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Feature: Busted for Handing Out Clean Needles -- The Mono Park 2 Fight Back in California's Central Valley

Hit hard by a double whammy of drought and economic slowdown, California's Central Valley has become a hotbed of methamphetamine and other injection drug use. Now, the dusty town of Modesto, in Stanislaus County, has become a focal point in the statewide and nationwide battle over how to help injection drug users. Last week, two volunteers at an unsanctioned needle exchange were in court in Modesto hoping to reach a plea bargain after they were arrested in April for handing out syringes. Now known as the Mono Park 2, they're looking at serious jail time for trying to save lives.

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mobile needle exchange/clinic site in nearby Fresno
The deal was supposed to be that Stanislaus County District Attorney Birgit Fladager would drop drug paraphernalia possession charges against exchange volunteers Kristy Tribuzio and Brian Robinson if they agreed to quit handing out needles until there was a legal program in place. But that didn't happen. Instead, at the last minute, the DA rejected the plea deal. Another hearing is set for November 9. If the DA and defense attorneys cannot reach agreement then, the case will go to trial.

The case has its genesis in longstanding efforts to win official approval for a needle exchange in Modesto. California law allows for needle exchanges, but only as a local option. The county board of supervisors must declare a health emergency in order for needle exchanges to operate legally.

In a 2008 report, Containing the Emerging Threat of Hepatitis through a Syringe Exchange Program (begins on page 22), the Stanislaus County Civil Grand Jury recommended the county authorize syringe exchanges and implement them either directly or through a community based contractor. The effort also had the support of county public health officials, including Public Health Department, the Advisory Board for Substance Abuse Programs, the Local AIDS Advisory Implementation Group, and the Hepatitis C Task Force, who cited a high incidence of Hepatitis C. They cited research indicating that needle exchanges reduced the spread of blood-borne diseases, brought injection drug users into contact with public health workers, and did not result in increases in drug use.

But despite the input from the public health community and the grand jury report, the Stanislaus County Board of Supervisors a year ago voted unanimously against allowing needle exchanges. In so doing, they heeded their own prejudices and those of law enforcement over science-based policies and the advice of the public health community.

County Sheriff Adam Christianson and DA Fladager both spoke out against needle exchanges, saying they would enable drug users to continue their addiction. Fladager said needle exchanges sent the wrong message to young people and encouraged them to think the county would take care of them if they become addicted.

"All of the challenges we are faced with in Stanislaus County, the gangs, methamphetamine, crimes, all have elements of drug addiction," Christianson said. "A syringe exchange program enables people to continue with their drug addiction."

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used syringes collected by exchange -- they might otherwise have been discarded in public places
Noting that Hep C was not a big issue for the county because most patients are covered by insurance, Supervisor Bill O'Brien also objected on bizarre moral grounds. "Then there's the human issue. Giving a drug user a clean needle is not the best thing for him. Illegal drug use has a risk, and making it safer promotes it," he said.

Supervisor Jim DeMartini thanked the grand jury for the report, but then dismissively added, "Like many well-intentioned programs that don't work out, this will never work out and deliver the benefits promised."

Too bad the sheriff, the DA, and the county board don't agree with the nation's drug czar. "Needle exchange programs have been proven to reduce the transmission of blood-borne diseases," Gil Kerlikowske told Congress during confirmation hearings earlier this year. "A number of studies conducted in the US have shown needle exchange programs do not increase drug use. I understand that research has shown these programs, when implemented in the context of a comprehensive program that offers other services such as referral to counseling, healthcare, drug treatment, HIV/AIDS prevention, counseling and testing, are effective at connecting addicted users to drug treatment."

Given the knowledge base about the effectiveness of exchanges and the evident human need for them in Modesto, needle exchange advocates were not content to simply roll over and die. Instead, they created an unauthorized needle exchange in the city's Mono Park, also known as needle park by residents because of the used needles littering the ground there. The program was publicized and went along on a low-level basis without a hitch until April, when, after an elaborate undercover sting, police swooped down and arrested the exchange volunteers.

Kristi Tribuzio just happened to be volunteering with the needle exchange the day the bust went down. Now, she's one of the defendants. "There was a direct need for this, and when I found out there was an existing exchange -- I saw a flyer on a telephone pole -- I asked how is this happening?" she said. "I got involved; I was just going out there for the people. An undercover cop came up and did an exchange, and then, a little later eight to 10 undercover officers drove up with a drug dog and arrested us. It was pretty harsh and crazy," she recalled.

"Looking back, Brian and I think it was maybe naive of us to just go out there and do something that was helping people in line with other syringe exchange programs," said Tribuzio. "We didn't understand what the consequences could be."

Now, she and Robinson face up to a year in jail for violating the paraphernalia law. For Tribuzio, there were other consequences, including the loss of her contract position with the Stanislaus County drug and alcohol education and prevention program. "I was laid off two days after I was arrested. Because I was a contract worker, they didn't need a reason to fire me, and no official reason was given. Ironically, my employer supports needle exchange," she said. "Maybe that's why they laid me off instead of firing me for cause. Now, at least, I can get unemployment."

Tribuzio had previously worked as a substitute teacher, but she can't do that now, either. "I'm getting an MA in education, and I have a teaching credential, but my credential is now suspended," she said. "Imagine, a teacher in San Francisco could be doing just what I did, and there would be no problem."

That's because needle exchanges have been authorized by the San Francisco County Board of Supervisors, just as they have in most large California cities. But in more conservative locales, like the Central Valley, the fight is more difficult, and therein lies the problem -- and the solution -- said one prominent harm reductionist.

"What we need is to get legislation authorizing syringe exchanges on a statewide level rather than our current system, which requires that they be authorized by local authorities," said Hilary McQuie, Oakland-based Western director of the Harm Reduction Coalition. "Requiring local authorization means we have to deal with 54 jurisdictions instead of just one, and the politics makes it really difficult in conservative places like Fresno or Modesto. It will be really difficult to get syringe exchange approved in Modesto without a statewide mandate," she said.

Short of that, needle exchange advocates need to carefully lay the groundwork beforehand, she said. In that respect, the Modesto needle exchange perhaps suffered from political naivete. "The effort with the grand jury in Modesto was done in good faith, but the grand jury finding required a response from the Board of Supervisors within three months," she noted. "They hadn't really lined up their support with the Board, and the Board ended up voting against it. That was problematic."

While personally difficult for Tribuzio and Robinson, the battle over needle exchanges in Modesto has moved the issue forward locally and stirred support from around the country and the world. A Mono Park 2 Defense Committee has formed to back them. At last week's hearing, more than a dozen supporters were present in court, and the pair had letters of support from some 35 public health and harm reduction organizations here and abroad.

"We've gotten a ton of support from the harm reduction community," said Tribuzio. "This whole thing has been stressful and overwhelming for us, but they've given us a wealth of training, knowledge, and support, more than we ever expected. We've gotten support from people in other exchanges, and letters of support from around the world. We've also been building alliances with people in the community. Things in the Central Valley are crazy, and we can't turn our heads away in the face of disease. Now, at least, people are paying attention."

While Robinson and Tribuzio wait for their legal problems to be resolved, they continue to work with at-risk communities. "After the bust, we started Off The Streets, and that does everything except for needle exchange," said Tribuzio. "We're doing needs assessments, trying to get our fingers on the pulse of the community, trying to help where we can."

For McQuie, the trials and tribulations of the Mono Park 2 are, sadly, par for the course. "This is how most of the programs got started, doing them illegally, so they're in good company," she said.

Asia: Drug Users Form Regional Drug User Organization

In a meeting in Bangkok last weekend, more than two dozen drug users from nine different countries came together to put the finishing touches on the creation of a new drug user advocacy organization, the Asian Network of People who Use Drugs (ANPUD). The Bangkok meeting was the culmination of a two-year process began at a meeting of the International Congress on AIDS in Asia and the Pacific in Colombo, Sri Lanka, in 2007, and resulted in creating a constitution and selecting a steering committee for the new group. ANPUD adopts the principles of MIPUD (Meaningful Involvement of People who Use Drugs), and in doing so, aligns itself with other drug user advocacy groups, including the International Network of People who Use Drugs (INPUD), of which ANPUD is an independent affiliate, the Australian Injection and Illicit Drug Users League (AIVL),the Vancouver Area Network of Drug Users, and the Nothing About Us Without Us movement. ANPUD currently has more than 150 members and sees its mission to advocate for the rights of drug users and communities before national governments and the international community. There is plenty to do. Asia has the largest number of drug users in the world, but is, for the most part, woefully retrograde on drug policy issues. Not only do drug users face harsh criminal sanctions—up to and including the death penalty—but Asian has the lowest coverage of harm reduction services in the world. Access to harm reduction programs, such as needle exchanges and opioid maintenance therapy, is extremely limited. "People who use drugs are stigmatized, criminalized and abused in every country in Asia," said Jimmy Dorabjee, a key figure in the formation of ANPUD. "Our human rights are violated and we have little in the way of health services to stay alive. If governments do not see people who use drugs, hear us and talk to us, they will continue to ignore us." The Director of the UNAIDS Regional Support Team, Dr. Prasada Rao, spoke of the urgent need to engage with drug user networks and offered his support to ANPUD, saying that "For UNAIDS, HIV prevention among drug users is a key priority at the global level," said Dr. Prasada Rao, director of the UNAIDS Regional Support Team. "I am very pleased today to be here to see ANPUD being shaped into an organization that will play a key role in Asia's HIV response. It is critical that we are able to more effectively involve the voices of Asian people who use drugs in the scaling up of HIV prevention services across Asia." "When I go back home, I am now responsible for sharing the experiences with the 250 or so drug users who are actively advocating for better services at the national level," said Nepalese drug user and newly elected steering committee member Ekta Thapa Mahat. "It will be a great way for us to work together and help build the capacity of people who use drugs in Asia." "The results of the meeting exceeded my expectations," said Ele Morrison, program manager for AVIL's Regional Partnership Project. "The participants set ambitious goals for themselves and they have achieved a lot in just two days to set up this new organization. The building blocks for genuine ownership by people who use drugs is definitely there." While the meetings leading to the formation were organized and managed by drug users, the process received financial support from the World Health Organization, the UNAIDS Regional Task Force, and AIVL.
Location: 
Bangkok
Thailand

Feature: Federal Needle Exchange Funding Ban Battle Continues

Years of effort by harm reductionists, public health authorities, HIV/AIDS researchers and activists, and drug law reformers to undo the more than 20-year-old ban on federal funding for needle exchange programs (NEPs) may come to fruition this year, but there are significant obstacles to overcome. Still, advocates of the reform are cautiously optimistic.

Since 1988, the US government has prevented local and state public health authorities from using federal funds for NEPs, which studies have shown to be effective in reducing HIV infection rates among injection drug users (IDUs) and their sexual partners, promoting public health and safety by taking syringes off the streets, and protecting law enforcement personnel from injuries. NEPS have been endorsed by the World Health Organization, the American Medical Association, Centers for Disease Control and Prevention Director Thomas Frieden, and former Surgeons General Everett Koop and David Satcher, among many others.


Chicago map demonstrating the impact of the
1000-foot rule -- click for larger copies and more
maps of Chicago and San Francisco (courtesy
Dr.Russell Barbour, Center for Interdisciplinary
Research on AIDS, Yale School of Medicine)

Injection drug use accounts for up to 16% of the 56,000 new HIV infections in the US every year -- or nearly 9,000 people. IDUs represent 20% of the more than 1 million people living with HIV/AIDS in the US and the majority of the 3.2 million Americans living with hepatitis C infection.

Still, those numbers could have been higher. In a 2008 study, the CDC concluded that the incidence of HIV among injection drug users had decreased by 80% in the past 20 years, in part due to needle exchange programs. There are today an estimated 185 NEPs operating in 36 states, the District of Columbia, and Puerto Rico. But they rely on local or private funds, and many of them are failing to meet demand because of lack of funding. While the CDC says that its public health policy goal is 100% needle exchange, current estimates are that only 3.2% of needles used by drug users in urban areas are exchanged for clean ones.

The federal funding ban was first removed in a July 10 vote of the House Subcommittee on Labor, Health and Human Services, Education, and Related Agencies. A week later, the full Appropriations Committee approved the bill after voting down an amendment proposed by US Rep. Chet Edwards (D-TX) that would have reinstated the funding ban.

But the Appropriations Committee did approve an amendment dictating that federally funded NEPs could not operate "within 1,000 feet of a public or private day care center, elementary school, vocational school, secondary school, college, junior college, or university, or any public swimming pool, park, playground, video arcade, or youth center, or an event sponsored by any such entity."

A floor amendment by Rep. Mark Souder (R-IN) to reinstate the funding ban also was defeated, clearing the way for repeal of the ban to pass the House. But the thousand-foot language remains in the appropriations bill approved by the House, and it's extremely objectionable to reform advocates. The Senate committee working on the issue did not include ending the funding ban, but reform advocates are pinning their hopes on both ending the ban and killing the thousand-foot restriction on the end-game House-Senate appropriations conference committee.

"The Senate has taken up their version of the bill in committee, but hasn't had a full vote," explained Daniel Raymond, policy director for the Harm Reduction Coalition. "At the committee level, the Senate chose not to take any action on the ban. At this point, there is a conflict between the House and the Senate." HRC is lobbying the Senate to repeal the ban, without the restrictions.

"We commend the full House for recognizing that NEPs are essential, effective tools that work in our fight against HIV and hepatitis transmission," said Kevin Robert Frost, chief executive of the Foundation for AIDS Research. "And while the compromise in the bill isn't perfect, we are hopeful that a final bill will reach President Obama's desk without limitations."

"We urge Congress to recognize both the benefit and cost-savings of syringe exchange programs, and the research that NEPs do not have detrimental impact on communities," said Marjorie Hill of Gay Men's Health Crisis, which has just released yet another study demonstrating NEPs' effectiveness in decreasing the transmission of blood-borne diseases. "For too long, we have allowed ideology to drive public health policy. It is time to remove the federal funds ban for syringe exchange and remove the harmful 1,000 feet restriction," added Hill.

"The House bill, as it stands, still puts ideology before science by limiting how federal funds can be used for NEPs," Frost said. "But we have time to fix the legislation, and I'm hopeful that the full US Congress will realize the importance of allowing local elected and public health officials to make their own decisions about how to address their HIV and hepatitis epidemics."

"I believe that the president, the Senate, and the House all want to do the right thing and they're trying to figure out how to do it," said Bill McColl of AIDS Action. "If they follow their own rhetoric about science- and evidence-based HIV/AIDS prevention policy, then they will remove the thousand-foot restriction," he said.

"The thousand-foot provision is a backdoor means of reinstating the funding ban," McColl continued. "There is almost no urban environment in which it would allow needle exchanges to operate. There are no currently existing needle exchanges that would be able to get federal funding, so it just doesn't make sense to change the policy that way. Drug policy groups have gone and literally shown Congress maps of what would be excluded. They've got letters from mayors and police saying this is not a workable provision. Again, Congress and the president know what the science is."

In addition to eliminating federally-funded needle exchanges in vast swathes of the urban landscape, the thousand-foot rule would have other insidious effects, said McColl. "Having that rule would have undesirable side effects, in that it would separate needle exchange from other public health services. Our AIDS program does testing in areas with lots of drug use -- that's where we need to be testing, and that's where we want the population to have clean syringes. With federal funding available and with the thousand-foot rule, prevention services will be driven away from needle exchanges."

Alice Bell, prevention project coordinator for Prevention Point Pittsburgh, already lives with geographical restrictions. "We have a local regulation that specifies 1,500 feet from schools only, not all the other restrictions in the current language of the federal bill. We have to move our main needle exchange site because the building we're in is being sold, and we're having trouble finding a good place. Any federal restrictions would make it even tougher," she said.

Bell wants the federal funding ban ended, but worries that the thousand-foot rule would put a crimp in her efforts. "We still want it. We need the federal funding. Our program is expanding, but we can't really expand our exchange service because we don't have money for needles. The toughest thing is always getting money for needles. Ending the federal funding ban would make a huge difference to us."

Federal funding becomes even more significant when coupled with economic hard times and budget problems at the state and local level, Bell noted. "We're mostly funded through foundations and private donations, and we've begun getting some state and county money for overdose prevention and HIV prevention, but the needle exchange -- the core of what we do -- is the toughest to get funded."

"The Senate will most likely go along with the House in conference committee," said Drug Policy Alliance director of national affairs Bill Piper. "They will probably take a bunch of appropriations bills and put them in a massive omnibus spending bill. It is far from clear that there will be a ban in what comes out of the Congress."

But the thousand-foot rule has to go, he said. "A lot of groups have been lobbying really hard on the thousand-foot issue," Piper noted. "It would be an effective ban is many cities. Here in DC, for example, the only place you could do a needle exchange program would be down at the docks on the Potomac. The strategy is to convince the conference committee to either take that out or come up with something better."

Advocates are lobbying hard right now, said the Harm Reduction Coalition's Raymond. "Right now, we're doing a push to make sure the Senate is educated about the issue and ask the leadership to get on board with House's action to address the ban," he said. "The House version has the thousand-foot restriction, so we're also making the arguments about why that's not workable and needs to be redone. We've been circulating maps showing its impact to House members who are focused on the issue. This restriction goes far beyond any reasonable desire to balance public health with other interests. When that provision was thrown in at the last minute, its effects hadn't really been thought out," he argued.

"We keep up the work in reaching out to Congress on both House and Senate side," said Raymond, "and we're also asking the White House to show some leadership and urge the Senate to address the federal ban. We don't want this issue to get lost in the shuffle, we're calling on everyone in the community to make our voices heard and reaching out to our elected officials."

It may take awhile to get settled, said Piper. "The entire appropriations process is messed up, and a lot of will depend on if, when, and how the Senate deals with health care," he explained. "Supposedly, they will get the appropriations bills done by the end of October, but I think that's a fantasy. Last year, they didn't even do this year's appropriations bills until March."

Still, AIDS Action's McColl maintains a positive outlook. "I think the members who will be called on to vote on this understand the issues," he said. "I have a pretty good feeling about this. I'm hopeful this is the year."

Harm Reduction: Pennsylvania Allows Syringe Sales Without Prescription, Effective Immediately

Responding to years of agitation by harm reductionists and public health advocates, the Pennsylvania Board of Pharmacy Saturday published new regulations that will allow pharmacies to sell syringes without a prescription. The change goes into effect immediately. The move was lauded by activists as a significant public health victory in the battle against the spread of HIV/AIDS and Hepatitis C via injection drug use.

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popular syringe exchange logo
Under previous regulations, pharmacies could sell syringes only to people who obtained a doctor's prescription. The new regulations carry no limit on the number of syringes that can be purchased at a time, nor do they have age limits.

"This change is particularly important in Pennsylvania because we have only two locations -- Pittsburgh and Philadelphia -- in which legally authorized syringe exchange programs operate," said David Webber, an attorney for the AIDS Law Project of Pennsylvania. "These two programs alone are simply not adequate to address this problem across the entire state, but syringe exchange programs continue to be crucial in providing sterile syringes as well as access to drug treatment and health care for injection drug users."

"This is a chance for every pharmacy to become part of HIV prevention in Pennsylvania," said Scott Burris, professor at Temple University's School of Law and a national authority on syringe regulation and HIV prevention. "The pharmacy board has taken an important step forward for evidence-based policy."

It didn't come swiftly or easily. Activist organizations including the Pennsylvania Aids Law Project, Prevention Point Pittsburgh, Prevention Point Philadelphia, as well as legislators, HIV workers, and others had lobbied for the change for a decade. An article in the Lancaster Intelligencer Journal cited several efforts:

  • In 2002, a group called the Pennsylvania Coalition for Responsible Syringe Policy asked the Pharmacy Board to consider deregulation.
  • In 2005, another group called Pennsylvanians for the Deregulation of Syringe Sales filed a formal petition to the Board, and met with legislators and officials in the Rendell Administration.
  • In 2007, the the Pennsylvania Pharmacists Association endorsed syringe deregulation and asked the Pharmacy Board to move swiftly on it.

Robert Field, organizer of Pennsylvanians for the Deregulation of Syringe Sales and co-chair of the Lancaster-based Common Sense for Drug Policy, told the Intelligencer Journal he looked at syringe deregulation after efforts to start a syringe exchange program in Reading met with opposition. The board responded in August 2007, proposing new regulations allowing for over-the-counter syringe sales and opening them up for public comment. Thanks to concerns expressed by harm reduction and public health groups during the comment period, the board removed age and quantity restrictions.

The board heard a number of concerns from the Pennsylvania Medical Society that the rule change would increase drug use. But research won the day. "Studies indicate that making syringes available will reduce the spread of HIV and will not lead to an increase of illicit drug use," said Field.

The board also rejected record-keeping requirements requested by the House Professional Licensure Committee, saying it "does not believe that maintaining a record and requiring individuals to provide a name or other identifying information would advance the public health and safety."

Now the number of states that do not allow syringe sales without a prescription is down to two: Delaware and New Jersey.

Harm Reduction: Pennsylvania Allows Syringe Sales Without Prescription, Effective Immediately

Responding to years of agitation by harm reductionists and public health advocates, the Pennsylvania Board of Pharmacy Saturday published new regulations that will allow pharmacies to sell syringes without a prescription. The change goes into effect immediately. The move was lauded by activists as a significant public health victory in the battle against the spread of HIV/AIDS and Hepatitis C via injection drug use. Under previous regulations, pharmacies could sell syringes only to people who obtained a doctor’s prescription. The new regulations carry no limit on the number of syringes that can be purchased at a time, nor do they have age limits. “This change is particularly important in Pennsylvania because we have only two locations--Pittsburgh and Philadelphia--in which legally authorized syringe exchange programs operate,” said David Webber, an attorney for the AIDS Law Project of Pennsylvania. “These two programs alone are simply not adequate to address this problem across the entire state, but syringe exchange programs continue to be crucial in providing sterile syringes as well as access to drug treatment and health care for injection drug users.” “This is a chance for every pharmacy to become part of HIV prevention in Pennsylvania,” said Scott Burris, professor at Temple University’s School of Law and a national authority on syringe regulation and HIV prevention. “The pharmacy board has taken an important step forward for evidence-based policy.” It didn’t come swiftly or easily. Activist organizations including the Pennsylvania Aids Law Project, Prevention Point Pittsburgh, Prevention Point Philadelphia, as well as legislators, HIV workers, and others had lobbied for the change for a decade. In August 2007, the pharmacy board proposed new regulations allowing for over-the-counter syringe sales and opened them up for public comment. Thanks to concerns expressed by harm reduction and public health groups during the comment period, the board removed age and quantity restrictions. The board rejected record-keeping requirements requested by the House Professional Licensure Committee, saying it “does not believe that maintaining a record and requiring individuals to provide a name or other identifying information would advance the public health and safety.” Similarly, it rejected a number of concerns from the Pennsylvania Medical Society that the rule change would increase drug use. The board’s action reflected well-established scientific evidence that access to clean syringes is a critical component of stemming the spread of blood-borne diseases such as HIV and Hep C among injection drug users. Now the number of states that do not allow syringe sales without a prescription is down to two: Delaware and New Jersey.
Location: 
PA
United States

Harm Reduction: Funds Begin to Flow to DC Needle Exchange Programs

Eight months after Congress voted to end a decade-long ban on the use of federal funds for needle exchange programs (NEPs) in the District of Columbia, money is starting to flow to the programs in the city with the nation's highest rate of HIV. District officials had announced almost immediately after the congressional vote that they would fund NEPs in an effort to control the spread of the disease among injection drug users.

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PreventionWorks! at work (screen shot from nytimes.com '''slide show,'' June '07)
Now, according to the Washington Times, funding is finally reaching the city's NEPs. The city will spend $700,000 a year on NEPs, with the city's largest program, PreventionWorks!, getting $300,000 a year.

According to a DC HIV/AIDS Administration 2007 report, injection drug use is the second most common mode of acquiring the HIV virus after unprotected sex, and the District has some 10,000 injection drug users.

DC NEP advocates have long argued that the federal funding ban left them starved for funds and unable to adequately address the injection drug using population. PreventionWorks!, for example, has had to scrape by on private contributions, limiting the work it has been able to do.

The need is obvious and so is the response, Ken Vail, the group's executive director, told the Times. "If you want to reduce the spread of HIV... you put more syringes out there," he said.

Harm Reduction: San Antonio Needle Exchange Program Not To Be, Texas Attorney General Says Would Violate State Law

A state-sanctioned needle exchange program envisioned for Bexar County (greater San Antonio) under legislation passed last year will not happen -- at least not this year. Texas Attorney General Greg Abbott Monday issued an opinion saying that state drug laws blocked the program from moving forward.

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popular syringe exchange logo
The needle exchange program was envisioned to help slow the spread of HIV/AIDS and Hepatitis C among injection drugs users and would have been the first official program in Texas, which is the only state in the nation without one. The law was scheduled to take effect last September, but was put on hold after Bexar County District Attorney Susan Reed raised objections in August, saying that it would be illegal to conduct such a program because, in her opinion, the law was defective. That sparked State Senator Jeff Wentworth's request for an attorney general's opinion.

In addition to blocking the needle exchange program, the attorney general's opinion also opens the way to the vindictive prosecution of Bill Day, a 73-year-old AIDS sufferer who was ticketed along with two other people earlier this year for passing out clean needles. District Attorney Reed, a Republican who has warned she would arrest anyone trying to hand out needles, stayed Day's case pending Abbott's opinion, but is now likely to move forward with it.

While Day faces up to a year in jail if convicted of violating Texas drug paraphernalia laws, that's unlikely, First Assistant District Attorney Cliff Herberg told the Dallas Morning News. "Nobody expects that Mr. Day will go to jail," said Herberg. "If people think that he's well-intentioned, that's a punishment issue, not a guilt or innocence issue."

In his opinion, Abbott wrote the law passed last year was not written clearly enough to protect needle exchange participants from prosecution because it said only that the county health department "may" set up a needle exchange, not that it "will" set one up. While the legislature may have intended to set up a program, it needs to redraft the law to fix the language, he said.

Rep. Ruth Jones McClendon (D-San Antonio), the legislation's main sponsor, vowed to make fixing it one of her top priorities next year. "Obviously, I am terribly disappointed," she told the Morning News. "The outcome [with the needle exchange] would have been much more effective in saving thousands of lives and saving millions of taxpayer dollars at the same time."

Southwest Asia: In Harm Reduction Move, Iran to Provide Condoms, Syringes in Vending Machines

Officials of the Iranian government announced last week that they are embarking on a pilot program to provide syringes and condoms to drug users in an effort to prevent the spread of AIDS and hepatitis. The items will cost the equivalent of a nickel.

Situated next door to Afghanistan, home of 90% of the world's opium and heroin production, Iran now suffers one of the world's highest opiate addiction rates. Iranian officials generally estimate that 2 million of the country's 71 million people are addicted to opiates, now mainly heroin.

"Five of these machines which have been made will be installed in five of Tehran city's welfare shelters for addicts," the deputy head of Iran's anti-narcotics organization, Mohammad Reza Jahani, said in remarks reported by Agence France-Presse. "Condoms, syringes, bandages and plasters will be easily accessible just by inserting a coin. This protects addicts from acquiring AIDS and hepatitis."

Look for more syringe and condom vending machines, said Jahani. "The machines will be used for a three month trial period and if the scheme is successful then we will upgrade them and increase their distribution to other shelters," he said.

The harm reduction measure is the latest in a series of moves in the Islamic Republic's approach to drug use and addiction. While it still hangs traffickers and guns down smugglers, it now tries to treat users as "people who need help," or at least is starting to, rather than throwing them into already overcrowded jails.

Editorial: Yet More Unintended and Impossible-to-Predict Harm Caused by Drug Prohibition

David Borden, Executive Director

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David Borden
Four years ago, I opined about an issue that had come up in California, one affecting the schools and with which the legislature was grappling. According to NPR affiliate station KQED in Los Angeles at the time, many school systems had stopped providing locker space to students, because some administrators see lockers as facilitating the problems of guns and drugs. Of course, drug selling is a principle reason for carrying a gun to school, although only because drugs are illegal.

Unfortunately for California schoolkids, as a result of the locker closures, some young people had developed posture problems, with resultant chronic pain, as a result of having to carry all of their books around all day. KQED interviewed once such student from North Hollywood. He typically carried about 30 pounds of books with him, which was 19% of his body weight, nearly twice the maximum recommended by the American Chiropractic Association. As a teenager he had become a regular user of Tylenol in order to manage the pain.

The reason I chose that story for my editorial that week was the unpredictable nature of it. There are a lot of things that are easy to predict about drug prohibition laws, based on historical experience. We know that prohibition causes crime, and builds up organized crime entities, by putting a lucrative industry with its hundreds of billions of dollars of annual revenues into a criminal underground. We know that prohibition causes preventable deaths, especially of the addicted, by ensuring that users of the banned drugs obtain them from that underground, which lacks the regulation and quality controls that legal industries have. We know that prohibition has a corrupting effect on youth, and others -- the guns and the drug trade in the schools issue that legitimately concerned California administrators is a frightening example -- by providing job opportunities for those who are attracted to the those moneymaking opportunities and the associated glamour.

But who would have guessed the drug war would lead to teen back pain? Lest any should dismiss that issue as unimportant by comparison with the harms of drugs, and of guns in the schools, remember that the guns and drugs didn't go away as a result of the lock closures. Did anyone really think they would, for that matter? Back pain is an issue that can deeply affect the life of a sufferer, young or old, and which for many can go uncorrected for a lifetime. Lockers are part of a school's infrastucture. When drug policy leads us to start dismantling infrastructure, that is a sign of a policy problem.

This week our blog reported on another unpredictable public health problem from the drug laws, a more dramatic and gruesome one. In Brazil, the drug war is exacerbating a deadly plague carried by mosquitoes. The problem is that one in four people in the city of Rio de Janeiro live in the poverty-stricken "favelas," or shantytowns, where pools of water are common during the rainy season, which attracts the mosquito population. But access for authorities to the favelas is hampered by Rio's raging drug war, hampering efforts to contain the disease. Of course, these drug wars are happening only because drugs are illegal, prompting the governor of the state of Rio de Janeiro to call for legalization last year.

After 14 years in drug policy, it's not so very often that I learn a new angle. Yet I have no doubt that there are many unintended consequences of prohibition which have yet to be brought to light, and many impossible-to-predict harms from prohibition that we have yet to see.

Harm Reduction: New Jersey's First Legal Needle Exchange Is Open

The needle exchange program bill passed nearly a year ago by the New Jersey state legislature has borne its first fruit. A needle exchange program operated by the South Jersey AIDS Alliance in Atlantic City began operations Tuesday.

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Under the New Jersey law, up to a half-dozen municipalities can apply to operate needle exchange programs. Atlantic City has long clamored for such a program and is the first off the mark, but preparations for similar programs are underway in Camden, Newark, and Paterson.

Needle exchange programs are a proven means of reducing the spread of blood-borne diseases, such as HIV/AIDS and Hepatitis C.

According to a report from the Drug Policy Alliance's New Jersey head Roseanne Scotti, who was instrumental in guiding the legislation to passage, 20 people registered for the Atlantic City program on its first day of operation. The program runs out of the South Jersey AIDS Alliance drop-in center and is currently limited to four hours a day on Tuesdays, Wednesdays, and Thursdays. The city plans to take the exchange program mobile, but it still working on gathering the money to pay for a van.

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