to counter the drug problem, the Swiss began experimenting with NEPs. The first step was to make syringes available in every pharmacy. Switzerland also legalized syringe sales via public vending machines. For three francs or about $2.43, anyone can buy two syringes, extra needles, alcohol, swabs, gauze, and a condom packaged in a cigarette-sized pack labelled "Flash."[38]

In 1988, Zurich's Platzpitz Park was opened for free needle distribution. Up to 300 syringes were given away each day. The original aim had been to create a "safe" place for Zurich's own addicts. But before long, the city was flooded with foreign addicts. The number of needles exchanged grew to 12,000 per day before the park was closed in 1992.[39]

After police closed Platzpitz, thousands of addicts relocated a half-mile away to an abandoned railway station called "Letten" where the Swiss experiment evolved into a grotesque spectacle.

Needle exchanges grew to 15,000 per day.[40]

Letten became a war zone between rival drug-dealing gangs. When police tried to investigate crimes, they faced gunfire and their cars were attacked and overturned by addicts. Local police arrested a drug dealer after the fourth murder within just one month. Fellow drug dealers stormed the police station demanding the man's release or else they would blow-up the station.[41] He was released. In February, 1995, Swiss authorities closed Letten and moved the addicts to government sponsored centers and "shooting galleries."

Dr. Franziska Haller, a Swiss psychologist, pharmacist, and anti-drug activist, said that Zurich's permissive drug policy was designed to put pressure on the federal government to start a nationwide heroin distribution program. She says this is a big step toward drug legalization -- the ultimate goal of pro-drug forces.

Opposition to NEPs and government-sponsored heroin experiments has not been tolerated. Doctors who protested the initial NEP were quashed by the media and pro-NEP physicians. Even a public school teacher who warned her elementary students about the risks of illicit drugs lost her job because of pressure from pro-drug groups. One of her students had died from a heroin overdose.[42]

Switzerland has the highest heroin addiction rate (30,000 addicts) and second highest HIV infection rate in Europe. It experiences between 350 and 400 illicit drug overdose deaths each year.[43] To address the growing problem without experiencing more "Lettens," the Swiss federal government started giving drugs to some addicts. Switzerland has an ongoing experiment in nine cities where heroin, morphine and methadone are given to addicts. The project, which is scheduled to end in December, 1996, includes 700 addicts. Nearly half of these addicts are HIV-positive. They are given free drugs up to nine times a day. At night they are given heroin cigarettes to be used at home. The cost is covered by health insurance or the government.[44]

Dr. Andre Seidenberg, who runs a Swiss government-sponsored heroin maintenance clinic for 100 addicts, believes that "heroin consumption should be medicalized." He would "like to see heroin distribution trials in the U.S."[45]

The experiment's aim is to improve addict health, decrease criminal activity, cut addicts off from drug dealers and stop abuse. Unfortunately, the number of addicts is rising, and the experiment has not cut illegal drug abuse and crime. It is also reported that police officials in Bern and Zurich have been ordered not to arrest drug consumers and dealers.[46]

On July 1, 1995, Swiss prison authorities began experimenting with heroin-addicted inmates. Junkie prisoners with at least a nine-month sentence who were age 20 and older were given heroin. The rationale for this experiment was not announced.[47]

It appears that Switzerland is moving towards drug legalization. The problems associated with NEPs and drug maintenance programs have contributed to a shift in attitude toward drugs. On November 9, 1995, 94 Swiss executives called for the government to embrace a "harm reduction" strategy that includes an expansion of the legal heroin distribution program. Six of the executives were representatives of American companies in Switzerland: Andersen Consulting AG, American Express, Polaroid, Atag Ernst & Young AG, Agfa Gevaert AG and Revisuisse Price Waterhouse AG.[48]

Roland C. Rasi, general manager of the Swiss Bank Corporation, spoke for the executives when he announced the 11-part "harm reduction" strategy. The strategy would shift funds from enforcement to treatment such as medicalized heroin distribution. It would also demand that Swiss companies employ drug addicts in order to better integrate them into society. He described one Swiss company that proudly hires auto mechanics who are addicted to heroin.

In 1996, the Swiss people will decide whether to legalize now-illicit drugs. The vote is expected to be close. Dr. Haller said she hopes America does not follow Switzerland's drug example.

WHAT DOES THE RESEARCH SAY ABOUT NEPS?

The Washington-based Drug Policy Foundation (DPF), which is supported by pro-drug billionaire George Soros, has hosted several Capitol Hill seminars to brief Congressional staff about NEPs. Arnold Trebach, DPF's president and an American University professor, said at one of the seminars that the "dominant morality is that drug abuse is a greater threat than AIDS."[49] Trebach said the federal government's needle exchange policy is "obscene." He says the research supports NEPs.

In September, 1995, the National Academy of Sciences announced the results of its government-requested study of NEPs in its work, "Preventing HIV Transmission: The Role of Sterile Needles and Bleach".[50] The panel called for the Surgeon General to rescind the present prohibition against applying any federal funds to support NEPs.

Dr. Moses, the study chairman, said that data from a program in New Haven showed that the rate of HIV infection in needles turned into the exchange had decreased by one-third.[51]

Edward Kaplan, a professor with Yale University's School of Management, evaluated the New Haven NEP. Kaplan, a statistician, says he is not an NEP advocate, but that he believes NEPs are effective.[52]

Moses also cited a study in Tacoma, Washington, which found a dramatic drop in blood-borne diseases after an NEP started. That study examined hepatitis B infection rates among NEP participants and found these people were eight times less likely than non-participants to contract the blood-borne infection. This study is supposedly analogous for HIV infections.[53]

Dr. Don Des Jarlais, research director of the Chemical Dependency Institute at Beth Israel Medical Center in New York, endorses NAS's recommendation. "Anyone who's looking at it from the perspective of preventing HIV transmission," said Des Jarlais, "comes to the conclusion that we ought to be doing more syringe exchange."[54]

Dr. Peter Lurie led a CHARITABLE DONATIONS COMMITTEE-funded study entitled, "The Public Health Impact of Needle Exchange Programs in the United States and Abroad," 1993. The study evaluated 23 of the programs in 15 cities across four countries. His study was extensively reported by the NAS. Lurie concluded that NEPs "do not appear to increase drug use and do prevent HIV infections in injecting drug users, their sex partners, and their children."[55] His 700-page report calls for more federal funds for NEPs, repeal of laws precluding purchase of syringes without a prescription, and repeal of paraphernalia laws.

Lurie's analysis evaluated eight needle exchange studies that measured drug use levels. Only one study showed an increase in drug use. Three showed a decrease, and four found no change. Lurie

found 10 of 14 other studies that showed a reduction in HIV infection among NEP participants.[56]

Lurie's report acknowledges numerous problems: None of the studies reviewed were "randomized; self-reported behavior (subject to response bias) was often used as an outcome; follow-up was often poor; and risk behavior was often only roughly measured."[57] Lurie admits that he can't determine whether NEPs change the community level of drug use, and he found no evidence that NEPs increase use of drug treatment.[58] With regard to New Haven-type studies that test only syringes, Lurie says, "The validity of testing of syringes is limited."[59]

On the key issue whether NEPs effect HIV infection rates, Lurie states, "Studies of the effect of NEPs on HIV infection rates...probably cannot provide clear evidence that NEPs decrease

HIV infection rates. However, NEPs do not appear to be associated with increased rates of HIV infection."[60]

Even a 1993 General Accounting Office report concludes, "Research suggests [that syringe exchange programs have] promise as an AIDS prevention strategy."[61] GAO's "promise" and Lurie's "cannot provide" are not comforting conclusions.

On April 6, 1995, ABC's Catherine Crier interviewed Ton Quadt, the Dutch Drug Rehabilitation Coordinator. Quadt said, "If you put in enough clean syringes and needles, people don't have to use dirty needles, so the risk of getting HIV is lessened." Since the program began 10 years ago, the AIDS infection rate of those in the program has dropped from 11 percent to 4 percent.[62]

Enthusiasm for NAS's recommendation to lift the ban on NEP funding is not universally shared. Assistant Secretary of HHS Philip Lee said, "I have not been convinced on the evidence that has been presented so far."[63] His skepticism is well founded. On October 16, 1989, then Secretary of HHS Louis Sullivan hosted a conference with 12 scientific and legal experts to discuss NEPs.[64] The consultants recommended designing a new multi-center experiment lasting three to five years. Unfortunately, that recommendation was never undertaken.

Lead consultant Dr. Edward Brandt, Jr., a former Assistant Secretary for Health and then the Executive Dean of the College of Medicine of the University of Oklahoma, said, "It will be extraordinarily difficult to provide a scientifically rigorous answer [with regard to NEPs slowing HIV infection without increasing drug abuse]."[65]

Considering the NEPs at that time, Brandt concluded, "It is not possible to perform a meaningful evaluation of existing programs because none were designed and initiated with a stringent evaluation approach as a primary objective. Also, comparison among programs through a multi-center evaluation is not possible because of major differences in program objectives, design, and operation."[66]

Brandt's reservations are evidenced in key studies cited in the NAS report. For example, the New Haven study is based on a mathematical model using six independent variables to predict the rate of infection. The unreliability of any of these variables invalidates the result. The New Haven study includes key assumptions. For example, it assumes that any needle returned by a participant other than the one to whom it had been issued had been shared and that any needle returned by a participant to whom it had been issued had been unshared.[67] Both assumptions are suspect.

More than half (60 percent) of the New Haven participants dropped out. Those who remained in the program were most likely motivated to protect themselves from infection and the drop-outs likely continued in their high-risk lifestyles.[68]

The Yale study fails to consider the seroconversion rates in addicts and also relies on self-reporting by addicts, a group not known for reliability.

Additionally, most NEPs provide a host of services which account for some of the reported "success." Outreach programs without needle exchange have been shown to have some effect.

Dr. Janet Lapey, a medical doctor, studies NEPs for Drug Watch International, a worldwide anti-drug organization.[69] She critiqued NAS's report, saying: It downplays sexual transmission of HIV among addicts. Some resort to prostitution to fund their addiction. After all, non-needle using crack addicts have high incidence of HIV. It cites a NEP study that had no increase in heroin use by young users. This is not surprising given that NEPs and drug treatment programs are usually populated by older drug users. It fails to interview neighborhood residents near NEPs to see whether they approve of the effect of these programs. It trivializes the drug problem and provides no solutions other than NEPs. It does not cite studies that measured HIV seroconversion rates, the only true indication of effectiveness. It does not measure whether drug use rises in NEP service areas. It gives credibility to pro-needle studies and claims that anti-needle studies are lacking. She says this biased use of statistics is analogous to the tobacco companies using statisticians to support their claim that smoking does not cause cancer.

James L. Curtis, director of the Department of Psychiatry, Harlem Hospital Center, wrote to New Jersey Governor Christine Todd Whitman to recommend against NEPs. Curtis said, "On the unproved assumption that these programs prevent the spread of AIDS, addicts are actively encouraged to continue to inject themselves with illegal drugs, and are exempted from arrest in areas surrounding the needle exchange program. Indeed the addict is partially financed in continuing this self-damaging behavior."[70]

Finally, Dr. Mitchell Rosenthal, director of the Phoenix House Foundation, a drug treatment organization, said, "I don't think we have any data yet that is compelling that needle exchange is making a difference."[71]

POLICY DILEMMA

California Governor Pete Wilson vetoed a bill that would have authorized state-funded NEPs. He explained, the "real question...is whether the hoped-for reduction in needle-transmitted HIV infection justifies sending a mixed message that will threaten to undermine the credibility of all society's other anti-drug efforts -- especially those preventive education efforts aimed at dissuading young audiences from choosing to engage in drug use."[72]

The NAS agrees with Wilson's reservations. The report says, "The long-term effects of these programs on the level of illicit drug use in communities are not yet known."[73] It acknowledges that "the act of giving a needle to an IDU has a powerful symbolism that has sparked fears about the potential negative effects of NEPs."[74]

Wilson recognizes the hyperbolic nature of a pro-needle policy. "If we are going to demand that young people exercise personal responsibility," Wilson explained, and "if we say that they must suffer the consequences of their personal choices, [then] what are they to think, when in the next breath we give formal sanction to a project which facilitates drug use?"[75]

Congressman Charles Rangel (D-N.Y.) opposes NEPs. He has said, "Our goal should be to eliminate drug abuse, not to find a cleaner, safer way to do it. Sure, IV drug abusers put themselves at risk of AIDS through sharing needles and, certainly, we want to slow its spread, but there are better ways than giving addicts needles to do their drugs."[76]

Former national drug czar William Bennett agrees. NEPs are rejected because they "may also confound a community's anti-drug efforts by implicitly condoning the intravenous use of illegal drugs."[77]

Lee Brown, who resigned as President Clinton's drug czar last December, said the Office of National Drug Control Policy "can find no compelling reason for the administration to depart from existing federal policy regarding needle exchange...[It] is neither an adequate substitute for drug treatment nor a preferred means of entry into drug treatment."[78]

Dr. Moses, chairman of the NAS panel, claims that NEPs "often result in more referrals to drug abuse treatment."[79] Evidence to support this statement is minimal.

Most addicts in treatment are there because of a run-in with the criminal justice system, not because of a run-in with an NEP. According to Dr. Lapey, only 16 percent of NEP participants voluntarily enter treatment.[80]

Two of the three medical doctors on the NAS panel, Dr. Herbert D. Kleber and Dr. Lawrence S. Brown, claim that the news media have exaggerated NAS's findings and that NEPs "are not the

panacea their supporters hope for....We personally believe that the spread of HIV is better combatted by the expansion and improvement of drug abuse treatment rather than NEPs, and any government funds should instead be used for that purpose."[81]

A myth associated with NEPs is that there is a long wait for treatment. But according to Rosenthal, treatment candidates are not turned away without help. There is a four-week waiting period for in-patient treatment, but all candidates for admission are placed into a "day care" program until such time as beds become available. The "day care" unit lasts eight hours a day, and patients can receive AIDS education and counselling. [82]

Rosenthal says that the greatest HIV threat among heterosexuals is from sexual contact, not dirty needles. Clean needles will not modify sexual behavior in the IDU. He explains that in the

New Haven study, fewer than a third of the participants employed safe-sex practices most of the time.[83]

Dr. David Williams of the University of Michigan Institute for Social Research says that NEPs raise important ethical and moral problems. "People can be morally compelled," said Williams, "to support a lesser harm [drug abuse] in order to overcome a greater harm [AIDS]."[84]

In response to this philosophy, Rep. Rangel said, "Supporters of free needles may have their hearts in the right place, but they have overlooked some very important considerations. These people should enlist in efforts to expand comprehensive treatment and rehabilitation services. Better to stop needle use altogether."[85]

HOW MUCH SUPPORT DO NEPS ENJOY?

The DPF and the NAS report say that the public favors NEPs. They site a 1994 survey of 1,001 Americans by Peter D. Hart Research Associates, Inc., Washington, D.C., which showed that 55 percent favor implementing NEPs to reduce the spread of diseases such as AIDS.[86]

The NAS report also profiles 23 other surveys with mixed results. A 1988 CBS News/New York Times</I> national poll found that only 40 percent of Americans favor giving injection drug users sterilized needles to slow down the spread of AIDS. A 1989 Media General/Associated Press</I> national poll found that half of all Americans favor giving needles to addicts given the promise that it will slow down the spread of AIDS.[87]

To measure America's commitment to NEPs, pollsters should set a better context for the needle question. Perhaps the pollster should ask, "Would you support giving clean needles to drug

addicts to slow the spread of HIV, if you knew that this policy shift might increase illicit drug use among America's youth?" Most likely, a majority of Americans would answer "no."

WHAT ARE THE SOCIAL CONSEQUENCES?

There is ample evidence that NEPs contribute to serious social consequences for affected communities. For example, Regina Policastro, an editor for a small Boston newspaper, wrote about her experience with an NEP client. On November 11, 1991, "a woman, having received a state-provided free needle, engaged in prostitution, and overdosed right in front of Policastro's child in her yard."[88] Police did nothing because the woman had an authorized needle identification card.

The plentiful supply of free needles has created a rogue practice. The Boston Herald</I> reports that Boston police were on the lookout for a junkie who obtains allegedly AIDS-tainted needles from a local NEP and then sells them for use as weapons. An unidentified Boston officer overheard schoolkids say, "It's better than a gun because a gun you can do time for."[89] Similar scares are common among New York City commuters.

Reverend Steve Peterson, pastor of Holy Cross Lutheran Church in Madison, Wisconsin, expressed grave concern that Madison's NEP -- which is only 250 feet from the school -- will put his parish elementary school children at risk. He explained, "Our concern is that the needle exchange violates the spirit of the drug-free zone."[90]

Milt McPike, a Madison high school principal, said, "I have a lot of concerns about stuff like that [NEPs] near schools."[91] His job is to protect children, and their welfare must be balanced

with the need to control HIV among drug addicts.

Nancy Sosman knows all too well the problems NEPs bring to a community. Sosman is a member of the Coalition for a Better Community, a New York City citizens group opposed to NEPs. Since the Lower East Side NEP began, she says, "We've seen an increase in dirty syringes on our streets, in our school yards and in our parks....There has been a dramatic increase in the public display of injecting drugs.... Brazen addicts shoplift, loot and steal to buy drugs."[92] Sosman says that there are no controls on the number of syringes given to an addict at the NEP and in fact, she has seen NEP participants sell their syringes to buy drugs. Even "exchange workers have been photographed selling needles away from the NEP."[93]

New Haven Police Chief Nicholas Pastore supports NEPs. Pastore told ABC's Catherine Crier, "The thing that I feel good about is that that heroin addict is not preying on society, is not killing somebody, not banging somebody on the head, not breaking into your or my home. They're getting help...."[94] That's not Nancy Sosman's observation. She says that the NEP participants fan out into her neighborhood "to buy drugs, use drugs, sell drugs and steal to get money for drugs. Our local police will never be able to stop the trafficking of illegal drugs."[95]

Curtis contends that NEPs are bad medicine. "The police make no attempt to arrest addicts even though it still is illegal to possess and inject illegal drugs. The drug dealers flock to these neighborhoods in order to sell drugs which are openly used even in broad daylight. These neighborhoods experience dramatic deterioration with a corrupting influence on many candy stores, newspaper stands and grocery stores. The sidewalks are littered with used and bloody needles, syringes and empty vials of crack cocaine. Furthermore some addicts make a business of selling these needles to purchase other drugs such as cocaine which they prefer.[96]

Curtis continues, "Addicts commonly support their habit by selling drugs to other addicts, by recruiting new addicts, and by prostitution or by exchanging sex for drugs, all of which behavior contributes to spread of the AIDS virus."[97] NEPs "promote a breakdown in law and order," the Harlem doctor says. "They are poor medicine and poor public health practice. In fact, these programs constitute a reckless experiment with human beings, totally unregulated by research guidelines ordinarily applied to protect human subjects from potentially dangerous research."[98]

CONCLUSION

On April 2, 1995, Saudi Arabia beheaded three drug smugglers. A little earlier, Singapore did the same.[99] There are no NEPs in Riyadh and few addicts on Singapore's streets. Neither country has an AIDS epidemic. If America seeks to reduce drug use, it must stop coddling addicts. Drug abusers need treatment, not encouragement to keep injecting deadly drugs. Although AIDS will kill some, most will die from drug overdoses or other high-risk behaviors.

Congressman Rangel tells public officials not to fool themselves about NEPs. "Can police honestly enforce laws against people who use 'government-issue' needles when the government is the very source of the tool to commit the offense?"[100]

The growing needle exchange debate is really about drug legalization. Pro-drug forces have nurtured a cadre of scientists and others to give their fight the appearance of legitimacy. But they have yet to satisfy the strict, scientific requirements set forth in the law.

Before the federal government boards this Titanic</I>, it should sponsor research like that suggested by former Secretary of HHS Sullivan or even embrace some of Dr. Lurie's recommendations for methodologically-sound NEP studies. Then, if the evidence satisfies the requirements of Congress, the lifting of the funding ban could be reconsidered.

In the meantime, missteps with the NEP policy could lead the nation down a tragic path. NEPs provide no guarantee to solve the AIDS epidemic nor stop the drug scourge.

5/8/96