Injection Drug Use, HIV/AIDS, and Hepatitis C

Harm Reduction Policies Slow Spread Of Diseases

House Needle Exchange Funding Amendment Raises Questions, Senate Version Retains Ban

As previously reported by Common Sense for Drug Policy, the U.S. House of Representatives recently passed an appropriations bill that, for the first time in over 20 years, does not include the notorious ban on federal funding of needle exchange programs. However, a July 31, 2009 Washington Independent article exposes flaws in the House amendment and warns of possible trouble ahead ("Congress Looks to Lift Two-Decade Ban on Federal Needle Exchange Funds"). As the article states, "ban critics cheered [the legislation's passage] as a long step toward curbing the spread of blood-borne diseases like HIV. Yet the proposal moving through Congress, according to many health and human rights advocates, has been diluted to the point that it won't help the same urban areas most afflicted by those illnesses." Additionally, the version of the bill circulating in the Senate "retains the needle-funding ban."

Despite his best intentions, House Appropriations Committee Chairman and bill sponsor David Obey (D-Wis.) felt obligated to include a restriction in the funding ban repeal that "prohibits [needle exchange programs] from operating within 1,000 feet of schools, daycare centers and other areas where children are likely to congregate," including "pools, parks, video arcades 'or any event sponsored by any such entity,'" and universities - a particularly puzzling inclusion, as most people who attend those institutions are legal adults. According to the Independent, Obey "included the restriction, not because he supports it, but to appease conservative critics who might have killed the entire provision otherwise." However, "needle exchange supporters argue" that the provision renders the bill near-entirely unworkable in urban areas because "the geographic restraints are so expansive that they'll neuter most benefits that would come with allowing funding of clean needle programs."

Allan Clear, who serves as the Harm Reduction Coalition's executive director, summarized needle exchange advocates' concerns most succinctly: "'It's too restrictive,' [he] said [...]. 'You couldn't open a program in Washington, D.C. - or most any urban area - with these restrictions." According to William McColl, political director for advocacy group AIDS Action, "If the bill is enacted as it stands, [...] 'it would preclude the use of needle exchange in the areas that need it most." Human Rights Watch's Rebecca Schleifer elaborated, stating that "As a practical matter, you won't be able to have needle exchange in the city [where] there are schools and daycare centers everywhere." She concluded by telling the Independent that the restrictions "make the bill 'meaningless as a practical matter, even if it's important as a symbolic matter."

However, the Independent provides harm reduction advocates with a glimmer of hope. After briefly discussing the Senate's decision to leave the funding ban intact, the article notes that "Needle exchange supporters on and off Capitol Hill are hoping to remove the geographic restrictions when the two chambers meet to hash out the differences between the two bills." Hopefully, the Senate will concur with the House's decision, and perhaps the two chambers could design a proposal that protects both public safety and needle exchange programs' ability to effectively operate in areas that need their services most direly. But, according to the article that "process [...] won't arrive until September, at the earliest." While harm reduction proponents would like to see the ban repealed more quickly, the delay does provide citizens, health and human rights groups, and other interested parties ample time to contact their representatives, organize events and demonstrations, and generally push their perspectives into public view.

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House Passes Appropriations Bill with Needle Exchange Funding Ban Repeal In Tact

Despite his best efforts to continue the ban on federal funding for syringe exchange programs, Rep. Mark Souder (R-IN) failed to convince the majority of his colleagues to remove an amendment that sought, as AP reported on July 25, 2009 ("House Permits Needle Exchange Programs"), to allow communities to use federal funding for needle exchange programs. The vote was close - 218 to 211 - but harm reduction advocates ultimately prevailed on the controversial measure, even after sitting through a "brief but passionate debate on [the] amendment [added] by [Souder] to keep the ban in place."

Souder argued that "HIV is spread chiefly through sexual activities and that needle exchange programs don't have a proven record of success." He added that "providing needles acts as a way for drug users to sustain their intravenous drug use and does not address the primary illness of the drug addiction." However, fellow Representatives like Lucille Roybal-Allard (D-CA) rebutted, saying "the scientific evidence is indisputable and that needle exchange programs put addicts into contact with social service agencies, opening the door for them to seek treatment." As mentioned above, Roybal-Allard's argument proved more convincing, and for the first time since 1988, the federal government will monetarily support syringe exchange programs in regions that wish to establish them.

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House Subcommittee Lifts Ban on Federal Funding for Needle Exchange

Syringe exchange programs moved one step closer to having access to federal funding following the House Appropriations Subcommittee on Labor, Health, and Human Services' removal of the long-standing ban. Chairman of the House Committee on Appropriations David Obey wrote in a July 10 press release that "Scientific studies have documented that needle exchange programs, when implemented as part of a comprehensive prevention strategy, are an effective public health intervention for reducing AIDS/HIV infections and do not promote drug use." Obey also stated that the Subcommittee felt the time had come to "lift this ban and let State and local jurisdictions determine if they want to pursue this approach."

However, as Philadelphia City Paper blogger Isaiah Thompson ("House Subcommittee Removed Ban on Needle Exchange Programs") reminds readers, "This isn't the end, [and] the measure still has to be approved by the Senate" and the full House itself. But, if recent protests in both Philadelphia and Washington, D.C. are any indication, concerned citizens are looking to Congress to, as Philadelphia activist Jose De Marco put it in a press release ("AIDS Activists Take Over Capitol Rotunda to Demand Action on AIDS from Obama and Congress") issued by Health GAP, "show real courage where the President has not."

For more on this historic deletion, stop by David Borden's blog post on the issue here.

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Legal Syringe Exchanges Begin Operation In New Jersey

The first legal syringe exchanges in the state of New Jersey began operation recently.

The Philadelphia Inquirer reported on Jan. 30, 2008 (Getting Out the Word on Needle Exchange") that "In the two weeks since it launched, only seven people have signed up for the Camden Area Health and Education Center syringe-exchange program, in a city with more than its share of intravenous drug users. Camden County ranks among the top in the state for drug abusers, with 1,516 heroin and opiate users alone seeking help in 2006, according to the New Jersey Substance Abuse Monitoring System. The state had more than 22,053 people who sought treatment for heroin abuse that year. The city of Camden ranks ninth among New Jersey municipalities for residents infected with HIV/AIDS, which is commonly transmitted among intravenous drug users by sharing needles. As of June 30, 2005, there were 1,384 cases in the city, according to the New Jersey Division of HIV/AIDS Services. Newark leads the state with 12,720. Camden's is the second syringe-exchange program to open in New Jersey since passage of legislation last year aimed at reducing the spread of blood-borne diseases among intravenous drug users. The state was the last in the country to legalize needle exchanges. Philadelphia already offers the service."

According to the Inquirer, "In Atlantic City, a needle exchange opened in a drop-in HIV counseling center in November and has already registered 170 people in a state-mandated database. Exchanges are also set to open in Paterson and Newark. Part of the Atlantic City program's allure is that it is run by an established treatment facility. That exchanges are made indoors and there are free coffee and doughnuts doesn't hurt, either. In Camden, the service is run out of a van and offers only the warm hearts of workers and fresh needles."

The Inquirer noted that "In Camden, the program has drawn much less scrutiny than a proposal to move a methadone clinic from near Cooper University Hospital to a site just a few hundred yards from the needle-exchange van. On Monday, members of Camden's Sacred Heart Church gathered to oppose the relocation of the Parkside Recovery Methadone Clinic. But they had little to say about the exchange. 'The exchange is run very well and can save lives,' said Msgr. Michael Doyle of Sacred Heart, who has been in Camden for 40 years. 'This is where the drug people are,' he said, explaining that the exchange saves lives, but that he believed methadone clinics perpetuate addiction. He said he thought that moving the methadone clinic would concentrate the problems of all of Camden County in an area of the city that has struggled for years to remake itself."

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San Antonio Authorities Arrest Syringe Exchange Workers

The Texas state legislature authorized creation of the state's first legal needle exchange, as a pilot project, in San Antonio. Local officials are blocking the plan and now harm reduction workers involved in a needle exchange there have been arrested.

The Los Angeles Times reported on Jan. 28, 2008 ("His Needle Plan Has Touched A Nerve") that "Bill Day doesn't fancy himself an outlaw -- and with his Mr. Rogers demeanor, he definitely doesn't look the part. But soon the 73-year-old lay chaplain could spend up to a year in jail for breaking a law that he considers immoral. Day hands out clean needles to drug addicts on some of the seediest streets in this south Texas city. He does it because he's convinced that it reduces human suffering by curtailing the spread of HIV, a view that has been supported by medical research for more than a decade. However, Day's actions are illegal in Texas -- the only state that has not started a needle-exchange program of some kind. So when a San Antonio police officer spotted him swapping syringes with prostitutes and junkies this month, he was arrested on drug paraphernalia charges."

According to the Times, "Neel Lane, a high-powered San Antonio lawyer who agreed to defend Day for free after learning about his case through their church, St. Mark's Episcopal, said it was time for the Lone Star State to admit it was behind the times. 'When you're the only state that doesn't have [a needle-exchange program], you're either the 2% smartest or 2% dumbest in the country,' Lane said. Though Texas is the only state that has not begun at least a pilot needle-exchange program in any city, lawmakers last year authorized one -- for San Antonio. Bexar County public health officials are studying whether to launch it, but Dist. Atty. Susan Reed has warned that she could prosecute anyone who distributes needles because she considers the act illegal. 'I'm telling [local officials], and I'm telling the police chief, I don't think they have any kind of criminal immunity,' Reed said in August, according to the San Antonio Express-News. Reed has not explained why she opposes the program, and her office did not return requests for comment. But at the request of a state lawmaker, Texas' attorney general is reviewing the dispute. Day and two associates, cited with him on Jan. 5, initially faced Class C misdemeanors, which are punishable by a fine of up to $500. But Reed's office and police plan to increase the charges to distributing drug paraphernalia, a Class A misdemeanor, which carries a possible one-year jail sentence."

The Times noted that "Day's supporters say they are outraged that police and prosecutors are treating the activists as criminals. 'How silly to arrest senior citizens who are trying to stop the spread of HIV in their community,' said Jill Rips, deputy executive director of the San Antonio AIDS Foundation, which provides HIV testing and runs a hospice. 'Don't police have something better to do?' Day said he accepted the arrest as part of a process that his community must go through before it could begin a healthy debate about reducing the spread of AIDS by addicts."

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Progress and Public Health At Last: Congress Lifts Ban on Local Funding for DC Syringe Exchanges

Legislation recently signed by the President contained a provision lifting the ban on local funding for syringe exchanges in the District of Columbia. The New York Times reported on Dec. 27, 2007 ("New law Allows Needle Exchanges in Washington") that "Since 1999, the nation's capital, which reports having the highest rate of AIDS infection of any major city in the country, has been the only city barred by federal law from using municipal money for needle exchanges. A recent report by the city showed that intravenous drug users' sharing of needles was second only to unprotected sex as a leading cause of H.I.V. transmission. Congress controls local government here, and for nine years members of the House, expressing concerns about worsening drug abuse, had inserted into the bill approving the city's budget a provision to prohibit financing needle exchange programs. But with Republicans' loss of Congressional control to Democrats, this year's bill, signed by Mr. Bush on Wednesday, reversed the ban."

According to the Times, "Officials of the District of Columbia Health Department said that with the ban lifted, they would allocate $1 million for such programs in 2008."

The Times noted that "'For too long, Congress has unfairly imposed on the citizens of D.C. by trying out their social experiments there,' said Representative Jose E. Serrano, the New York Democrat who heads the House Appropriations subcommittee that handles the city's budget. 'The ban on needle exchanges was one of the most egregious of these impositions, especially because the consensus is clear that these programs save lives.'"

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The Tenderloin, a notorious San Francisco dwelling of injection drug users, is an obvious choice for a city-funded, legal center where intraveneous drug users can receive free needles and consume drugs in a safe environment according to an October 19, 2007 San Francisco Chronicle article ("S.F. Injection Center Idea Draws Support and Doubt"). The Chronicle reported that 'Momentum for such a center seems to be gaining strength among drug reform advocates and some public health workers, who say it will help stop the spread of HIV and hepatitis C, prevent deaths from drug overdoses and keep dirty needles off city streets.Supporters include the San Francisco AIDS Foundation, the Mission Neighborhood Resource Center, the Harm Reduction Coalition and San Francisco General Hospital's Opiate Treatment Outpatient Program. But so far, no San Francisco politician appears ready to champion the cause."

According to the Chronicle, "It took 10 years of community organizing for the Vancouver center to go from idea to reality, said Sarah Evans, the center's program coordinator, who spoke Thursday at the San Francisco symposium. Insite, which opened four years ago, is North America's only injection drug center, though many exist in Europe. Insite is a rather bland, sterile place used by 800 intravenous drug users every day. They bring their own drugs - most often heroin, crack, cocaine and crystal methamphetamine - but are given free needles by the center's staff. The center hands out and collects 2 million needles a year. Despite a lot of initial skepticism, the Vancouver center now has the backing of the majority of the public, the mayor, the police chief and local merchants, Evans said."

The Chronicle noted that "The center has proven it can help stop the spread of disease and prevent deaths from overdoses, said Dr. Thomas Kerr, an HIV/AIDS researcher at the University of British Columbia. He has studied Vancouver's injection facility since its inception, and spoke at Thursday's event. Kerr said 800 overdoses have happened at the facility, but they have resulted in no deaths because trained professionals are right there. Without the center, overdoses would happen in back alleys or single-room-occupancy hotel rooms where there would be no help, he and other supporters of the facility said.' It's really been studied to death - it's time to move on,' Kerr said. 'It's obvious this is something that works."

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Change In The Works: DC Syringe Exchange Program Looks Toward Repeal Of Federal Ban On Funding

The federal ban on funding of syringe exchange services in the District of Columbia is edging closer to an end. The full US House of Representatives agreed to drop the ban from the DC budget bill. According to the Library of Congress's THOMAS system, the amendment to prohibit the use of funds to be used for the Prevention Works! or Whitman-Walker Clinic needle exchange programs (House Amendment 466, sponsored by Rep. Mark Souder (R-IN) amending HR2829) was defeated by a roll call vote of 208-216 on June 28, 2007.

The Washington Post wrote in an editorial on July 2, 2007 Needle-Exchange Victory"):
"OF THE 36 congressional riders that cluttered the appropriations bill for the District of Columbia, the ban on the use of local funds for needle-exchange programs was the most harmful. With intravenous drug use accounting for about one-third of new AIDS cases each year, the District has had to watch from the sidelines as the scourge with no cure claimed more and more lives. That congressionally enforced inaction might be coming to a merciful end with the House's vote last week to repeal the prohibition.

"Since 1998, the District has been forbidden to use its own money to fund needle exchanges. Thank Rep. Todd Tiahrt (R-Kan.) for this. He is among that group of politicians who firmly believe that giving addicts clean needles encourages drug use or is ineffective. Never mind that needle-exchange programs greatly reduce the risk of contracting or spreading HIV, the virus that causes AIDS, and that they put the users in contact with workers who could steer them into drug treatment. Never mind that medical groups, including the federal Centers for Disease Control and Prevention, recognize such programs as key tools to combat the epidemic.

"An amendment to reinstate the needle-exchange funding ban for the District was defeated. Now the action turns to the Senate. Giving the District the power to use its own money to help fight a fatal disease ravaging its population should remain untouched."

Groups in DC involved in syringe exchanges are preparing for the lifting of the funding restriction. The Washington Post reported on July 1, 2007 ("Big Break For Small Crusade") that "Now that the House has lifted the ban, over White House objections, such organizations as PreventionWorks! could begin tapping into local tax money as early as October, said D.C. Health Director Gregg A. Pane. The bill must still go through the Senate, which is not expected to reverse the decision. The Health Department would commit $1 million to support needle-exchange programs, HIV testing and intravenous-drug counseling services next year, Pane said. The city would allocate $250,000 to PreventionWorks!, he said, but would also encourage other programs in the city, including several run by the Health Department, to begin offering needle-exchange and drug counseling services. 'This isn't just giving away needles,' Pane said. 'It's a chance to interact with people. To do HIV and hepatitis testing and make the appropriate referrals to detox. It's a chance to interact with folks and do a number of good things.'"

The Post noted that "The Whitman-Walker Clinic helped set up PreventionWorks! after the clinic's government funding was jeopardized by the ban. In 1998, as the newly named executive director of PreventionWorks!, [Paola] Barahona delved into books at District libraries, teaching herself how to apply for private grants that would subsidize the program. With an operating budget of about $666,000 this year, almost all of the funding comes from private donations. It was only last year that PreventionWorks! got its first District contract. The $15,000 grant was not for a needle exchange but to provide HIV testing to Ward 7 residents as part of a three-month health initiative. By the end of the program, 433 people were tested; 5 percent tested positive. PreventionWorks! has two full-time employees: Barahona and Ron Daniels, who oversees its street outreach program. There are also three part-time workers. PreventionWorks! relies heavily on the 137 volunteers who help pass out needles and offer counseling at its offices, on 14th Street behind the Whitman-Walker food bank, or twice a week from its Winnebago at sites across the city. With the funds, she says, the program would expand such services as HIV testing and counseling and increase the number of support workers. From Oct. 1, 2005, to Sept. 30, PreventionWorks! counselors saw more than 10,000 addicts. During that time, they passed out more than 236,000 needles. The District has one of the highest HIV infection rates in the nation, with as many as one of 50 D.C. residents testing positive for the virus, according to Health Department estimates. About one-third of new AIDS cases annually are caused by syringes passed among drug users."

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Federal Ban On Funding For Syringe Exchange In Washington, DC May Soon Be Lifted

The ban on funding for syringe exchanges in Washington, DC, imposed by the US Congress years ago, may soon be lifted. The Associated Press reported on June 6, 2007 ("Needle Exchange Ban Lifted From DC Budget") that "A congressional subcommittee has voted to lift a ban on the use of local tax money for a needle exchange program in the District. Members of the House Subcommittee on Financial Services and General Government voted Tuesday to remove the prohibition from an appropriations bill governing the D.C. budget. The measure has been included as a rider each year since 1998."

According to AP, "The District has one of the worst rates of HIV/AIDS infection in the country. Officials said intravenous drug users account for a third of new AIDS cases, reported each year. A nonprofit group has operated a limited needle exchange program in the city for several years."

The AP noted that "The District budget is still subject to a series of votes in the House and Senate before it is sent to the White House for President George W. Bush's signature. D.C. Mayor Adrian Fenty has said he would provide local funding for a needle exchange program if the ban is removed."

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Canadians Support Sanitary Consumption Facilities

A survey of Canadian citizens in several major cities showed strong support for use of sanitary consumption facilities similar to the Insite project in Vancouver, British Columbia. The Edmonton Sun reported on May 30, 2007 ("Safe Injection Site Supported") that "A recent Canada West Foundation survey found 47% of Edmontonians think safe injection sites are a good or very good idea. The survey polled Canadians in seven major cities -- six in the west, plus Toronto. It found support for safe injection sites ranged from a low of 42% in Winnipeg to a high of nearly 55% in Vancouver."

According to the Sun, "Darren Grove, supervisor of Edmonton's park ranger unit, said while he doesn't have any hard numbers, he figures workers are picking up 1,000 to 1,500 discarded needles in the river valley each year. The last time the city had hard numbers was in 2005, when officials collected 497 needles from park areas, most of them around homeless camps. 'Absolutely there is a concern,' Grove said. 'We don't want to have someone stumble across them and accidentally get struck with a needle.' Marliss Taylor, who speaks for Streetworks, said while the group isn't pushing for a safe injection site, it would welcome one. 'We're not hopeful it will happen here at this time,' she conceded, noting the federal government appears opposed to the concept."

The Sun noted that "However, when respondents were asked to rank potential responses to illegal drug activity, safe injection sites ranked well below increased law enforcement and increased programs for addicts."

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Harm Reduction Works: Safe Injection Site Brings Users Into Detox, Treatment

Research published in the journal Addiction shows that use of a sanitary consumption facility by drug users in Vancouver, BC, is leading some drug users to enter detox and eventually drug treatment. The Vancouver Sun reported on May 25, 2007 ("Insite Raises Use Of Detox, Report Says") that "The report, published in a London-based medical journal, says Insite has resulted in a 30-per-cent increase in the use of detoxification programs such as methadone replacement therapy, addiction counselling, or participation in Narcotics Anonymous. That higher use of detox since Insite opened in 2003 suggests, based on previous research, that the facility 'has probably helped to reduce rates of injection drug use among users of the facility,' concluded the five scientists at the B.C. Centre for Excellence in HIV/AIDS in their report, published in the June issue of the peer-reviewed medical journal Addiction."

According to the Sun, "Health Minister Tony Clement questioned whether research supported Insite last September when he refused to grant a 31/ -year extension in the facility's federal permit. Clement, noting that Prime Minister Stephen Harper's government is about to introduce a tough national drug strategy that puts more focus on enforcement and less on so-called 'harm reduction' measures like injection sites and needle exchanges, suspended Ottawa's decision on Insite's future until the end of this year. 'The government seems intent on ignoring scientific evidence to pursue an ideological agenda at the expense of lives in the Downtown Eastside,' co-author Dr. Julio Montaner said in a statement. He said the new conclusions answer Clement's questions about whether Insite is contributing to lower drug use and fighting addiction."

The Sun noted that "The new report in Addictions, summarizing results of a study funded by the federal government, said the average number of users entering detox programs increased to 31.3 from 21.6 in the year after Insite opened. While that increase represents an increase of roughly 50 per cent, the researchers adjusted the results to take into consideration other factors in coming up with the 30-per-cent figure. 'There have been many benefits of Insite in terms of public order and reduced HIV risk,' said co-author Dr. Evan Wood. 'However, the fact that it appears to be pulling people out of the cycle of addiction by leading them into programs that reduce drug use is remarkable.'"

A copy of the Addiction article, "Rate of detoxification service use and its impact among a cohort of supervised injecting facility users," is available by clicking here.

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Texas House Passes Legislation Creating Legal Needle Exchange Pilot Project

The Texas State House of Representatives passed legislation creating the state's first legal needle exchange as a pilot project. The Ft. Worth Star-Telegram reported on May 22, 2007 ("House Votes For State's First Needle-Exchange Program, But Only In Bexar County") that "The Texas House voted to allow the state to create the first ever needle-exchange program for intravenous drug users -- but only as a pilot project around San Antonio. The provision was added to a broad Medicaid bill, Senate Bill 10, which was sponsored in the House by Rep. Dianne White Delisi, R-Temple. Rep. Ruth McClendon, D-San Antonio, at first tried to add an amendment to the bill that would create a statewide needle-exchange program. But she limited her amendment to Bexar County, where San Antonio is, when it appeared that she did not have support in the House for the broader program."

According to the Star-Telegram, "McClendon said Texas is the only state without a needle-exchange program. 'The purpose of the clean-needle program is to keep them from spreading the disease,' she said, referring to hepatitis C and HIV, which are commonly spread by intravenous drug use. Delisi did not dispute the public health benefits but said that constituent concerns about appearing to support illegal drug use outweighed those benefits. 'Our constituents [are concerned] about [whether] promoting the free exchange of needles for the illegal use of intravenous drugs is something the state should be doing,' she said.

The Star-Telegram noted that "Under the program, IV drug users could anonymously exchange their used syringes for clean ones. The details of the program remain to be worked out. The amendment was adopted in the House 71-60."

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Cities In New Jersey Apply To Begin Legal Syringe Exchange Programs

Now that the state has finally authorized it, several cities in New Jersey have begun the process of applying to the state to begin legally operating syringe exchange programs. The Cherry Hill Courier-Post reported on May 13, 2007 ("Cities Apply To Start Needle Program") that "Five of the 12 eligible cities have applied to the state Department of Health and Senior Services to begin pilot needle exchange programs. Up to six municipalities could receive permission to start needle exchange programs -- hoped to curb the spread of HIV/AIDS and other diseases among intravenous drug users -- provided they exceed certain statistics: 350 residents with HIV/AIDS and a prevalence rate attributable to drug use of more than 300 per 100,000 residents. Of the 12 cities that meet the criteria, Camden and Atlantic City, which have long sought exchange programs, applied, along with Newark, Paterson and Trenton. Asbury Park, New Brunswick, Plainfield, East Orange, Elizabeth, Irvington and Jersey City did not. 'It's been a battle, so we're glad to see it,' said Ron Cash, director of Atlantic City's Health Department, which plans to provide needle exchanges through vans and fixed sites."

According to the Courier-Post, "By the end of the summer there could be up to five programs in New Jersey -- the last state to have any sort of needle exchange program. Camden's program will begin once the state approves its program, which is expected to occur by the end of June. 'It's going to be crucial to saving lives of injection drug users,' said Jose Quann, program coordinator of the Camden Area Health Education Center. 'It's going to affect the community at large where contaminated needles wouldn't be discarded all over the city. Injection drug users will have access to sterile syringes that they might not get infected or infect their loved ones.'"

The Courier-Post noted that "Roseanne Scotti, director of the Drug Policy Alliance, said the programs will work in New Jersey without the rise in crime that critics predict. Some cities that didn't apply are waiting to see how the programs do before starting ones, Scotti said. 'It's a process that takes time,' Scotti said. 'Atlantic City and Camden spent a couple years -- while they were advocating for this -- educating their city officials and educating the staff at the organizations that would do this. . . . I certainly think there are other cities that are interested and that they will just apply late and the state will hopefully grant them some leeway there. We're talking about saving lives here.' If New Jersey's pilot programs work, the Health Commissioner will report to the Legislature in five years whether the program should become permanent and possibly expanded."

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Texas Senate Approves Syringe Exchange Legislation

The Texas Senate approved legislation allowing operation of syringe exchanges in the state. The San Antonio Express-News reported on April 27, 2007 ("Needle Exchange Approved") that "Texans could save a lot of money if illegal drug users were allowed to exchange clean needles, Sen. Bob Deuell said Thursday before the Senate approved such a program. Texas is the only state in the country that does not allow a needle exchange program for drug users. The Senate voted 22-7 for the measure, which has not cleared the House."

According to the Express-News, "'It brings people in to get rehabilitated. It lessens the contaminated needles in the drug-using community. It cuts down on diseases such as HIV and hepatitis B and C,' said Deuell, a physician and Republican from Greenville. 'And, in the long run, it will save the state money.' The bill did not trigger debate. Treating one person with HIV costs taxpayers an estimated $385,000 over a lifetime, Deuell said. Contaminated needles are responsible for half of all HIV cases and 40 percent of hepatitis C cases in Texas, he said. 'There is no good reason to continue to refuse what we know clearly works,' Deuell said. A clean needle exchange program has resulted in many drug users 'getting off drugs because they went someplace where people cared and got into a rehabilitation program before they caught a disease that might kill them,' he said."

The Express-News noted that "Chances of the bill passing the House are unclear. Many people believe a needle-exchange program encourages drug addicts, said Deuell, who once shared that attitude."

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Maine Legislature Considers Bill To Ease Some Restrictions On Syringe Exchanges

A bill in the Maine Legislature would ease some of the restrictions under which the state's syringe exchanges operate. The Portland Press Herald reported on May 11, 2007 ("Needle Swap Bill Gets Good Reception") that "A state panel is backing legislation that would relax limits on needle-exchange programs for drug users as a way to reduce the transmission of blood-borne infections such as human immunodeficiency virus and viral hepatitis. A bill before the Legislature would allow participants to exchange an unlimited number of used syringes for sterile ones, eliminating the current limit of 10 per visit. The measure also would protect participants from criminal charges that could stem from the possession of residual amounts of drugs in the used syringes."

According to the Press Herald, ""Clearly, if you're in a rural area, this bill will help you, because you can drive fewer times and exchange more needles," said the bill's sponsor, Rep. Lisa Miller, D-Somerville. Miller introduced the bill at the request of the state HIV Advisory Committee. The proposal will go before the Health and Human Services Committee today for a public hearing. A total of 555 people are enrolled in four state-certified needle-exchange programs in Maine. The programs are in Portland, Augusta, Bangor and Ellsworth. On average, 10 syringes are the equivalent of a three-day supply, said Martin Sabol, the advisory committee chairman and manager of Portland's infectious-disease program."

The Press Herald noted that "Maine would not be alone in having no cap on exchange programs. Oregon, Hawaii, San Francisco and Baltimore already allow an unlimited number, she said. Proponents acknowledged that some uneasiness remains around needle-exchange programs because of a sense that they condone drug use. Maine passed a law allowing them 10 years ago."

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The Last State Gives In: New Jersey Approves Syringe Exchange

After a tense legislative session New Jersey became the final state in the US to approve access to sterile syringes. The Newark Star-Ledger reported on Dec. 12, 2006 ("Lawmakers OK Clean-Needle Bill") that "After more than a dozen years and countless hours of impassioned debate, the Legislature yesterday passed a bill to prevent the spread of HIV and AIDS among drug addicts by allowing needle exchange programs in six cities. Gov. Jon Corzine said he would sign the bill into law quickly. 'The science is clear: Needle exchange programs reduce sharing of contaminated needles, reduce transmission of HIV and hepatitis C and serve as gateways to treatment,' Corzine said. For 13 years, lawmakers have wrestled with the legal and moral paradox of giving addicts syringes to use illicit drugs. Opponents questioned scores of scientific studies, the vast majority of which have found that needle exchanges reduce drug users' exposure to AIDS and do not entice more people to use drugs."

According to the Star-Ledger, "'The bottom line is that this program will save lives,' Corzine said. 'I applaud the Legislature for getting it to my desk, and I look forward to signing the bill and seeing the program implemented rapidly.' Health and Senior Services Commissioner Fred Jacobs called the vote a 'great day for public health in New Jersey' and praised the inclusion of $10 million for drug treatment services. 'Hopefully we will put this behind us and get on with the issue of saving lives,' Jacobs said. Atlantic City health officer Ron Cash, who came to witness the vote in Trenton, said the city already has passed an ordinance permitting the pilot exchange program -- a requirement of the bill -- and could have a syringe access program operating in three to six months. 'We've tried education, counseling,' Cash said. 'We just want this as a tool to fight the disease.'"

The Star-Ledger noted that "After more than two hours of emotional discussion, the Senate approved the bill ( S494 ) 23-16. Minutes later, the Assembly passed the bill 49-27 with four abstentions. 'The action we are taking today will save lives,' said Assembly Speaker Joseph Roberts ( D-Camden )."

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There They Go Again: US Blocks World Health Organization Resolution on AIDS Treatment

The United States once again has blocked a UN resolution on AIDS because of objections to needle exchange programs. The Associated Press reported on Sept. 21, 2006 ("AIDS Treatment Resolution Withdrawn At WHO Meeting Because Of US Opposition") that "A resolution calling for universal access to HIV/AIDS treatment has been withdrawn from the World Health Organization's Asia-Pacific conference because the United States insisted on changing it, senior officials said Friday. American officials submitted a series of last-minute amendments to remove expressions of support in the resolution for items such as needle exchange programs for drug addicts, said officials at the meeting in Auckland, New Zealand's largest city. New Zealand Health Minister Pete Hodgson, who chaired WHO's annual weeklong conference of officials from the Western Pacific region, said the U.S. amendments would have watered down the resolution. Negotiations failed to resolve differences over the wording. 'So, having ascertained that no resolution would do no damage ... I put it to the meeting that we would be better off to have no resolution than one that was perceived to be weakened,' Hodgson told The Associated Press."

According to AP, "Hodgson said one of the issues U.S. delegates had sought to change was references to needle exchange programs for intravenous drug users — which advocates say help stop the spread of HIV through the sharing of syringes. The U.S. 'position is that if they have needle exchanges then people will use needles more and use intravenous drugs more,' Hodgson said. 'I think it is demonstrably wrong. New Zealand has had needle swaps for 20 years — it has been an amazing success.' WHO's acting regional director, Richard Nesbit, confirmed the resolution had been withdrawn on the last day of the conference after U.S. officials sought changes. He said the U.S. delegation also had issues with spelling out specific high-risk groups such as sex workers, intravenous drug users and men who have sex with men. 'They had been advised by Washington to make a number of changes to the language,' Nesbit said, adding that WHO estimates injecting drug users make up more than a third of the region's new HIV cases."

AP noted that "UNAIDS estimated that 8.3 million people were living with HIV, the virus that causes AIDS, last year in the Asia-Pacific region — including South Asia, Indonesia and Thailand, which are not part of the Western Pacific region. Nearly 85 percent of those infected had no access to anti-retroviral drug treatment, it said."

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New Jersey Inches Toward Approving Access To Sterile Syringes

The state of New Jersey is moving nearer to finally allowing access to sterile syringes. The Newark Star-Ledger reported on Sept. 19, 2006 ("Senate Panel Advances Needle Exchange Bill") that "After a full day of public hearings and backroom bargaining, the state Senate Health Committee reached a compromise last night on legislation aimed at combating the spread of AIDS by allowing addicts to exchange dirty needles for clean ones. The bill (S-494) was approved 5-2, with one abstention, after being amended to limit needle exchange programs to six municipalities and subject them to re-evaluation at the end of five years. It was alsochanged to include $10 million for drug treatment programs, which some senators insisted should be the state's priority. The committee deadlocked and took no action on companion legislation that would have allowed pharmacies to sell up to 10 syringes without a prescription. Sen. Joseph Vitale (D-Middlesex), the sponsor of that bill (S-823) and the committee chairman, said, 'We all want to have further discussion and a little more research.'"

According to the Star-Ledger, "Yesterday, Health and Senior Services Commissioner Fred Jacobs told lawmakers the state "should not delay another minute" in providing access to clean needles. He said New Jersey is "the only state in the nation that has failed to give communities the tools they need" to combat the spread of AIDS. In July, Delaware established a pilot needle exchange program, leaving New Jersey as the only state that has no such program and also forbids the sale of syringes without a prescription.

The Star-Ledger reported that "The bill must also be approved by the Budget and Appropriations Committee because of the $10 million for treatment programs, and then go to the full Senate and Assembly. The legislation would allow up to six cities or towns to apply to the state Health Department to begin demonstration programs. Camden and Atlantic City have already expressed interest. Atlantic City attempted to set up its own program but last year a state appeals court ruled it was illegal. Sen. Nia Gill (D-Essex), who sponsored the needle-exchange legislation, said the compromise version is 'not perfect, but I'm not here to be the enemy of the good.' Her original version would have allowed any municipality to establish such a program. Roseanne Scotti, director of the Drug Policy Alliance of New Jersey, said the bill's approval was 'a huge step' and 'really historic.' She said it was the first time in her 13 years of lobbying that such a bill won approval in the Senate Health Committee, which last year killed a needle-exchange program passed by the Assembly.

The Star-Ledger noted that "Jacobs, the state health commissioner, said replacing HIV-infected needles with clean ones is a basic public health measure on a par with killing mosquitoes that spread the West Nile virus or pulling 'bad spinach' from grocery shelves. Addicts will 'be on drugs with or without these free syringes,' Jacobs said. 'If you don't have infected syringes, you don't pass the infection.'

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Massachusetts Legislature Overrides Veto, Approves Clean Needle Sales

The Massachusetts State Legislature in July overrode the governor's veto of legislation to allow sale of sterile syringes without prescription. The Worcester Telegram & Gazette reported on July 24, 2006 ("Lawmakers Override Needle Veto") that "State lawmakers last week overrode a Gov. Mitt Romney veto of the long-debated bill, which opponents criticized for putting the state in the position of condoning intravenous drug use. 'This particular bill, now that it's the law, will, in fact, slow down the spread of HIV,' said Edla L. Bloom, executive director of AIDS Project Worcester. 'There will be tangible numbers. People that are getting infected from injection drug use, or relationships with people who are injection drug users, those numbers will go down as they have in other states.' Buying hypodermic needles in Massachusetts has long required a prescription."

According to the Telegram & Gazette, "The fight over the needle bill was an offshoot of a contentious debate over clean needle exchange that in recent years has visited many cities in Massachusetts. Supporters of needle-exchange programs point to Boston and Cambridge -- both have been distributing needles to addicts for more than a decade -- which boast of the lowest rates of injection-related HIV transmissions in the state. The HIV service community was virtually united in support of distributing needles to addicts who otherwise would be prone to sharing needles and spreading the disease. But in many cases it came up against unwavering political opposition. District 4 City Councilor Barbara G. Haller has been one of Worcester's loudest voices against providing addicts with easy access to clean syringes, arguing that advocates of such policy do more harm than good. Ms. Haller said government should be aggressively reaching out to addicts with information about the dangers of drug use, information that also should be made available to the public at-large and children. Drug use, she said, ought to be taboo."

The Telegram & Gazette noted that "In the wake of the more than two-thirds override vote by both the Senate and House, AIDS Action Committee of Massachusetts Executive Director Rebecca Haag said the result would be lives that are saved, a reduction in new infections and millions in savings for the state in health care costs. State data show 39 percent of people with HIV/AIDS in Massachusetts infected directly or indirectly by a dirty needle."

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Romney Says No; Governor's Veto Puts Needle Users' Lives At Risk

The governor of Massachusetts, Milt Romney Jr., in June 2006 vetoed a piece of legislation which would have reduced the incidence of HIV/AIDS in Massachusetts. The Lowell Sun reported on July 1, 2006 ("Romney Vetoes Needle-Sale Measure") that "Gov. Mitt Romney yesterday vetoed a bill that would allow for the sale of hypodermic needles without prescription, saying it could help promote heroin use and send the wrong message to young people. Romney said the bill, which proponents hope will stem the spread of blood-borne diseases such as HIV and hepatitis C, would have had 'unintended consequences' such as encouraging more widespread heroin use."

According to the Sun, "The veto was disappointing news, if not surprising, for Lowell Health Director Frank Singleton. 'All the evidence shows this bill would do good,' he said, reached by phone yesterday. In addition to preventing the spread of disease, decriminalizing the possession of needles helps protect police and other public safety officers, because IV drug users don't hide their needles in their pockets and clothing, Singleton added. 'There would not be more dirty needles in the street,' he said. '( The decision to veto is ) basically a political decision made by some people on an ideological basis.'"

The Sun noted that "Proponents of the bill cited a 2001 study by the American Journal of Public Health that studied drug use in 90 metropolitan areas and found there was no evidence that allowing needles to be sold over the counter would lead to increased drug use. Most states in the U.S. allow sales of hypodermic needles without a prescription for that reason, Singleton said. 'If ( all these problems ) are going on, why are all the other states allowing over-the-counter sales?' he said. 'We're not exactly in the majority here.'"

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Connecticut Needle Exchange Wins Protection In Federal Court

The American Civil Liberties Union's Drug Law Reform Project succeeded in winning heightened protection for a Connecticut needle exchange in June 2006. According to the Drug War Chronicle ("ACLU Wins Victory In Connecticut Needle Exchange Case," June 2, 2006), "In a case brought by the American Civil Liberties Union Drug Law Reform Project, a federal judge has ruled that protections she previously granted to people possessing needles should be expanded to include other injecting equipment as well."

The Chronicle reported that "In 2001, acting on complaints of harassment and persecution by drug users and needle exchange workers in Bridgeport and citing the Fourth Amendment's protections against unreasonable search and seizure, the ACLU won an order blocking the Bridgeport Police Department 'from searching, stopping, arresting, punishing or penalizing... any person based solely upon that person's possession of up to thirty sets of injection equipment.' But as she prepared to hand down her latest ruling Thursday, US District Court Judge Janet Hall complained that 'my order may well have been written in invisible ink.' On Thursday, she chastised the Bridgeport police for failing to diligently follow her earlier order, but rejected an ACLU motion to find the department in contempt. She did, however, expand the protection in the earlier order to include injection equipment such as cotton balls and items used to cook drugs."

The Chronicle noted that "The Bridgeport Syringe Exchange, in operation for more than a dozen years now, is one of around 200 such programs in the country. Every scientific study of needle exchanges has found that they are an effective way of reducing the spread of infectious diseases such as HIV/AIDS and Hepatitis C. 'The police can contribute to public health and safety by supporting efforts that engage injection drug users in disease prevention programs that simultaneously serve as conduits to treatment for addiction,' said Robert Heimer, PhD, a professor at Yale School of Public Health and a nationally renowned expert on the emergence and prevention of infectious diseases. 'In the long run, this is the only reliable means to decrease addiction at the community level.'"

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US Pressure May Weaken UN Declaration On AIDS

AIDS experts and advocates are concerned that US pressure may hinder the worldwide fight against AIDS. The Washington Post reported on June 1, 2006 ("Weaker UN Declaration On AIDS Is Feared") that "Negotiations over an updated version of the United Nations' 'declaration of commitment' on AIDS are bogging down in battles over the language sensitivities of Islamic countries and the reluctance of the United States to have specific, very expensive global targets spelled out in detail. According to numerous people in close contact with the negotiating teams, the declaration that will be presented to the General Assembly tomorrow may be far weaker than the one adopted in 2001. Though that declaration was not a binding document the way a treaty is, it is widely believed to have been a key factor in marshaling the world's energy and resources to address the needs of AIDS patients in the developing world. Some participants said it will be ironic if the new declaration turns out to be vague in its goals and sanitized in its language, as an unprecedented number of activist groups and civil society organizations -- about 800 in all -- were invited to take part in preparing it and have been pressing for greater explicitness and accountability. 'We are seeing the U.N. system poised to take an enormous step backward,' said Kim Nichols of the New York-based African Services Committee. 'If we can't arrive at a unified set of global targets, then we're in deep, deep trouble.'"

According to the Post, " UNAIDS, the United Nations' AIDS program, estimates that $20 billion to $23 billion a year will be needed by 2010. The United States now spends more on AIDS in the developing world than any other country and is considered likely to continue supporting the large number of people now getting antiretroviral therapy through the $15 billion President's Emergency Plan for AIDS Relief (PEPFAR) even after its five-year term expires. People familiar with the negotiations here said the U.S. delegation fears that the United States will be held more accountable than other donors for funding shortfalls that may occur in the future if the targets are spelled out explicitly. Civil society groups want a target of providing drugs by 2010 to 80 percent of people whose infection is advanced enough to require antiretroviral treatment and to 80 percent of infected pregnant women, as well as to all people who have both tuberculosis and AIDS. None of those goals is mentioned in a draft of the declaration dated May 30. The United States is seeking to have the document 'take note' of a goal of providing UNAIDS $20 billion to $23 billion by 2010, rather than having that need 'recognized.'"

UN officials and AIDS experts are expressing concern that anti-AIDS efforts are faltering internationally. Reuters reported on May 30, 2006 ("Anti-AIDS Drive Still Falling Short After 25 Years") that "Twenty-five years after AIDS was first recognized, the world is still falling short in its battle against the disease with severe gaps in prevention and treatment, the United Nations said on Tuesday. 'Despite some notable achievements, the response to the AIDS epidemic to date has been nowhere near adequate,' said UNAIDS, the U.N. agency that coordinates the global campaign against the pandemic."

According to Reuters, "The global AIDS incidence rate is believed to have peaked in the late 1990s. About 1.3 million people in the developing world are now on life-extending antiretroviral medicines, which saved about 300,000 lives last year alone. Still, some 4.1 million people were newly infected and 2.8 million died in 2005. There were 4.9 million new infections and 3.1 million deaths in 2004. Fewer than half of young people were knowledgeable about AIDS. Among those injecting illegal drugs or having homosexual sex, few received preventive services last year. The global supply of condoms was less than 50 percent of what was needed, and antiretroviral drugs, while more widely available, remained costly and hard to get. Ignored in many countries are prostitutes, said Thoraya Obeid, the Saudi Arabian executive director of the U.N. Population Fund. She said they also had the right to prevention and treatment, especially since many were poor women or girls, sold into prostitution and victims of violence. However, a final statement by governments at the conference this week is not expected to refer to prostitutes, drug users or homosexuals, due to objections from Islamic nations, some Catholic countries and the United States which fear that merely mentioning these groups would endorse their behavior. Infected individuals still suffer from ostracism and discrimination, while the vast majority of the world's 40 million infected people have never been tested for HIV and are unaware of their status, the report said."

Reuters noted that "While $8.9 billion is expected to be available in 2006 to combat AIDS in developing countries, $14.9 billion will be needed, UNAIDS said. By 2008, it predicted, $22.1 billion would be needed, including $11.4 billion for prevention plans alone."

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Tories Tentatively Support Independent Panel Recommendation Endorsing Safe Consumption Rooms

In England in May 2006, an independent panel funded by the Joseph Rowntree Foundation issued a report endorsing use of safe consumption rooms. The Guardian reported on May 23, 2006 ("Heroin Addicts Could Inject Themselves At Supervised Centres In Police-Backed Plans") that "Police chiefs have backed proposals which could see heroin addicts injecting themselves in officially sanctioned centres. An independent working group, tasked by the Joseph Rowntree Foundation, will today recommend the introduction of supervised drug consumption rooms to the UK, so that users could take illegal drugs in safe, hygienic surroundings. Members of the group included Andy Hayman, a Scotland Yard assistant commissioner who also chairs the Association of Chief Police Officers' drugs portfolio, and his Acpo colleague, Met police detective superintendent Kevin Green."

According to the Guardian, "There are 65 drug consumption rooms ( DCRs ) in eight countries worldwide, including Switzerland, Germany, Spain, Australia and Canada, and the working group, which visited some of these during its 20-month research period, believe they reduce the risk of harm to the individual as well as the costs to society. Unlike so-called 'shooting galleries', which are largely unsupervised and where drugs are often purchased, or premises where prescribed heroin is available, users would bring their own drugs to DCRs, and although supervisors would not be able to intervene, they could advise and give immediate assistance if a user collapsed. The initial pilot proposal is for injection facilities, but European countries are increasingly adding smoking rooms, where heroin and crack cocaine can be smoked."

The Guardian noted that "Four years ago, the Home Office rejected similar recommendations from the home affairs select committee. But Dame Ruth Runciman, the chairwoman of the independent working group, hoped the government would now reconsider. 'The Home Office rightly said in 2002 that there was not enough evaluated evidence from drug consumption rooms abroad,' said Dame Ruth. 'There has been a lot more evidence since. There have been millions of injections in drug rooms abroad and only one death, which was not due to an overdose.' She suggested the consumption rooms could be run by local authorities, the NHS and voluntary bodies, but added: 'Most importantly and without question, they must involve the police.' She said the two police officers on the working group supported the group's findings as individuals, but she was aware there would be a range of reactions among the police."

Unfortunately the UK's Home Office may not be as willing to examine the evidence as Dame Ruth hoped. The opposition Tories may on the other hand be more flexible. The Daily Telegraph reported on May 24, 2006 ( "Tories Back Injection Centres For Drug Addicts") that "The Tories tentatively supported calls yesterday for the Government to set up special centres where heroin addicts could legally inject themselves. In a surprise move, Edward Garnier, the shadow home affairs minister, said: 'We do not rule out [these] recommendations. If this is to take place in a controlled environment and is to be used as a stepping stone to actually getting people off drugs, we will look at this carefully.'"

The ruling Labour Party on the other hand was less receptive. According to the Telegraph, "Vernon Coaker, the Home Office minister, said the Government's position was unchanged. 'The reasons for rejecting it in 2002 are as valid today - the risk of an increase in localised dealing, anti-social behaviour and acquisitive crime,' he said. But the DrugScope charity, which campaigns to shape drugs policy, welcomed the Joseph Rowntree Foundation report and said it hoped for a rational debate. 'A policy which can save lives deserves serious consideration, however controversial it may seem at first,' said Martin Barnes, the charity's chief executive."

A copy of "The Report of the Independent Working Group on Drug Consumption Rooms" is available from the Joseph Rowntree Foundation website as well as through the CSDP research archive.