Ideology scored another victory over public health and sound science last week when seven New Jersey legislators obtained a court order barring needle exchange programs in the state. The crusading seven, led by Sen. Tom Kean Jr. (R-Union) claim that such programs, which allow drug users to exchange their dirty needles for new sterile equipment, encourage the use of illicit drugs and do nothing to stop the spread of HIV/AIDS. It is certainly an understandable point of view: making it easier for users of illicit drugs to obtain their paraphernalia is not the normal business of public health professionals. But then again, these are not normal circumstances.
According to the Centers for Disease Control and Prevention (CDC), the use of injected drugs or having sex with an intravenous drug user has accounted for over one third of the AIDS cases in the United States since the epidemic began. Almost 250,000 AIDS cases diagnoses in the United States are attributable to intravenous drug use. The idea of needle exchange programs (NEPs), while repugnant in some senses, offers an attractive "harm reduction" strategy. Eliminating intravenous drug use entirely is the shared vision of the public health community and politicians alike, but in the meantime, it is the responsibility of public health proponents to try to reduce it and its associated health risks (not just risks to drug users, but also to their sexual partners and their children).
NEPs offer several obvious benefits.
--Increasing the availability of sterile equipment means that users are less likely to share needles and spread HIV and other bloodborne diseases.
--NEP centers can distribute needles while offering important information on drug treatment options at the same time, doubling the prevention potential.
--Needle "exchange" means that addicts will trade a used needle in rather than haphazardly discarding it, reducing the threat of accidental infection among nonusers.
--NEPs are even cost effective: mathematical models place the cost of each averted infection at $9,400 compared to $119,000 for the lifetime cost of AIDS treatment.(1)
New Jersey Assemblyman Joe Pennacchio (R-Morris) claims that NEPs do nothing to prevent the spread of HIV/AIDS and that they only encourage drug use. Those wondering whether the legislator's assertion is legitimate should review what experts have to say on the topic. According to the World Health Organization's 2002 study, HIV infection rates in cities with needle exhange programs declined by an average of 18.6% annually; in cities without NEPs infection rates increased at an average of 8.1% per year. The Centers for Disease Control and Prevention, the World Health Organization, the American Medical Association, the National Research Council, and the Institute of Medicine have all researched the topic and concluded that there is no credible evidence that needle exchange increases drug use.
Undoubtedly Senator Kean, Assemblyman Pennacchio, and the other New Jersey politicians only want to promote the highest standard of living possible for their constituents. In the interest of doing just that, they ought to put away their "umbrellas cause rain" quackery and embrace what sound science has to offer.
1 Lurie, et al. "The Public Health Impact of Needle Exchange Programs in the United States and Abroad." Prepared for the CDC September, 1993.
Mara Burney is a research intern at the American Council on Science and Health.