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What
is needle exchange and Harm Reduction?
Needle
exchange programs allow injection drug users (IDU)
to trade in their used syringes for sterile ones
in the hopes of stopping the spread of HIV, hepatitis,
and other blood born viruses. Needle exchange programs
(NEPs) are part of a growing movement called Harm
Reduction.
The
philosophy and practice of Harm Reduction represents
a major shift in traditional services available
to drug users. The philosophy of Harm Reduction
works within a model of addiction as a specific
regimen and not the description of a certain individual.
In other words, there are no moral or pathological
judgments regarding someone's drug use and abstinence
is not a stipulation to receive services. The practice
of Harm Reduction utilizes a set of pragmatic strategies
to reduce the negative consequences of drug use,
incorporating a continuum of strategies from safer
use, to managed use to abstinence. Needle exchange
is only one aspect of Harm Reduction. Other services
include, but are not limited to: the distribution
of safer sex equipment; on-site wound care; providing
avenues to food, shelter and health care; political
and legal advocacy; distributing information about
safer drug use; overdose prevention; HIV testing
and support; and transportation and referrals to
abstinence drug treatment programs upon request.
(For a more detailed definition, see Principles
of Harm Reduction by the Harm Reduction Coalition.)
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Does
giving out sterile syringes encourage the use of
illicit substances?
NEPs
do not promote the idea that injecting is a great
thing, nor do they propagate the lifestyle as romantic
or desirable. Instead, when it comes to administering
services to minimize drug related harm, there is
no moral judgment regarding an individual's drug
use. The intent is not to get people sober (even
though this does happen), but to provide health
information and access to safer injection equipment
that will inevitably save their lives while they
are using. Furthermore, research has shown that
this approach actually creates the conditions for
people to manage or decrease their drug use. People
come to the needle exchange and feel comfortable
because they are not being judged. This provides
a safe and trusting environment so people can share
important information about their lives - which
is the first step towards making life changes, whatever
those changes might be.
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Does
needle exchange create more injection drug users?
There
have been six government reports on the viability
of needle exchange in the United States and they
all concur that access to sterile needles reduces
the spread of HIV and does not increase drug use
- and no research conducted on US programs contradict
these findings. For example, three years after a
San Francisco needle exchange program opened, the
average age of injectors increased while the minimum
age remained the same. Similar results also occurred
in the New Haven NEP. And in New York City, the
number of new users choosing to inject drugs has
decreased since the deployment of their NEP. In
1993 Massachusetts also conducted its own study.
Former Senator James J. Jajuga (D-Methuen) stated
that research showed that needle exchange programs
"did not enhance drug abuse as some believed.
It did not increase crime in those areas where needle
exchange was active," Jajuga confirmed.
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Does
needle exchange hinder other drug treatment efforts?
People
visit NEPs not only to exchange needles, but also
for conversation, a sense of place, to get referrals
to detox and to receive information about other
social services. Lex (his name has been changed
to protect his identity), a Massachusetts program
participant, described his experience:
Coming
to the needle exchange has opened a door for me
to use safely, for myself, and to be more responsible
with my using. It's actually opened a door also
for recovery and I am grateful for the needle
exchange because ití' not there for just
changing the needles. You can come here and talk
about stuff that is going on with you.
In
1992-93 nearly 20% of participants in a New Haven
NEP initiated drug treatment and hundreds approached
the program exclusively for treatment referral.
Another study conducted at the University of California-Berkeley
even revealed a shortage of space in treatment centers
to support the number of users using the needle
exchange as an initial step towards making progressive
life changes.
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What
is the situation in Massachusetts?
In
1993, Governor William Weld (R) passed a needle
exchange pilot program which legalized the possession
of needles. The law states, "notwithholding
any general or specific law to the contrary, needles
and syringes may distributed or possessed as part
of a pilot program approved by the [Massachusetts]
Department of Public Health - and any such distribution
or exchange of said needles and/or syringes shall
not be a crime." This law allowed for 10 pilot,
state-funded NEPs and granted the Department of
Public Health authority to fund the programs in
cities and towns where "local approval"
was obtained.
Local
approval can happen two ways. The mayor can either
pass an executive order approving the program for
the city, or the city council has to vote in favor
of the program. Since 1993 local approval for needle
exchange has only passed in Boston, Northampton,
Provincetown and Cambridge (all implemented through
Executive Order). In Northampton, Massachusetts,
for example, former Mayor Mary Ford wrote an executive
order that instituted what is now the Northampton
Needle Exchange. However, in cities like Springfield
local approval has been directed through the city
council and they have voted against such programs
being administered in their city (although Springfield
voted in favor of a NEP in 1998, but then rescinded
that vote illegally).
Moreover,
local politicians in many of these cities with high
rates of HIV transmission have not only voted against
the establishment of a pilot program in their city,
but theyíve even launched aggressive attacks
in opposition to the possibility of their implementation.
There are no NEPs in Holyoke, Springfield, New Bedford,
Worcester, Fall River, Lynn, and Lawrence - cities
in which 60-80% of AIDS cases are due to injection
drug use. Politicians in many Massachusetts cities
with high rates of HIV transmission have fought
against the establishment of a pilot program in
their city. Massachusetts is one of only five states
that criminalize the sale and possession of needles
without a prescription and we have the 9th highest
rate of injection related HIV in the US.
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What
professional organizations and institutions are
in favor of needle exchange?
The
American Medical Association, the American Public
Health Association, the National Academy of Sciences,
the Center for Disease Control and Prevention, the
National Institute of Health, and the Association
of State and Territorial Health Officials are among
the many organizations which have endorsed needle
exchange.
In
addition, the Mass. Nurses Association, the Mass
Medical Society, Suffolk County District Attorney
Ralph Martin, and Boston Police Commissioner Paul
Evans supported a recent proposal to expand NEPs
in Massachusetts. During the 1998 World AIDS Day
nearly 300 Massachusetts physicians and 275 nurses
called on Governor Celluci to exercise his power
and declare a public health emergency and expand
access to sterile needles. And in April of 1999,
a statewide survey of registered voters conducted
by the McCormick Institute at UMass-Boston found
that 62% of respondents supported needle exchange.
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