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The Debate Over Needle Exchange

There are few public health issues as politically charged as the debate over whether the federal government should fund programs that provide clean needles to drug addicts to help prevent the spread of HIV. Clean needle exchange programs fall under the category of harm reduction policy -- a concept in which public policy aims to lessen the health and social consequences of drug use, particularly the transmission of HIV. The Atlanta-based Centers for Disease Control & Prevention estimate that 90 percent of new AIDS cases in women and 93 percent of new cases in children are due to or linked to injecting drugs. Overall, three-quarters of new AIDS cases are attributable to intravenous drug use.

Experts argue that harm reduction policies decrease the negative consequences of drug use as well as act as a bridge to treatment and general medical care. (The general health status of heroin addicts is usually worse than that of non-addicts, but the former do not routinely seek out medical services. Instead, they land in expensive emergency rooms, often after their condition has greatly deteriorated. Needle exchange and other harm reduction programs can point them to needed care earlier.)

Needle exchange programs have been recommended as a cost-effective way of reaching drug users, but the federal government has maintained a ban on funding such programs since 1988. Today, some 100 communities around the U.S., including New Haven, Connecticut, and Tacoma, Washington, are using their own funds to support needle exchange programs designed to curb the spread of HIV among intravenous drug users.

A syringe

Support for these programs varies. Residents in some communities where needle exchange programs exist say it has tainted the neighborhoods. Nancy Sausman has been trying to shut down the needle exchange program in her Lower East Side New York City neighborhood since 1994. Sausman says needle exchange projects do not promote public health and turn communities into havens for drug addicts. She says she and her neighbors have found used needles littered in the neighborhood and seen people shooting up on the street. These programs "are distribution centers for needles and drug paraphernalia," she says. "They have nothing to do with health and only work to bring down communities." Others argue that needle exchange programs produce more drug use and increase drug-related deaths. James Curtis, MD, director of psychiatry and addiction services for Harlem Hospital Center in New York, is firmly opposed to needle exchange. "Addicts need to be treated. . . . They should not be given needles and encouraged to continue their addiction," he says. Critics note that in 1986, the Swiss began experimenting with needle exchange programs. By 1988, Zurich's Platzpitz Park became a center for free needle distribution. But the city became a haven for foreign addicts and the number of needles exchanged each day grew four-fold from 3,000 to 12,000 per day before the park was closed in 1992.

A condom

Needle exchange programs often do other "harm reduction," such as distributing condoms to IV drug users to help prevent the spread of AIDS.

But others say the programs save lives. The American Medical Association, the Centers for Disease Control, and the Institute of Medicine, among others, have come out in their favor. Winnie Fairchild, a resident of Washington, D.C., says having access to a clean needle exchange program would have made the difference between life and death for her. Fairchild, a former heroin addict who is HIV positive, says she would not be infected with the AIDS virus if she had used clean needles. "Had this needle exchange program been around when I was a drug user, I would not be a client at this [HIV] clinic."

Despite scores of studies from a variety of private and government agencies that have shown that clean needle programs curb the spread of HIV and do not boost drug use, the debate over their utility is likely to rage on. Congress last year specifically barred the federal government from lifting the ban on federal funding of needle exchange programs until March 1998.

--Janet Firshein

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