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Harm Intensification

The Effectiveness of Syringe Exchange as an HIV Prevention Strategy

For this partners' forum, the Global Health Council will bring together experts working on or knowledgeable about HIV prevention through syringe exchange. We will hear both from advocates for syringe exchange and from those who oppose it. This forum will examine evidence of the impact of these programs on HIV transmission and drug use. We will additionally examine the barriers to implementing and scaling up this prevention approach, especially in US programs overseas.

Silly Scott

Scott was being silly last Friday night when he published his "D.C. Needle Exchange Ban Lifted: Let's Do Heroin!" blog post. In fact, Scott was being silly in multiple ways. First, the DC needle exchange ban is only a ban on the District using its own tax dollars to fund the program. The PreventionWorks needle exchange program has been operating now for almost nine years, legally, and before that its predecessor program at the Whitman-Walker AIDS Clinic operated the exchange. It has been making do with private funding. Lifting of this ban means that PreventionWorks will be able to expand its operations, and that more needle exchange programs will be able to open, all of them together reaching more of the people who need the help. But it's not a matter of whether Scott personally could have gotten clean needles. Second, the PreventionWorks office is only a 15 minute walk from our office, so if Scott had really wanted to use heroin all this time, he wouldn't even have had to travel far to get clean needles. (It's a pretty walk, too, and there's a nice coffee shop in the neighborhood.) Third, as I pointed out in my editorial this week, the risk created by infected used syringes, while a major one, is by no means the only risk. So long as heroin itself continues to be illegal, the user will continue to be "at risk of overdose from fluctuating purity or poisoning from adulteration," and the addict will continue to suffer "severe financial debilitation from the high street prices created by prohibition," some of them "driven to extreme measures to afford drugs that would cost pennies to produce in a legal market." I know for a fact that Scott understands this as well as I do, and I published that editorial less than 24 hours before Scott wrote his blog post, so it must have been fresh in his mind. (Fourth, Scott was simply being sarcastic, in case anyone didn't realize it. He and I both scoff at the idea that more needle exchange will lead to increased drug use -- and we have the evidence to back us up.) So, I'm afraid that Scott and I will be holding out for legalization before we start shooting smack. I recommend that you wait too. (I'm being sarcastic too -- we also reject the idea that legalization will lead to large numbers of people using intense drugs like heroin who don't already use them now -- I certainly have no interest in it.)

chicagovigil.com responds to chicagovigil.org

The DEA is at it again, as Drug WarRant blogger Peter Guither puts it, and is holding another "vigil for lost promise" for people who have died from drugs, this one in Chicago (chicagovigil.org). The problem isn't so much what the DEA says -- some people do die from drugs -- but what they don't say. Hence Guither's vigil for lost promise for people who have died from the drug war (chicagovigil.com redirecting to it). It's too simplistic to blame it all on drugs. Even when it looks like drugs (e.g. it's not someone who was imprisoned under a law or shot by a SWAT team, someone actually died from some kind of drug use), it's often the combination of drugs with the drug laws that created the most deadly mix. Guess who has the top link in Google when searching on "vigil for lost promise," at least right now when I'm posting this?

Reflections from a Dr. Hurwitz patient

I am sure many of you recognize the name of Dr. Wm. Hurwitz. Dr. Hurwitz was a nationally known very prominent pain management physician. He was known for his very aggressive pain treatment and had patients from almost every state in the country. These were the patients that nobody else would take, they were too complicated, needed doses that were too high for other doctors. I was one of these patients and Dr. H saved my life. He is the most caring and compassionate dr I have ever known. In his younger years he served with Doctors Without Borders in Brazil. He was known never to turn away people who couldn't pay.