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Harm Reduction: DC Quick to Move After Congress Lifts Needle Exchange Funding Ban

Officials from the District of Columbia announced Wednesday that the District government will invest $650,000 in needle exchange programs. The move comes less than two weeks after Congress passed an appropriations bill relaxing a decade-old ban on the District using even its money to fund such programs.

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PreventionWorks at work (screen shot from recent nytimes.com '''slide show,'' June '07)
Mayor Adrian Fenty and several city council members made the announcement at a press conference at the headquarters of PreventionWorks!, a DC needle exchange program that had heretofore existed on only private funding. Now, it will get $300,000 in city funds. Public funding for needle exchange would help reduce the number of new HIV infections in the city, they said.

"This program goes to best practices to combat one of our greatest health problems," Fenty said at the news conference. Given the high prevalence of HIV in the District, "everyone should be concerned," he said. "HIV and AIDS are such well-known public health problems in the District of Columbia that people understand we have to have programs and services in the neighborhoods," the mayor said.

The rest of the $650,000 will go to fund additional needle exchange programs throughout the city, he said.

It is money well spent, said DC Councilmember David Catania (I-At Large), chairman of the Committee on Health. "The cost of infection is immeasurably higher in terms of dollars and lives," he said.

If You Oppose Harm Reduction, You Support AIDS and Death

The Drug Czar's blog has been very concerned about harm reduction lately. They've taken the counterintuitive position of opposing efforts to save the lives of drug users, which seems like a strange choice. Now I understand why: they think harm reduction is the opposite of what it actually is.
These so-called "harm reduction" strategies are poor public policy because their underlying philosophy involves giving up on those who can successfully recover from drug addiction. [PushingBack.com]
This is wrong for a very simple reason: you cannot recover from addiction if you're dead. Harm reduction programs are not an alternative to treatment, rather they go hand in hand. Harm reduction keeps people healthy and alive, thereby creating opportunities for them to subsequently recover from addiction.

We could do nothing. That would be "giving up." We could ask drug addicts to either quit or die. That would be "giving up." Instead, harm reduction activists have taken to the streets and attacked this problem directly. They've studied the leading causes of death among drug users and created programs to reduce those casualties. That's the opposite of giving up.

Just pretend for a moment that you're cruel and you want drug users to die in large numbers. How would you go about it? Well, you would begin by eliminating regulated distribution so that users are forced to obtain unsafe products from criminals on the street. You would reduce access to clean needles in order to spread AIDS. You would enforce criminal sanctions against users so that they're afraid to seek help. And you would lobby aggressively against anyone who's studied the problem and proposed programs to reduce AIDS and overdoses.

Now I'm not saying the Drug Czar wants to kill people. I'm just saying he presides over a policy that is perfectly tailored to achieve that outcome. And he dares to suggest that the people out there working with addicts and saving lives are the ones who've given up.
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Press Release: PreventionWorks! Selects New Executive Director To Advance Agency As A HIV Continuum Of Care Service Provider

[Courtesy of PreventionWorks!] NEWS RELEASE: November 20, 2007 CONTACT: Beth Beck: beth.beck@cancer.org, (202) 253-0397 PreventionWorks! Selects New Executive Director To Advance Agency As A HIV Continuum Of Care Service Provider November 20, 2007 – Washington, DC – PreventionWorks!, a non-profit community-based organization committed to addressing HIV/AIDS and related health issues among drug users, their families, friends and partners, announced today the appointment of its new Executive Director. Ken Vail, MPH, MA, has been selected to lead the agency, as it prepares to expand and enhance service delivery to the District’s most vulnerable populations. The appointment of Mr. Vail is the result of an official search that began after Paola Barahona, Founding Executive Director, announced her departure in August of this year. "After an exhaustive and detailed search, that included the efforts of an executive search firm, it became clear to the Board of Directors that we already had the best candidate for the job", said Beth Beck, Board President, Prevention Works!. “As the search moved forward, it was evident to the Board that Mr. Vail’s knowledge, skills, experience, and vision were directly in line with the growth the agency is experiencing in response to the continually shifting HIV/AIDS epidemic and we are very excited to have him aboard.” Mr. Vail was most recently the Interim Executive Director for PreventionWorks! and took over the operations of the agency in August. Before coming to PreventionWorks! he was the Director of Prevention for Community Health Action of Staten Island. Mr. Vail has more than 17 years of experience in the fields of public health, medical anthropology and direct service provision. He has a strong background in non-profit program planning and management, staff development, grant writing and program evaluation. Mr. Vail also has extensive experience as an HIV prevention educator and is an expert in the theory and practice of harm reduction. “I am very excited and humbled to become the next Executive Director for PreventionWorks!” said Vail. “I have worked my whole life to serve populations most impacted by HIV disease and illness and I look forward to working with staff, volunteers, clients, and the Board of Directors to move the agency forward.” “As Executive Director, my initial focus will be to strengthen the organizational infrastructure to effectively position the agency as a comprehensive continuum of care service provider to best improve the health of DC’s drug using populations and most vulnerable residents.” Transition Guides, an executive firm specializing in non-profit agencies, and the Board of Directors at PreventionWorks, conducted the search for the executive director position.
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Washington, DC
United States

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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popular syringe exchange logo
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.

Needle Exchange Action May Be Imminent

Last spring at the National African American Drug Policy Coalition summit here in Washington, the question was asked of Donna Christian-Christensen (Congressional Delegate from Guam, the closest thing the territories have to US Representatives), a physician and chair of the Congressional Black Caucus’ Health Braintrust, what the prospects were for repealing the ban on use of federal AIDS grant funds to support needle exchange. Her answer was, "We're going to give it a good try." I took that to mean "it's not going to happen this time." The issue has made some progress however, at least as it affects us here in the District of Columbia, where a particularly infamous part of the annual appropriations bill prevents DC from spending even its own locally-collected tax funds on needle exchange appears to be on its way to getting repealed, thanks to positive action by a House subcommittee that drafted the new appropriations bill. I know better than to take it as a given that repeal will make it all the way through. But it is looking pretty good, and at the PreventionWorks! anniversary party this evening -- attended by new PW executive director Ken Vail -- AIDS Action lobbyist Bill McColl informed the crowd that it could hit the floor within a few days. Earlier this year we reported that Hillary Clinton was noncommittal about lifting the ban during a videotaped exchange at a private forum with prominent AIDS activists. The exchange was fascinating; after several pointed back-and-forths with Housing Works executive director Charles King, Sen. Clinton directly acknowledged that it was political concerns only that accounted for her position (though the kinds of concerns that can't necessarily be dismissed offhand). Sen. Obama, by contrast, had stated his support for lifting the ban. This week Clinton took the plunge and made strong pro-needle exchange promises in a campaign statement on AIDS funding. What would ultimately happen with this in a Clinton presidency, or any Democratic presidency, is probably hard to predict -- politics is still politics. But the fact that the Democratic candidates are lining up to support the issue has McColl feeling cautiously optimistic that the Democratic Congress won't drop the ball on the DC language at least. And it's encouraging for all of us about the long-term. The federal needle exchange restriction came to a boil during the Clinton administration, when the findings needed to lift the ban -- needle exchange doesn't increase drug use, but does reduce the spread of HIV -- were made by the administration, but not acted on. Some advocates believe that if Donna Shalala had been on a certain Air Force One flight, instead of Barry McCaffrey, that it would have happened. It took a change in Congress to even get the issue back onto the radar screen; more may be needed to actually get the law changed. Still, let's keep our fingers crossed for the DC ban to be lifted, maybe even by the end of the year. Assuming that happens: Let's Do Heroin! (That was sarcasm, in case anyone didn't realize.)
Location: 
Washington, DC
United States

Hillary Clinton Pledges Support for Needle Exchange

After hilariously claiming that she needed to see more evidence of its effectiveness, democratic presidential hopeful Hillary Clinton seems to have found the answers she was looking for.* Her campaign has announced support for harm reduction, including needle exchange:
She also supports using U.S. funding to support proven harm reduction efforts - including needle exchange - to help hard-to-reach populations, and will continue to support new evidence-based prevention methods as additional scientific research helps us understand how to best address this epidemic. [HillaryClinton.com]

We've heard similar pledges from Obama and Edwards, and it's likely safe to assume other democratic candidates will toe the line on this one (possibly excluding drug war hall-of-famer Joe Biden).

It's nice to see Washington politicians getting it right on needle exchange. Of course, this is really about whether or not we want huge numbers of people to die from AIDS in the name of drug war politics. We needn't fall to our knees in gratitude when someone understands such an obvious humanitarian concern. Rather, we should be demanding answers from any candidate who hasn’t yet spoken out against the federal government's catastrophic ban on life-saving intervention programs.

*By "hilarious," I meant that the mountain of evidence showing that needle exchange saves lives is so huge that I couldn't imagine Hillary Clinton actually had time to read it.

(This blog post was published by StoptheDrugWar.org's lobbying arm, the Drug Reform Coordination Network, which also shares the cost of maintaining this web site. DRCNet Foundation takes no positions on candidates for public office, in compliance with section 501(c)(3) of the Internal Revenue Code, and does not pay for reporting that could be interpreted or misinterpreted as doing so.)

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John Edwards Supports Needle Exchange

As part his new proposed plan to combat AIDS, democratic presidential hopeful John Edwards is speaking out in favor of needle exchange:
"And I think we also ought to promote programs that prevent harm and specifically needle exchange, which I support. We ought to get rid of the federal ban on needle exchange." [NPR]

Drug war absolutists have long opposed needle exchange, despite overwhelming evidence that it prevents AIDS and saves lives. It is just amazing that the people in charge of protecting Americans from drugs support policies that spread AIDS and kill people.

Edwards deserves credit for calling out one of our nation's most ill-conceived drug policies. It's a no-brainer for sure, but at least he got it right.

And in the process, John, you may have stumbled upon a nifty device for drafting a superb drug policy platform for your campaign: simply check what the federal policy is on any drug issue and advocate the opposite. You will be correct every time.

Update: At the risk of further emboldening the hysterical Obama fans who freaked out over my last post, and irrationally implied that he's good on drug policy, it's only fair to add that Barack Obama has also spoken in favor of needle exchange. Hillary Clinton, who's otherwise sounded good on drug policy (for a front-runner, anyway) wants to see more proof that it works, which, at this point, is like demanding proof that the sun will rise tomorrow.

(This blog post was published by StoptheDrugWar.org's lobbying arm, the Drug Reform Coordination Network, which also shares the cost of maintaining this web site. DRCNet Foundation takes no positions on candidates for public office, in compliance with section 501(c)(3) of the Internal Revenue Code, and does not pay for reporting that could be interpreted or misinterpreted as doing so.)
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Harm Reduction: Pennsylvania Moves to End Prescription Requirement for Buying Needles

Pennsylvania is one of the few states remaining that still require a prescription to buy a needle, but that could change soon. The Pennsylvania Pharmacy Board has submitted for public comment a proposed rule that would eliminate the prescription requirement.

The move is generally supported by Keystone State harm reduction organizations, who view it as a move that will help reduce the incidence of HIV/AIDS and other blood-borne diseases among injection drug users.

The proposed rule would limit the number of needles one could purchase without a prescription to 30 at a time. Most other states have no limit on the number of needles that can be purchased. Syringes would remain stored in the prescription area of drug stores. People who wish to obtain a prescription to purchase needles (for insurance purposes) would still be able to do so.

The period for public comment will end September 25, after which the board will decide whether or not to move forward on the proposed rule.

Press Release: A Turning Point for Needle Exchange in D.C., With New Leadership and Influx of Public Funding PreventionWorks Prepares for Growth, Expansion

FOR IMMEDIATE RELEASE: September 4, 2007 CONTACT: Ken Vail at 202-588-5580, www.PreventionWorksDC.org A Turning Point for Needle Exchange in D.C. With New Leadership and Influx of Public Funding PreventionWorks Prepares for Growth, Expansion Nine years after its founding in 1998, PreventionWorks, Washington D.C.'s only needle exchange program, has announced the departure of its long-time and respected Executive Director, Paola Barahona, the first and only person to hold the position. In her nine years of service, Barahona has raised more than $3.5 million in private funding to support and sustain the work of PreventionWorks which, until this year, was prohibited by an act of Congress from receiving or utilizing public funding for its needle exchange services. PreventionWorks provides access to sterile syringes, offers tools and information for leading healthier lives, and provides access and referrals to drug treatment, medical and social services. Its services are client-focused, culturally appropriate, and community supported. All services are provided without judgment. James Millner, a nationally known healthcare communications consultant who served on the board of directors of PreventionWorks, including a term as board president, says, The coinciding departures of both Paola and me truly mark the beginning of a new era for PreventionWorks. We leave behind a respected organization with a solid and stable foundation from which it can grow and expand to meet the significant challenges ahead. But we cannot move forward without properly acknowledging the tireless efforts of Paola Barahona, without whom PreventionWorks and needle exchange entirely would likely not exist in our nations capital. She deserves the thanks and appreciation of this entire city. Under the leadership of PreventionWorks President, Beth Beck, a Regional Director for the American Cancer Society, the board of directors has established a Transition Committee to oversee a national search for a new Executive Director. Chaired by PreventionWorks board of directors member Naomi Long (Director of the Washington Metro office for the Drug Policy Alliance), the Committee includes Barbara Chinn of Whitman-Walker Clinic, Channing Wickham of the Washington AIDS Partnership, James Millner (Past President, PreventionWorks board of directors), Patsy Fleming (Whitman Walker Clinics National AIDS Policy Director) and Scott Sanders of High Noon Communications. The board of directors is working with Transition Guides, a consulting firm dedicated to sustaining and strengthening nonprofits through better managed leadership transitions, to ensure the stability of the unique services provided by PreventionWorks during and after the leadership transition. Mr. Kenneth Vail, MPH, MA, has been hired as Interim Executive Director to manage PreventionWorks during its search for permanent staff leadership. Mr. Vail has 17 years of experience establishing and leading syringe access programs in Santa Cruz, California, Cleveland, Ohio, San Francisco, California, and Staten Island, New York, and has worked in HIV outreach, prevention and education in Boston, Massachusetts, San Jose, California, and Temirtau, Kazakhstan. For nearly a decade, PreventionWorks has grown and strengthened into an organization that is today a critical part of the District of Columbias HIV prevention strategy. No longer a stop-gap or temporary solution to provide clean needles to drug users, PreventionWorks is transitioning into a full service HIV prevention and health advocacy group for drug users, their families, friends and partners. For further information about the transition or PreventionWorks, please contact Ken Vail at 202-588-5580.
Location: 
Washington, DC
United States

Feature: Yellow Journalism -- San Francisco Exchange Programs Scored Over Dirty Needles

A series of sensationalistic articles in the San Francisco Chronicle over the past two weeks highlighted the problem of discarded needles near one of the city's needle exchange programs. The series appears -- on the surface -- to have prodded city officials to act on the problem. More accurately, it informed the public of planning that had been going on behind the scenes, though without informing readers of that. While the articles posed as muckraking, civic-minded journalism, they smeared needle exchange workers -- they failed, most importantly, to ask the most basic questions needed to actually determine the programs' impact on needle discarding -- and unnecessarily contributed to public fears about the programs.

The Chronicle series began Sunday July 29 with "The Situation at Golden Gate Park; Sunday in the Park -- With Needles," where the paper reported that the park was "littered" with discarded syringes. The reporting made it seem as if the discarded syringes were the fault of needle exchange programs:

"They tell us he was steaming, but San Francisco Mayor Gavin Newsom shouldn't have been too surprised when The Chronicle reported that Golden Gate Park was littered with used drug syringes.

"After all, his own Public Health Department spent $800,000 last year to help hand out some 2 million syringes to drug users under the city's needle exchange program -- sometimes 20 at a time.

"Although Health Department officials say 2 million needles were returned, the fact is they don't count them and can only estimate how many are coming back.

"And from the looks of things, a lot of them aren't."

That same article was also shocked to report that drug users can actually buy needles without a prescription:

"Under legislation passed in 2005 by the same Board of Supervisors whose members now decry the needle problem, anyone over 18 can walk into a Walgreens or Rite Aid and buy as many as 10 needles -- no questions asked."

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syringes
Like needle exchanges, non-prescription syringe access is a harm reduction measure designed to save lives and improve the public health by reducing the spread of disease through making needle access easier. Its beneficial impact, however, is blunted by a California statute defining syringe possession as a violation of the paraphernalia law. Hence, users anxious to avoid trouble with law enforcement may be rendered more anxious to get rid of their needles once done with them, and less likely to save them long enough to take them back to a program.

In that article and a same-day companion piece, "Golden Gate Park sweep -- can city make it stick? 'March of junkies': Haight's residents fume over needles," the Chronicle described finding needles in Golden Gate Park and interviewed neighbors upset with finding discarded syringes in the area. It made for compelling reading, but left several critical questions unanswered:

  • How many needles were being discarded in the park before there were needle exchange programs?
  • How many of the needles found by the authors of the neighborhood residents they quoted came from the needle exchange program?
  • What is the risk of HIV or Hep C infection from being pricked with a discarded needle? What was it before there were needle exchange programs?
  • How many needles not returned to the program are actually being unsafely discarded?
  • Overall, how significant is the threat to public safety from discarded syringes, and how does it compare with the threat from pre-needle exchange days?

If advocates and researchers are right, the answers to those questions don't support the premise of the Chronicle stories. "Nobody wants dirty syringes lying around," said Hilary McQuie, Oakland-based Western Director for the Harm Reduction Coalition. "But there were syringes everywhere in San Francisco before we started needle exchanges here in 1988. There is no recognition [in the Chronicle story] that there was a problem with discarded syringes before needle exchange came around, or that needle exchanges help reduce the problem."

The Chronicle also seemed to go out of its way to paint one program, the Homeless Youth Alliance, and its director, Mary Howe, in an unflattering light:

"Finding the needle exchange in the Haight isn't easy. Walk west on Haight Street, take a right at Cole, and turn in the first doorway. There's no identification, just a blue sign that says, 'entrance.'

"Walk up the hall, which smells of urine, and then knock on the scratched and battered wooden door. After two or three tries, someone might open the door a crack to see what you want.

"Welcome to a city drug needle exchange and HIV prevention facility.

"When then-Mayor Frank Jordan signed legislation endorsing needle exchanges in 1992, it was a high-minded, civically progressive program to slow the spread of HIV and hepatitis C. Drug users would get a needle, use it, then return it for a clean one. That's still the idea -- and it is a good one -- but somewhere along the line the concept went low-rent.

"Today the Haight facility looks more like a hole in the wall. The neighbors, many of whom say they have never been told what's going on up the street, find syringes in their gardens. And the original idea -- a one-for-one exchange -- is largely ignored.

"The exchange is run by the Homeless Youth Alliance, which gets a yearly budget of $275,000 from the city Department of Public Health. As the alliance's program director, Mary Howe, admits, they make no more than a rough count of the incoming needles. If someone says he returned 40, they hand over 40 new ones. And, if he doesn't have any, they give him 20 as a startup stash.

"'The point for a needle exchange is not to get every needle back,' says Howe. 'The majority of users dispose of needles in a respectful manner.'

"And those who don't?

"'That's not my responsibility,' Howe said. 'I can't hold everyone's hand and make everyone put them in a bio bucket. If someone has a liquor store, and they sell liquor to someone who gets into an accident, is it the store's fault?'"

"The Chronicle totally attacked Mary Howe," McQuie complained. "She's one of the few people who has a good relationship with the homeless users in Golden Gate Park, and the Chronicle didn't mention that her staff does regular clean-ups [collections of discarded syringes] there."

"That's right, said Peter Davidson, board chairman for the Homeless Youth Alliance. "We go out there monthly and clean up dirty needles," he said. "It's a large park, though, and I have to wonder why we are blamed for every needle in it. Picking on a small, poorly-funded needle exchange program doesn't seem particularly productive," he said.

"We're a little bit frustrated with the Chronicle coverage," said Davidson, "but we hope this whole kerfluffle will cause some movement."

Of course, no one wants people getting stuck with discarded needles, but some research can help to put that problem in perspective too. Infections from needle sticks are quite rare outside medical facilities, according to Dr. Robert Heimer, a professor in the Division of Epidemiology of Microbial Diseases at Yale University and an expert on HIV survival in syringes. "While HIV will survive for weeks inside a syringe, needle sticks are not likely to transmit the virus since virus on the surface of the needle, which would be introduced into the body of the person being pricked, loses viability quickly upon drying. Supporting this are the data from hospital needle stick transmission, which were strongly associated with fresh blood," he said.

A 1998 review of the literature on needle stick infections agreed. It found no HIV infections contracted via needle sticks among garbage disposal workers in one study reviewed. Other studies found low numbers (less than 15) cases of hepatitis infections contracted through needle sticks.

In the third article (so far) in the series, "Needles talk of town; SF officials promise system of drop boxes," the Chronicle patted itself on the back for prompting the city to act with its "exposé" of the dirty needle problem:

"City officials and nonprofit agency leaders, responding to an outcry over used syringes littering parks, promise to reform San Francisco's needle-exchange program -- including locked, 24-hour syringe drop boxes and technologically advanced syringes."

Indeed, both city officials and needle exchange program heads were quoted as saying they would be acting soon to install drop boxes where dirty needles could be dropped off. San Francisco currently doesn't have any, which probably goes a long way toward explaining why the city's return rate is only around 70% instead of the 90% reported in some cities that do have drop boxes. But it is not that the city and the exchanges suddenly woke up because of the Chronicle's reporting. According to insiders, planning for drop boxes has been ongoing, and the first ones will appear shortly. What the Chronicle's reporting really did was goose city hall and the exchanges to let the public know what was already underway.

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popular needle exchange logo
"Mary has been meeting with the public health department, the AIDS Foundation, and the police on disposal boxes for the last year and a half," said Davidson. "Everyone agrees it's a good idea. She's been shopping a written proposal around, but when it came to needles in Golden Gate Park, Parks and Recreation didn't want to get involved."

"We've been talking with the city public health department for awhile about disposal boxes, and I think this series and all the uproar it has aroused will make it happen," said McQuie. "That would be a good public relations move, but people don't want to carry their syringes around because of our paraphernalia law here in California." In the face of the assault on the NEPs in San Francisco, McQuie went on the offensive. "What we really need is to change the needle law so people don't feel like they have to get rid of them. We need syringe exchange machines like soda machines, where you put one in and take one out. And we need safe injection sites," she said.

Heimer also had some observations and suggestions about reducing the number of dirty needles strewn about in public. "Our studies comparing Springfield, Massachusetts, where there is no legal access to syringes, to New Haven and Hartford, where there is, found far more unsafe discarding in Springfield (44%) than in Connecticut cities (13.5%)," he pointed out. His unspoken conclusion was obvious: remove restrictions to needle access if you want to lower rates of unsafe discarding.

"We need publicly accessible drop boxes," Heimer suggested, "along with training injectors to use proper containers, training police to not harass people who carry syringes (then people won't have to chuck their rigs when approached by police), and expanding syringe exchange hours and, counter-intuitively, liberalizing exchange policies," he said. "We found that syringe return rates in three US cities -- Oakland, Chicago, and Hartford -- were highest (nearly 90%) in the city with the most liberal policy (Chicago) and lowest (only 50%) in the city with the most restrictive policy (Hartford).

But such fine points apparently did not interest the self-styled crusaders at the Chronicle. While the newspaper may have done a public service by reporting on the discarded needle problem, the way it did so was a disservice to the hard-working, dedicated people who run these programs for the public health. One would think the citizens of San Francisco deserve better than shabby, sensationalized reporting when it comes to critical public health issues. We only hope that the Chronicle's botched job leads to advances, not setbacks, for harm reduction and needle access in California.

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