White House Pushes Cautiously Forward on Needle Exchange

Clean syringes become part of federal AIDS strategy.

As most people know, addicts who inject drugs have played a major role in the HIV epidemic. In the U.S. alone, there are an estimated one million “injection drug users,” as the government calls them. They are linked to almost 20% of new HIV infections each year. (Roughly 56,000 new HIV infections occur in the United States annually, according to CDC estimates.)

And in black and white, on page 16 of the July 2010 position paper titled “National HIV/AIDS Strategy for the United States”, the White House made it official. In a list of “proven biomedical and behavioral approaches that reduce the probability of HIV transmission,” the report has this to say:

 “Among injection drug users, sharing needles and other drug paraphernalia increases the risk of HIV infection. Several studies have found that providing sterilized equipment to injection drug users substantially reduces risk of HIV infection, increases the probability that they will initiate drug treatment, and does not increase drug use.”

That relatively mild statement represents a bold departure from the AIDS/HIV policies of previous administrations--when such policies existed at all. The White House has bolstered its contention with citations:

Latkin, C, Davey, M, and Hua, W. Needle Exchange Program Utilization and Entry into Drug User Treatment: Is There a Long- Term Connection in Baltimore, Maryland? Subst Use Misuse, 41(14):1991-2001.

Vlahov D, Junge B. The role of needle exchange programs in HIV prevention. Public Health Rep. 1998;113 (Suppl 1):75-80.

Put simply, clean needles save lives. Needle exchange programs put more addicts in contact with social services, thereby easing their entry into drug treatment programs.

“Comprehensive, evidence-based drug prevention and treatment strategies have contributed to reducing HIV infections,” the report states. “In 1993, injection drug users comprised 31 percent of AIDS cases nationally compared to 17 percent by 2007. Studies show that comprehensive prevention and drug treatment programs, including needle exchange, have dramatically cut the number of new HIV infections among people who inject drugs by 80 percent since the mid-1990s.”

By the end of this year, the report pledges, “Centers for Disease Control and Prevention (CDC)  and the  Substance Abuse and Mental Health Services Administration (SAMHSA) will complete guidance for evidence-based comprehensive prevention, including syringe exchange and drug treatment programs, for injection drug users.”

One question not answered in the White House document—how to pay for new treatment initiatives of this kind.

Graphics Credit: https://www.accesscontinuingeducation.com

Needle Exchange in America

AIDS/harm reduction activists press Obama.

First, the good news: After 20 years, the U.S. Congress has voted to remove the funding ban on syringe exchange programs designed to combat AIDS and to bring hard drug users within the orbit of the medical health community.

Now, the bad news: Conservative legislators have managed to insert a provision in the bill prohibiting needle exchange centers within 1,000 feet of schools, day care centers, colleges, playgrounds, youth centers, swimming pools—and just about any other institution you care to come up with. In short, the legislation would make it virtually impossible to operate a viable needle exchange program, even if sufficient levels of federal funding can be obtained. As one harm reduction activist put it in the Seattle Stranger: The only place you could put a federally-funded needle exchange program in the entire city of Chicago... is O’Hare Airport? Gee, it’s almost like Democrats aren’t really serious about allowing funding live-saving needle programs at all.”

Clearly, needle exchange activists are still waiting for an unambiguous sign from the White House that Obama plans to uphold his campaign promises in this regard. Obama’s go-slow policy on needle exchange has frustrated AIDS activists in particular.

Physicians for Human Rights, a group that supports clean syringe exchange programs, made October 14 a National Call-in Day, noting on its web site that “Senators need to hear from President Obama that his Administration supports syringe exchange. Now is the time to urge President Obama to fulfill his campaign promise to end the ban and to urge the Senate to act.”

In a post in January of this year, I wrote: “Obama’s agenda, as spelled out at Whitehouse.gov, calls for rescinding the ban in an effort to save lives by reducing the transmission of HIV/AIDS. ‘The President,’ according to the agenda, ‘supports lifting the federal ban on needle exchange, which could dramatically reduce rates of infection among drug users.’"

Syringe exchange programs, Physicians for Human Rights declares, “do more than provide clean syringes and properly dispose of used ones; they link people into the health care system and drug treatment programs that save lives.”

In short, says the group, “the presence of syringe exchange programs in communities does not increase rates of drug use, nor does it lead to a rise in crime. What it does do: decrease transmission of HIV, Hepatitis C and other diseases.”

Moreover, during his confirmation hearings drug czar Gil Kirlikowske said that “a number of studies conducted in the US have shown needle exchange programs do not increase drug use.”

It’s a confusing picture in the field: Needle exchange programs exist, in San Francisco, Toronto, New York and other major metropolitan areas, because county and other local and regional officials have authorized it, even when funding was precarious. Alongside these programs, a plethora of illegal needle exchange operations is also in place. The Drug War Chronicle quoted the Western director of the Harm Reduction Coalition: “We need to get legislation authorizing syringe exchanges on a statewide level.... Requiring local authorization means we have to deals with 54 jurisdictions instead of just one.”

Back in May, Maia Szalavitz reported in Time that the president was planning to move deliberately as part of a broader HIV/AIDS strategy, even though groups from the World Health Organization (WHO) to the American Medical Association have gone on record with the view that giving clean needles to drug addicts is a successful strategy to reduce the spread of HIV disease. Studies by Don Des Jarlais of Beth Israel Hospital in New York suggest that infection rates in New York’s drug addict population may have dropped more than 75 % over the last few years as clean needle programs became increasingly available.

In a report last month by the Drug Reform Coordination Effort (DRCNet), a spokesperson for the AIDS Action group was determined to remain positive. “I have a pretty good feeling about this,” he said. “I’m hopeful this is the year.”

addiction drugs

Harm Reduction Scorecard

A look at drug strategies worldwide.

A fascinating study released earlier this year by the International Harm Reduction Association (IHRA) provides a snapshot of the staggering country-by-country variations in drug law and policy across the globe.

While Western Europe and North America have in place a solid base of operational heroin substitution therapies, such as methadone, these same Western countries have fallen behind in prison addiction programs, including all-important needle exchanges.

Countries lacking widespread access to heroin substitution programs include Russia, Afghanistan, Pakistan, Cambodia, and most of Latin America with the exception of Mexico. These are also, coincidentally or not, all regions of substantial opium cultivation.

As it turns out, every major nation except South Africa—where the ravages of HIV are all too evident--has put in place needle and syringe exchange programs of one scope or another, in at least one location in the country.

Interestingly, the IHRA report, titled “Harm Reduction Policy and Practice Wordwide,” finds that some of the countries with the most active needle exchange programs in prisons include Armenia, Kyrgyzstan, Romania—and Iran, which also offers heroin substitution therapy in prisons. Notable countries lacking widespread needle exchange programs in prisons include the United States, Latin America, and portions of Western Europe.

Finally, regarding the most radical category in the harm reduction arsenal—drug consumption rooms, also known as safe injection facilities—the world has been significantly slower to adopt this approach to the public consumption of injectable drugs. The document lists the existence of drug consumption rooms in Canada, Australia, Germany, Norway, the Netherlands, Spain, and Switzerland.

The report, prepared by Catherine Cook, a Research Analyst with IHRA, notes that the listings do not indicated “the scope, quality or coverage of services.” And while almost all countries have national policy documents that make reference to harm reduction policies for health or drug-related policy, strategies vary widely.

“Of particular interest here is the US,” the report notes, “which includes harm reduction in its national HIV and hepatitis C strategy documents, but not in those relating to drug policy.”


Graphic Credit: Bristol Drugs Project


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Obama Set to Name New Drug Czar

Seattle police chief gets the nod.

Drug reformers, hoping for the appointment of a public health official, expressed initial dismay at the news that President Barack Obama will nominate Seattle Police Chief Gil Kerlikowske as the nation’s new “drug czar.”

As the president’s evident choice to head up the White House Office of National Drug Control Policy (ONDCP), Kerlikowske is not known for highlighting drug issues in national law enforcement circles, notes the Drug War Chronicle. “While we’re disappointed that President Obama seems poised to nominate a police chief instead of a major public heath advocate as drug czar,” said Drug Policy Alliance’s Ethan Nadelmann, “we’re cautiously optimistic that Seattle Police Chief Gil Kerlikowske will support Obama’s drug policy reform agenda.”

According to the Seattle Post-Intelligencer, “He’s likely to be the best drug czar we’ve seen, but that’s not saying much,” Nadelmann said. “At least we know that when talk about needle exchanges and decriminalizing marijuana arrests, it’s not going to be the first time he’s heard about them.”

For those worried about a radical change in the nation’s drug policy, Seattle City Councilman Nick Licata sought to assure citizens that Kerlikowske is “not on a platform arguing for decriminalization of drugs or radical drug reform measures.”

A spokesperson for the American Civil Liberties Union (ACLU) told the Post-Intelligencer: “I would imagine that being a chief law-enforcement officer makes it very difficult for someone to speak out in favor of more progressive drug laws and drug policies.” However, former Seattle Police Chief and drug reform advocate Norm Stamper insisted that Kerlikowske was more inclined to support “research-driven and evidence-based conclusions about public policy.”

In “Advice for the New Drug Czar,” an article for the online edition of The American Prospect, drug policy experts Mark Kleiman of UCLA and Harold Pollack of the University of Chicago laid out their recommendations for Kerlikowske. Here is an example of their thinking:

--“You’ll be told that we have a national strategy resting on three legs: enforcement, prevention, and treatment. Don’t believe it. There is no coherent strategy. Enforcement, prevention and treatment are the names of three quarrelling constituency groups whose pressures you will sometimes need to resist....”

--“There are some real ‘drug wars’ raging: in Afghanistan, in Columbia, and in northern Mexico. Those wars matter terribly to the countries involved, but no outcome of those wars is likely to make the drug situation in the United States noticeably better or worse.”

--“Treatment needs to be more accessible and more accountable. Good news: even lousy treatment has benefits greater than its costs. Bad news: much of the treatment actually delivered is, in fact, pretty lousy. Demand to see results, and insist on rigorous evaluations. Focus resources on effective programs. It’s an outrage to have addicts dying of overdoses while on waiting lists for methadone treatment.”

--“Most primary care providers never perform highly cost-effective screening and brief intervention, because they’re neither trained for it nor paid for it. Many don’t think that dealing with drug abuse is in their job description; it needs to be.”

--“’Drug Czar’ is a silly title.”


Photo Credit: www.pbs.org

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Obama’s Emerging Drug Program

President to lift ban on needle exchanges.

While reformers are far from pleased with the initial rollout of President Obama’s drug policy agenda, treatment activists can at least point to a significant change in the federal stance on clean needle exchange programs. Unlike former President Bush, who supported a ban on federal funding of such public health programs, Obama’s agenda, as spelled out at Whitehouse.gov, calls for rescinding the ban in an effort to save lives by reducing the transmission of HIV/AIDS. "The President," according to the agenda, "supports lifting the federal ban on needle exchange, which could dramatically reduce rates of infection among drug users."

Opponents of needle exchange say the effort is similar to the medical marijuana movement—a stealth strategy for the legalization of drugs. However, as I wrote in an earlier post, the administration’s support of needle exchange is a timely recognition that cities like Vancouver and San Francisco are already experimenting with the notion of safe drug injection sites. (Part of the argument in favor of such sites is the opportunity for clean needle exchanges.)

Under the heading “Civil Rights,” the White House web site has also signaled support for the expanded use of drug courts to allow non-violent offenders into “the type of drug rehabilitation programs that have proven to work better than a prison term in changing bad behavior.” The agenda also calls for the reduction of sentencing inequities (“President Obama and Vice President Biden believe the disparity between sentencing crack and powder-based cocaine is wrong and should be completely eliminated”).

An article in Drug War Chronicle notes that “reformers may find themselves pleased with some Obama positions, but they will be less happy with others. The Obama administration wants to reduce inequities in the criminal justice system, but it is also taking thoroughly conventional positions on other drug policy issues.”

To wit, marijuana. Activists were hoping for a clear demonstration of support for the use of medical marijuana. So far, that hasn’t happened. Marijuana is not mentioned at all in the relevant sections of the online policy agenda, though the document is known to be a work in progress.

Nonetheless, it might be well to heed the advice offered by the U.K.’s Transform Drug Policy Foundation: “Lifting the disgraceful needle exchange funding ban is a good start considering we are only in day one—and the generally pragmatic tone bodes well. Can we be cautiously optimistic? Yes we can.”

Graphics Credit: Pharmacy Exchange

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A Dubious Choice for Drug Czar

Obama should just say no to Congressman Ramstad.

At the Huffington Post, Maia Szalavitz deconstructs the exaggerated outcome data being used by Minnesota Teen Challenge (MNTC) to document the supposed effectiveness of their addiction treatment program. Plenty of treatment programs inflate their success numbers, knowingly or unknowingly, by using flawed statistics to support their arguments. Often--as in this case--there is no control group, thereby making firm statements about the “success” of a treatment all but impossible to prove.

So why bother pointing out such obvious problems in the case of Minnesota Teen Challenge? Primarily, Szalavitz writes, because “the sole sponsor of an earmark providing $235,000 to Minnesota Teen Challenge, a branch of a national anti-addiction group which believes that recruiting people into the Assemblies of God ministry will cure their addiction,” was none other than Jim Ramstad (R-Minnesota) a populist conservative Obama is considering as the nation’s new “Drug Czar.”

(Earlier this year, Congressman Ramstad came out in opposition to plans for the crescent-shaped Flight 93 Memorial Project, arguing that the design had “Islamic features.”)

NORML, the National Organization for the Reform of Marijuana Laws, gives Ramstad a grade of 30, indicating a “hard-on-drugs” stance. Ramstad, an alcoholic in recovery, backs expanded drug testing for federal employees, and beefed-up military patrols along the Mexican border in order to battle “drugs and terrorism.”

Unfortunately for the country’s hard drug addicts, Ramstad is also adamantly opposed to such things as needle exchange programs and medical marijuana.

No word yet from Ramstad on sentencing issues or the matter of addiction treatment rather than incarceration.

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