DRCNet
Special
Report:
American
Public
Health
Association
Holds
Congressional
Briefing
on
Syringe
Exchange
2/27/98
-Adam J. Smith On Tuesday, 2/24, the APHA held a very well-attended briefing for congressional staffers on the topic of syringe exchange. At a moment in history when the mere mention of drugs or drug policy reform sends shivers through the very halls of Congress, the prestige of the 125 year-old APHA was an important factor in cutting through the politics of the debate and drawing a crowd of over 100 staffers to the luncheon. Three speakers, Harry Simpson, Executive Director of the Community Health Awareness Project in Detroit, Dr. Peter Beilenson, Health Commissioner for the City of Baltimore, and Dr. Don Des Jarlais, prominent AIDS researcher, currently on staff at the Beth Israel Medical Center in New York, made a compelling case in favor of syringe exchange from the practical, political and public health perspectives. Although all three speakers spoke of the imperative, both medical and moral, for lifting the current ban on the use of federal AIDS funding for these programs, the event also provided a broad-based education on the issue of harm reduction to staffers, who seemed eager both to learn more about syringe exchange and to gather rhetorical ammunition to take back to hesitant legislators. Harry Simpson spoke first and told the standing room only crowd of his 16 years as an injection drug user. Clean and sober today and the Executive Director of a full-service harm-reduction and public health center with an annual budget of over $1 million, Simpson eloquently made the case for helping, rather than discarding, our fellow citizens who find themselves mired in addiction and abuse. "As a recovering addict, when I first heard about syringe-exchange, my initial reaction was, 'you gonna give these folks free needles? That's the most ridiculous thing I've ever heard.'" Simpson went on to say, however, that today, as a practitioner of harm reduction and syringe exchange, he believed that the service was not only an effective AIDS-prevention strategy, but also provided a bridge for substance abusers which led to healthier lives and quite often to successful recovery. Dr. Beilenson spoke of the experience of the city of Baltimore, where AIDS is the #1 killer of persons 25-44 years-old. Baltimore, he said, had the largest city-run syringe exchange/harm reduction program in the country, with two mobile units, six separate sites and two pharmacies where syringes could be exchanged. Dr. Beilenson emphasized the superiority of exchanges, where dirty needles are taken back off the street and properly disposed of, over simple over-the-counter availability, which relied upon consumers to dispose of the potentially hazardous waste themselves. One staffer asked about reports that some sites around the country had given syringes to people who had not brought used syringes to exchange, to which Dr. Beilenson replied that while an exchange is formally required, and that the vast majority of clients did in fact come to the sites with used syringes, if staff believed that a person asking for syringes was, in fact, an IV drug user, it would not be in anyone's interest to turn them away. In Baltimore, where each syringe is computer coded, the city-run exchange gets back over 90% of the syringes that it gives out. Dr. Beilenson also noted that while the typical taxpayer cost for a single indigent AIDS patient easily surpassed $100,000, the cost of running Baltimore's entire exchange program was just $300,000, making the program an enormous cost-saving measure for the city. Dr. Beilenson also listed for the staffers four things that syringe exchange does NOT do: 1) increase the number of dirty needles on the streets (Baltimore has seen a decrease); 2) increase crime in their areas of operation (here again Baltimore has seen a decrease); 3) increase the use of drugs by clients (Baltimore's large-scale study found a 22% overall reduction in use by clients); 4) condone injection drug use, especially with regard to adolescents (Baltimore's program, which serves over 7,000 clients and which has exchanged 1.7 million syringes, has exactly two clients under 18 years of age). Dr. Don Des Jarlais spoke of the public health imperative for implementing programs which have now been common-practice for years in nearly every western society. He told the gathered staffers that more than one half of all new AIDS cases in the US came directly from infected needles, and that overall, more than 70% of new cases were injection-related. He said that IV drug users have multiple incentives to use the programs where they are available, as in addition to the health benefits, new needles worked and felt better than old, dull needles. In fact, 70-90% of users who had access to programs used them regularly. In addition, he stressed, syringe exchange programs were the single largest source of treatment referrals in areas in which they operated. In a nod to the partisan nature of the debate over the programs in the US, Des Jarlais addded that in the late 1980's "that noted British liberal Margaret Thatcher instituted nation-wide syringe exchange" as part of her country's AIDS prevention strategy, and that in contrast to the startling situation in the States, there is today in the UK almost no correlation between IV drug use and the AIDS virus. Throughout the program, attendees could be seen nodding in agreement and furiously taking notes. One staffer asked the panel how to broach the subject with a legislator for whom the moral imperative of helping drug addicted persons, or even the public health benefits of the programs, fell on deaf ears. Beilenson urged the staffer to argue dollars and cents. He reiterated his earlier assertion that Baltimore's $300,000 program was saving the city untold millions of dollars in health care costs each year. A warm round of applause closed the program, and a buzzing crowd of congressional aides spilled out into the hall and back to work. [AJS: Having witnessed this event with the knowledge that the House Republican leadership is in the process of crafting a comprehensive Drug War legislative package, one could not escape the feeling that a fight over drug policy, a real fight with real philosophical distinctions, is set to emerge in the House and to be played out over the next 3-4 years. That fight will pit war vs. peace, marginalization vs. integration, and punitive measures vs. public and individual health imperatives. At stake will be nothing less than the future direction of the democracy, and the type and the character of the nation that we will hand to our children in the new millennium.]
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