Leading congressional drug warrior Rep. Mark Souder (R-IN) has been waging his own war against harm reduction -- the notion that the way to deal with potentially dangerous behaviors, such as drug use, is to attempt to reduce the damage associated with them through, among other things, programs such as needle exchanges, safe injection sites, and opiate maintenance regimes. From his perch as chair of the House Government Reform Committee's Subcommittee on Criminal Justice, Drug Policy, and Human Resources, Souder has previously lashed out against harm reductionists at home and abroad.
The first sign that it might turn out differently came as more than two dozen people sporting bright yellow labels reading "Clean Needles Saved My Life," many of them clients of Housing Works, a major AIDS housing agency in New York City, strode off a bus chartered by the same agency to pack Room 2154 of the Rayburn Building, the Government Reform Committee's hearing location. The arrival of Housing Works' forces presaged an unexpectedly strong show of strength by harm reductionists and support from sympathetic members of Congress. By the end of the session, harm reduction had won a clear moral victory despite its proponents having endured some abuse. Those who stuck it through the lengthy deliberations were also treated to the occasional circus-like moment as passions flared on both sides.
The hearing came with the US government in the midst of a broader offensive against harm reduction activities. In November, then Undersecretary of State for International Narcotics and Law Enforcement Affairs Robert Charles met with United Nations Office of Drug Control head Antonio Maria Acosta to strongly urge the UN to remove all references to harm reduction from its literature, a demand with which the UN cravenly complied.
Similarly, Souder himself last week complained to drug czar John Walters about the US Agency for International Development (USAID) logo appearing on materials associated with last year's international harm reduction conference in Thailand. "Souder was upset that the USAID logo appeared on some harm reduction brochures that taught people how to inject safely," said Drug Policy Alliance national legislative director Bill Piper. "By the tone of his comments, it was clear he thought it was an inappropriate use of taxpayer money to pay for that sort of thing."
And in a recent Dear Colleague letter from Souder and Rep. Tom Davis, chairman of the Government Reform Committee, sent to every member of Congress, the two of them attacked the harm reduction concept and cited the findings of the International Narcotics Control Board (INCB) to help make their case -- erroneously, in the opinion of another congressman, discussed below.
And earlier this year, Souder staffer Mark Wheat announced his intention to hold hearings into the funding sources of the leading harm reduction group, the Harm Reduction Coalition. "Mark Wheat announced that HRC takes money from companies and then tells people how to beat drug tests!" exclaimed HRC executive director Allan Clear. "Maybe what he meant to say was that HRC tells people how they can remain HIV- and Hep C-negative by using sterile needles." Souder and his staffers also attacked HRC over its national harm reduction conference in New Orleans last year, Clear said. "You will remember that he attacked our funding from pharmaceutical companies for that conference."
Thanks to sympathetic members of the Democratic minority, Souder and his committee heard stout defenses of harm reduction. Democrats led by Rep. Elijah Cummings (D-MD), the ranking Democrat on the subcommittee, whose district includes Baltimore, and Rep. Henry Waxman (D-CA), ranking member of Government Reform, also stood up to the onslaught on harm reduction. And one of the witnesses was Peter Beilenson, Commissioner of Public Health for Baltimore, Cummings' city, where harm reduction programs such as needle exchanges are credited with saving lives by reducing the spread of diseases such as HIV and Hepatitis C.
Souder was followed by Rep. Elijah Cummings (D-MD), whose Baltimore district has seen the benefits of needle exchange programs first-hand. Cummings laid out an overwhelming case for needle exchanges, citing a lengthy list of studies, including one done by the National Institutes of Health at the request of Cummings and Rep. Waxman. "The bottom line," said Cummings, "is that in Baltimore, needle exchange programs are a fundamental component of a comprehensive strategy to reduce the spread of HIV and Hepatitis C. Only a misinterpretation of the scientific literature could lead one to believe that needle exchanges are ineffective or result in increased drug use," Cummings said.
But while indirectly attacking Souder for his anti-harm reduction position, Cummings also gave the Indiana Republican a left-handed compliment for sponsoring legislation that would allow increased access to buphrenorphine, a heroin substitute, subtly pointing out that Souder himself had embraced a harm reduction program.
Washington, DC's Delegate in Congress, Eleanor Holmes Norton (DC is not afforded a voting US Rep.), spoke for the District, saying, "We deeply resent in DC being the only jurisdiction in the United States that is not allowed to spend our own money on needle exchange programs." Norton also took issue with Souder's contention that harm reduction is about keeping people on drugs. "I take strong exception to those who say that we believe such things if we support harm reduction," she said, making clear that while she supports needle exchanges, she does not support either heroin maintenance or "legalization."
Rep. Waxman stopped in to briefly join the fray. While courteous toward Souder, Waxman was also blunt. "This hearing appears designed to bolster an ideological point of view," he said. "But the best way to be pragmatic is to listen to the science. If you're going to ignore the evidence," he told the chairman, "you're putting ideology over science." Waxman criticized the aforementioned Souder/Davis Dear Colleague letter, saying that it mischaracterized the contents of a recent report of the International Narcotics Control Board as opposing needle exchange. In fact the report acknowledged a role for needle exchange programs, albeit grudgingly. Souder and Waxman then engaged in a back and forth in which Souder defended the letter but Waxman stood by his criticism. It was the first of many contentious moments during the session.
The cavalcade of witnesses -- pro and con -- then began. It was not an auspicious start for the prohibitionists, as former DEA head Peter Bensinger spoke about Switzerland's "Needle Park" -- which he dubbed "Needle Exchange Park" -- asserting without any evidence that needle exchange programs are ineffective, and instead recommended returning to the glory days of the 1980s, when "just say no" would suffice.
Next up was Zainuddin Bahari, chief executive officer of the Humane Treatment Home in Malaysia, the first a group of Asian treatment hardliners imported from Asia for the hearing, a number of them associated with the largely US-funded Colombo Plan Drug Awareness Program. All intoxicants are forbidden by the Muslim faith, Bahari said. Harm reduction and continued drug use are "unacceptable," he said, and needle exchanges and safe injection sites are "delusions." Also represented were Afghanistan, Sri Lanka and Indonesia.
Yunus Pathi, of Pengasih Treatment Program, also from Malaysia, spoke words that may have revealed the main intent of the hearing. "There is a confused message from Washington," Pathi complained. "The US government needs to clarify what its policies are. People are saying that USAID and INL will fund needle exchange, and we need to hear from the Office of National Drug Control Policy and the State Department that that is not US policy." But Pathi also, perhaps inadvertently, revealed the lack of a consensus to support his position within his own nation -- the people saying that there is US funding for needle exchange are people who presumably want needle exchange or perhaps even offer it, and other Malaysians are presumably permitting them.
And that couldn't be more important, according to Chris Beyrer, an expert in international public health from Johns Hopkins University, who called the rise in global HIV/AIDS outbreaks among injection drug users (IDUs) "explosive." Beyrer cited a raft of distressing statistics including grim numbers from Thailand, where "HIV prevalence among Bangkok IDUs went from 2% to 40% in 6 months in 1989." The pandemic has been "transnational," has often though not always, "led to further spread among non-injecting populations" and has "proven difficult to control."
The testimony went on all afternoon and into the early evening. In addition to prohibitionists like Voth, Barthwell, and former Michigan drug czar Robert Peterson, the panel also heard from some prominent harm reduction advocates. Among them was Dr. Robert Newman, head of Continuum Health Partners and director of the International Center for Advancement of Addiction Treatment. Newman, a leading proponent of methadone maintenance, came out strongly for fully funding treatment on request. But Newman also spoke out for harm reduction, calling it a needed approach "to lessen suffering, illness, and deaths."
The panel also heard from the Rev. Edwin Sanders, pastor of the Metropolitan Interdenominational Church in Nashville and leader of Religious Leaders for a More Compassionate Drug Policy. While Sanders acknowledged the "horrors" of the drug situation in African-American communities, and stopped short of calling for legalization, he called criminalization "an expanded horror."
Following Sanders was Baltimore health commissioner Peter Beilenson, a pioneer in getting needle exchanges started in that heavily drug-using city. "We are proud that in Baltimore we have nearly tripled the number of people in treatment from 11,000 to 25,000," he said, "but we need 40,000 slots." But treatment isn't the only means of dealing with the drug using population, he said. Needle exchange programs "are the way many addicts interface with the public health system," he said, pointing out that Baltimore's needle exchange program "has enrolled over 2,300 persons into drug treatment programs and has high treatment retention rates."
"This turned out to be a really good discussion of harm reduction issues, and needle exchanges in particular," said DPA's Piper, who attended the hearing. "I think our side did really well in presenting harm reduction as scientifically proven and laying out the evidence, while painting the other side as merely ideological," he told DRCNet.
"I think his aim was to discredit harm reduction and set the stage for blocking the use of federal dollars for harm reduction efforts abroad," Piper wagered. "Congress already prohibits the use of federal funds for domestic needle exchanges, but it sometimes gives money to international harm reduction organizations. While that federal money may be earmarked for other things, some of these groups do needle exchange and maybe he wants to go after those."
But, Piper continued, Souder heard a strong defense of harm reduction from people like Beilenson and the Democratic subcommittee members. "The hearing made clear that science is on the side of harm reduction and needle exchanges. I could tell from the expression on Souder's face that he was getting a perspective he wasn't expecting," the Hill watcher said. "It's hard to say where he is going to go now."
Nevertheless, it did not all go easily for the harm reductionists. Again pulling out their copy of "It's Just A Plant," Souder and freshman Republican Rep. Patrick McHenry (R-NC) used it to figuratively bash Newman and Sanders for their association with Drug Policy Alliance -- listed in the book as a funder of it -- as members of DPA's board of directors. The nastiness proved too much for one observer, who called out to McHenry "why don't you just smoke a joint and relax" and walked out in disgust.
But Souder's and McHenry's bile were more than matched by support and an unusual degree of backbone from committee Democrats. Rep. Danny Davis (D-IL), an active proponent of support for ex-offenders, read out loud the entire text of a pro-harm reduction letter signed by the Students for Sensible Drug Policy (SSDP) Roosevelt University (Chicago) chapter, SSDP's national office, and the Midwest Harm Reduction Institute.
And Cummings rose to the occasion by defending his invitees and criticizing their treatment to which they were subjected. "This reminds me of the Clinton hearings," Cummings remarked, protesting that "[Sanders] doesn't even know about this book." Cummings cited the respect he had shown to the majority's witnesses and demanded the same treatment for the minority's witnesses. "These are Americans, all of whom want to make a difference in the world," he said, likening Souder's and McHenry's attacks to "McCarthyism." Cummings also lamented that "we just spent all this time doing what we did, whatever that was," and displayed some irritation after Souder debated Beilenson on the fine points of data from Baltimore's needle exchange program in an attempt to question the studies' pro-needle exchange conclusions. "Maybe, just maybe, it's because Baltimore has a great public health commissioner," he spoke in a voice dripping with sarcasm, "just maybe."
Norton also took on former deputy drug czar Barthwell, noting that Barthwell supported methadone maintenance even though there were problems with some of the programs. "If that didn't stop you from supporting methadone, why can't you support well-run needle exchange programs like in Baltimore?" she demanded. Norton also skeptically commented on the "sweeping statements" that characterized Barthwell's testimony.
"It became clear that the Democrats were already supportive, and I was pleasantly surprised at how forceful they were," said DPA's Piper. "I don't think this hearing changed anyone's positions, but if anything, Souder may now have a better understanding of what harm reduction is all about." Still, Piper said, "It's clear that Souder is trying to make harm reduction a big issue this year. This hearing was designed to get his perspective on the record, to try to give harm reduction a bad name, so that when he tries to restrict such activities later this year, his groundwork will already be laid. Souder has made it clear that he is concerned that federal tax dollars are going to harm reduction efforts, and these hearings are part of a larger campaign."
"The fact that Souder is holding this hearing is a particular hallmark of how far out of the mainstream this government is prepared to go," said Clear, he argued during a teleconference just before the hearing. "Harm reduction is a public health strategy that is already national policy in the Britain, Holland, Australia, Canada, and other countries. These are not maverick programs. We've had harm reduction programs in Hawaii and New Mexico, needle exchanges in cities across the country, and those programs have been evaluated as successes for more than a decade. If the science didn't show that needle exchanges work, we wouldn't be investing in them," he said.
The attack on harm reduction is an attack on society's weakest members, Clear continued. "These attacks suggest that the government thinks that some people have value and some people don't. And drug users have no value whatsoever," he said. "If we cannot protect our most vulnerable, we can't protect anyone."
"As far as I can tell, Souder has never attempted to communicate with anyone from the harm reduction world," said HRC's Donald Grove. "His method is to talk to people from the drug czar's office, drug prevention, and law enforcement, not us. This is not real participatory democracy. Souder is trying to construct a position not based on who is doing harm reduction or what it looks like or what it achieves, but instead based on ideological opposition to the whole concept," he told DRCNet before the hearing. "Our big question is what is he seeking? What will Souder consider success?"
Robert Cordero, director of federal advocacy for Housing Works, was pleased with the hearing's outcome and called out to Rep. Souder to get the message. "Harm reduction advocates across the country should thank Congressman Souder for organizing a hearing that clearly demonstrated the flawed logic of those who oppose the science-based intervention of needle exchange programs in reducing HIV and Hepatitis infection, while increasing access to health care and drug treatment for drug users. Housing Works clients know that needle exchange programs save lives. As DC Delegate Eleanor Holmes-Norton stated at the hearing, 'we should all be concerned about death reduction.' Congressman Souder, are you listening?"
Next possible front in the international harm reduction wars: the European Parliament in Brussels, Belgium, where prohibitionists led by a Swedish MEP are hosting a conference this March 1-2, whose featured speakers include US drug czar John Walters. The conference convenes with important EU drug policy decisions looming in the near future. More about this in Drug War Chronicle soon.