large cities in the U.S. have needle exchange programs, although they
receive no federal funding and the Bush Administration opposes them.  They
tend to be located in the seediest part of the city, and they hand out
clean, sterile needles to anyone that wants one, no questions asked.  Why?  Because sharing needles spreads AIDS.  In the biz we call this sort of thing “harm reduction.”


programs have resulted in lower incidence of HIV infection, and in
spite of concerns to the contrary, they are not associated with
increased drug use.  It turns out people do not start using heroin just because there’s a guy on the corner handing out needles.


In Vancouver, B.C., they go even further.  A pilot program there offers a safe injection site.  Users go in, get sterile equipment, swab their skin with alcohol, and inject themselves under the watchful eyes of nurses.  A waiver makes the clients and staff at the site immune from drug law enforcement. 


As you might expect, this program is not favored by conservatives.  But a new study shows uniformly positive results.  Like the needle exchanges here, the program decreases HIV infection.  Crime in the neighborhood has not increased.  And many people who come in ask for help—not to shoot up but to get into treatment. 


here’s the conundrum: the Vancouver safe injection site facilitates
drug use (though not for anyone who doesn’t already use them).  It also saves lives.  From a strictly public health perspective, there’s no doubt about its value. 


Efforts to eliminate drug use through law enforcement have been an abject failure from the very beginning of the “War on Drugs.”  I’m
sure many people would say “screw the addicts, let ‘em get AIDS and
die,” but even if you take that morally questionable tact, you can’t
ignore the enormous cost in dollars of every single AIDS case, or the
fact that every HIV-infected junkie potentially puts numerous others at


What do you think?  Is a safe injection site a legitimate AIDS prevention tactic?

Clarification:  Yorel
suggests that addicts buy their own damn syringes, but in fact they are
not available over-the-counter in many places.  In some states
people caught with a syringe are arrested for possession of drug
paraphernalia.  Consider this:


In 1992, Connecticut legalized sale and possession of up to 10 syringes
without a prescription. An evaluation was made of risky injection practices
and HIV infection among drug users both before and after the new law.
· Syringe sharing was reduced by 40%
· Street purchase of syringes dropped by 62%
· Police incidents of needlestick dropped by 66% (drug injectors
no longer felt they needed to conceal syringes from police)
Source: Groseclose SL, Weinstein B, Jones TS, et al. (CDC and Connecticut
State Health Dept) Impact of Increased Legal Access to Needles and Syringes
on Practices of Injecting Drug Users and Police Officers-Connecticut, 1992-1993
Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology
10:82 © Lippincott-Raven Publishers, Philadelphia

· At these success rates, New York State HIV infections could
be reduced by 6 per day.
· If these infections are not prevented, it will cost $109,500,000
in AIDS care (at an estimated lifetime cost of $50,000 per person with AIDS
x 2,190 preventable infections). (This does not include the cost of foster
care for orphaned children)
· The cost of these infections to families, particularly to orphaned
children, is incalculable. The majority of injection-related HIV infections
are among New York’s communities of color, already suffering from poverty,
inadequate access to healthcare and housing.




19 thoughts on “

  1. I dunno. You don’t need a Rx to buy syringes. It sounds like a matter of personal responsibility. They should go buy their own. It seems rather foolish to enable the delivery of illegal drugs. Two wrongs = right? Questionable. I suppose if local governments want to do this, fine, but it is not the business of the federal government. But what’s new? The feds are already up to their eyeballs doing what constitutionally they should not do; those things reserved to the states. I should stop now. G’night. 

  2. Most definitely.  Providing a safe way of doing what a person is going to do regardless only makes sense.  And if someone thinks a person is going to run out and try heroin because there are free needles available… well, we know who the crack smokers are, don’t we ?

  3. It don’t think it should be a matter of what is morally right and wrong.  Things are usually not simplistically black and white as suggested above. Like many things, this a matter of doing what can be done to solve the most problems for the most people.  This is public health issue, and an expensive one at that. Drug addiction, in my opinion, is also a public health issue.  Yes, people make bad choices.  But the whole of society pays the costs of those decisions.  How can we minimize the damage? It sounds to me like the city of Vancouver has the right idea. 
    (Somehow I managed to leave that comment without getting too high on my soapbox about the idiotic marijauna prohibition and drug wars. Yay for me.)

  4. A resounding YES. Humanity needs to grow out of its shallow concept of ethics- remember, “Conservative Approach” equals “Doesn’t Work” and “Traditional Morality” equals “False Image of Human Nature.” What’s ethical is what works for the common/greater good. Absolutely, these poor souls who stepped on the land mine of addiction would be better off without it, but those who’ve been there know that it is NOT a simple matter of “self discipline.” We must drop the “Yuck Factor” and do what needs to be done. (And here you do need an Rx to buy needles and syringes. They are “controlled substances.”)

  5. I agree with RevChuck. While reading your post, I was reminded of an article I was reading a couple days ago about the history of prohibition. From the middle 19th century until 1919 when the 18th amendment on Prohibition was passed, many conservatives argued that alcohol addiction was morally reprehensible. But the article also described how outlawing alcohol consumption led to the rise of organized crime, and provided criminals with huge sums of money. People realized that the advantages to Prohibition were greatly offset by the disadvantages of the rise in crime and its trade, and that gradually led to the repeal in 1933. If only we could learn from history! Outlawing a substance does not make the problem go away, and can lead to bigger, more morally reprehensible problems!

  6. Every time I try to form an intelligent opinion on this, I get stuck on the surrealism of offering drug users a safe way to shoot up.  I just can’t get past it.  It inhibits my ability to care one way or the other, when the world is so upside down. 

  7. Can we please dispense with the notion that treating drug addicts like human beings is going to make them more likely to use? I say: if the research indicates that such programs decrease the instance of HIV, and do not increase the instance of drug use, then what else is there to say? Drugs have won the war on drugs. It’s past time that we learned how to deal with the fact of drug use in our society.

  8. I think that safe injection sites would be a good thing… if it helps prevent a horrible incurable virus, then I’m all for it… Don’t get me wrong, I’m not all for the drugs, but the prevention of the spread of a disease turns me on.

  9. I may be a conservative Republican, but I’m not going to stupidly parrot party lines. Yes to needle exchange programs. It’s a no-brainer. Heroin use recidivism is 97%. Yep. 97 out of 100 people who use heroin will always use heroin, at least on and off, with flirtations at sobriety. I know. I was married to a heroin addict for more than seven years. Needle exchange does not promote drug abuse. Drug abuse will happen regardless. Needle exchange programs not only save lives (the addicts AND their significant others, who may not know- at least immediately- that their partner is using), but also tax dollars. Let’s see- the cost of a few needles, vs. the cost of long-term care for a terminal illness for someone who is uninsured. Hmnn. Yep. No-brainer. Lisa

  10. I can’t imagine anyone who sees this as a moral issue about drug use.  Drugs have been used for as long as they have existed.  Animals eat coffe beans in the wild for the rush.   It’s just the last few hundred years that we have made it illegal, and let’s reacp the results.
    Prohibition – spawned 100 years of gang amd mob activity that still has a legacy today
    WAR on DRUGS- abysmal failure and launched a second wave of organized crime.  The US is funding the growers, the distributors and the DEA.  What a debacle.  This also makes getting treatment more stigmatized and increases – YEP – HIV rates, and all the other health care and human costs assosciated with this.
    Make it all legal, tax the be-jebers out of it, and fund health care reform.

  11. I want more than anything for nobody to use drugs. Drugs ruin lives. But AIDS ruins lives too. I would definitely vote in favor of this program in my community. But I live in Texas… fat chance.~Q

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